Journal of Nutrition and Health

The Korean Nutrition Society (한국영양학회)
권호 표지
DOI QR코드

DOI QR Code

Degree of Nutritional Support and Nutritional Status in MICU Patients

내과계 중환자의 영양공급 현황 및 영양상태 변화

  • Chi, Soo-Na (Department of Nutrition Team, NHIC Ilsan Hospital) ;
  • Ko, Jea-Young (Department of Nutrition Team, NHIC Ilsan Hospital) ;
  • Lee, Su-Ha (Department of Nutrition Team, NHIC Ilsan Hospital) ;
  • Lim, Eun-Hwa (Department of Nutrition Team, NHIC Ilsan Hospital) ;
  • Kown, Kuk-Hwan (Department of Surgery, NHIC Ilsan Hospital) ;
  • Yoon, Mi-Seon (Department of Nursing, NHIC Ilsan Hospital) ;
  • Kim, Eun-Sook (Department of Nursing, NHIC Ilsan Hospital)
  • 지수나 (국민건강보험공단 일산병원 영양팀) ;
  • 고재영 (국민건강보험공단 일산병원 영양팀) ;
  • 이수하 (국민건강보험공단 일산병원 영양팀) ;
  • 임은화 (국민건강보험공단 일산병원 영양팀) ;
  • 권국환 (국민건강보험공단 일산병원 외과) ;
  • 윤미선 (국민건강보험공단 일산병원 간호부) ;
  • 김은숙 (국민건강보험공단 일산병원 간호부)
  • Received : 2011.06.28
  • Accepted : 2011.10.15
  • Published : 2011.10.31
Download PDF
⟨ Previous Next ⟩

Abstract

The objective of this study was to determine the nutritional support in patients treated in medical intensive care units (MICUs) by evaluating the extent of current nutritional support using the patient care plan and considering the association between nutritional status and the amount of nutrition supplied. From April to December 2010, 114 patients (age ${\qeq}$ 18 years) admitted to the MICU and who underwent nutritional support for > 5 days were included. Descriptive statistics showed that the 114 patients received nutritional support within 1.2 ${\pm}$ 0.7 days and for 16.2 ${\pm}$ 11.7 days in the MICUs. The total delivered/required caloric ratio was 81.08 ${\pm}$ 27.31%, and the protein ratio was 80.32 ${\pm}$ 28.93%. Patients who received > 80% of required calories and protein showed improved nutritional status (p < 0.05). The results showed that adequate nutritional support is crucial to critically ill patients. We suggest early nutritional screening using simple tools such as periodic monitoring and management to recalculate nutritional status and nutritional requirements and nutritional support using a multidisciplinary method. Systematic nutritional support teams are needed to provide adequate nutritional support for patients in the MICU.

Keywords

References

  1. Heyland DK, Schroter-Noppe D, Drover JW, Jain M, Keefe L, Dhaliwal R, Day A. Nutrition support in the critical care setting: current practice in Canadian ICUs-opportunities for improvement? JPEN J Parenter Enteral Nutr 2003; 27(1): 74-83 https://doi.org/10.1177/014860710302700174
  2. McWhirter JP, Pennington CR. Incidence and recognition of malnutrition in hospital. BMJ 1994; 308(6934): 945-948 https://doi.org/10.1136/bmj.308.6934.945
  3. Giner M, Laviano A, Meguid MM, Gleason JR. In 1995 a correlation between malnutrition and poor outcome in critically ill patients still exists. Nutrition 1996; 12(1): 23-29 https://doi.org/10.1016/0899-9007(95)00015-1
  4. Norman K, Pichard C, Lochs H, Pirlich M. Prognostic impact of disease-related malnutrition. Clin Nutr 2008; 27(1): 5-15 https://doi.org/10.1016/j.clnu.2007.10.007
  5. Allison SP. Malnutrition, disease, and outcome. Nutrition 2000; 16(7-8): 590-593 https://doi.org/10.1016/S0899-9007(00)00368-3
  6. Windsor JA, Hill GL. Risk factors for postoperative pneumonia. The importance of protein depletion. Ann Surg 1988; 208(2): 209-214 https://doi.org/10.1097/00000658-198808000-00013
  7. Heyland DK, MacDonald S, Keefe L, Drover JW. Total parenteral nutrition in the critically ill patient: a meta-analysis. JAMA 1998; 280(23): 2013-2019 https://doi.org/10.1001/jama.280.23.2013
  8. Hill GL. Jonathan E. Rhoads Lecture. Body composition research: implications for the practice of clinical nutrition. JPEN J Parenter Enteral Nutr 1992; 16(3): 197-218 https://doi.org/10.1177/0148607192016003197
  9. Pirlich M, Lochs H. Nutrition in the elderly. Best Pract Res Clin Gastroenterol 2001; 15(6): 869-884 https://doi.org/10.1053/bega.2001.0246
  10. Lee JS, Byeon SH, Park KH, Kown MH, LEE MK, Kim SN, Shin CS, editors. Nutrition status and nutritional support needs in intensive care. Proceedings of the 3th KSPEN conference; 2003 Sep 30. Seoul, Korea
  11. Ra MY, Kim EM, Cho YY, Choi HM, Seo JM, editors. Impact of nutritional support on clinical outcomes in patients. Proceedings of the 3th KSPEN conference; 2003 Sep 30. Seoul, Korea
  12. Hong SK, editor. Nutritional therapy of intensive care. Proceedings of the 8th KSPEN conference; 2009 Aug 21. Seoul, Korea
  13. Dissanaike S, Shelton M, Warner K, O'Keefe GE. The risk for bloodstream infections is associated with increased parenteral caloric intake in patients receiving parenteral nutrition. Crit Care 2007; 11(5): R114 https://doi.org/10.1186/cc6167
  14. Krishnan JA, Parce PB, Martinez A, Diette GB, Brower RG. Caloric intake in medical ICU patients: consistency of care with guidelines and relationship to clinical outcomes. Chest 2003; 124 (1): 297-305 https://doi.org/10.1378/chest.124.1.297
  15. Pirlich M, Schutz T, Norman K, Gastell S, Lubke HJ, Bischoff SC, Bolder U, Frieling T, Güldenzoph H, Hahn K, Jauch KW, Schindler K, Stein J, Volkert D, Weimann A, Werner H, Wolf C, Zurcher G, Bauer P, Lochs H. The German hospital malnutrition study. Clin Nutr 2006; 25(4): 563-572 https://doi.org/10.1016/j.clnu.2006.03.005
  16. Heidegger CP, Romand JA, Treggiari MM, Pichard C. Is it now time to promote mixed enteral and parenteral nutrition for the critically ill patient? Intensive Care Med 2007; 33(6): 963-969 https://doi.org/10.1007/s00134-007-0654-7
  17. Chung HK, Lee SM, Lee JH, Shin CS. Energy deficiency aggravates clinical outcomes of critically ill patients. Korean J Crit Care Med 2005; 20(1): 49-53
  18. An GJ, Baek MY, Kim KO, Kim JE, Woo MH, Lee JH, Gang GR, Jung YM, editors. Degree of enteral tube feeding and nutritional status in the ICU patients. Proceedings of the 5th KSPEN conference; 2006 Sep 22. Seoul, Korea
  19. Knaus WA, Draper EA, Wagner DP, Zimmerman JE. APACHE II: a severity of disease classification system. Crit Care Med 1985; 13(10): 818-829 https://doi.org/10.1097/00003246-198510000-00009
  20. Del Bufalo C, Morelli A, Bassein L, Fasano L, Quarta CC, Pacilli AM, Gunella G. Severity scores in respiratory intensive care: APACHE II predicted mortality better than SAPS II. Respir Care 1995; 40(10): 1042-1047
  21. Han JS, Lee SM, Chung HK, Ahn HS, Lee SM. Development and evaluation of a Nutritional Risk Screening Tool (NRST) for hospitalized patients. Korean J Nutr 2009; 42(2): 119-127 https://doi.org/10.4163/kjn.2009.42.2.119
  22. Kondrup J, Rasmussen HH, Hamberg O, Stanga Z, Ad Hoc ESPEN Working Group. Nutritional risk screening (NRS 2002): a new method based on an analysis of controlled clinical trials. Clin Nutr 2003; 22(3): 321-336 https://doi.org/10.1016/S0261-5614(02)00214-5
  23. Kondrup J, Allison SP, Elia M, Vellas B, Plauth M. Educational and Clinical Practice Committee, European Society of Parenteral and Enteral Nutrition (ESPEN). ESPEN guidelines for nutrition screening 2002. Clin Nutr 2003; 22(4): 415-421 https://doi.org/10.1016/S0261-5614(03)00098-0
  24. Brugler L, Stankovic AK, Schlefer M, Bernstein L. A simplified nutrition screen for hospitalized patients using readily available laboratory and patient information. Nutrition 2005; 21(6): 650-658 https://doi.org/10.1016/j.nut.2004.10.012
  25. Bauer J, Capra S, Ferguson M. Use of the scored Patient-Generated Subjective Global Assessment (PG-SGA) as a nutrition assessment tool in patients with cancer. Eur J Clin Nutr 2002; 56 (8): 779-785 https://doi.org/10.1038/sj.ejcn.1601412
  26. The Korean Society of Parenteral and Enteral Nutrition. Nutrition support guideline. Seoul; 2007. p.9-10
  27. McClave SA, Martindale RG, Vanek VW, McCarthy M, Roberts P, Taylor B, Ochoa JB, Napolitano L, Cresci G; A.S.P.E.N. Board of Directors; American College of Critical Care Medicine; Society of Critical Care Medicine. Guidelines for the provision and assessment of nutrition support therapy in the adult critically ill patient: Society of Critical Care Medicine (SCCM) and American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.). JPEN J Parenter Enteral Nutr 2009; 33(3): 277-316 https://doi.org/10.1177/0148607109335234
  28. Gottschlich MM, DeLegge MH, Mattox T, Mueller C, Worthington P, Guenter P. The A.S.P.E.N nutrition support core curriculum. Maryland: American Society for Parenteral and Enteral Nutrition; 2007. p.493
  29. Gottschlich MM, Matarese LE, Shronts EP. Nutrition support dietetics. Maryland: American Society for Parenteral and Enteral Nutrition; 1993. p.236-237
  30. Funk KL, Ayton CM. Improving malnutrition documentation enhances reimbursement. J Am Diet Assoc 1995; 95(4): 468-475 https://doi.org/10.1016/S0002-8223(95)00123-9
  31. Park EK, Lee JH, Lim HS. Degree of enteral tube feeding in the intensive care unit and change in nutritional status. J Korean Diet Assoc 2001; 7(3): 217-226
  32. Singer P, Berger MM, Van den Berghe G, Biolo G, Calder P, Forbes A, Griffiths R, Kreyman G, Leverve X, Pichard C; ESPEN. ESPEN guidelines on parenteral nutrition: intensive care. Clin Nutr 2009; 28(4): 387-400 https://doi.org/10.1016/j.clnu.2009.04.024
  33. De Jonghe B, Appere-De-Vechi C, Fournier M, Tran B, Merrer J, Melchior JC, Outin H. A prospective survey of nutritional support practices in intensive care unit patients: What is prescribed? What is delivered? Crit Care Med 2001; 29(1): 8-12 https://doi.org/10.1097/00003246-200101000-00002
  34. Rubinson L, Diette GB, Song X, Brower RG, Krishnan JA. Low caloric intake is associated with nosocomial bloodstream infections in patients in the medical intensive care unit. Crit Care Med 2004; 32(2): 350-357 https://doi.org/10.1097/01.CCM.0000089641.06306.68
  35. Moon SS, Lim H, Choi JW, Kim DK, Lee JW, Ko S, Kim DC. Analysis of nutritional support status in the intensive care unit. Korean J Crit Care Med 2009; 24(3): 129-133 https://doi.org/10.4266/kjccm.2009.24.3.129
  36. Choi MS, Kim JN. A study on nutritional status and support in critically ill patients. J Korean Diet Assoc 1995; 1(1): 21-30
  37. Mackenzie SL, Zygun DA, Whitmore BL, Doig CJ, Hameed SM. Implementation of a nutrition support protocol increases the proportion of mechanically ventilated patients reaching enteral nutrition targets in the adult intensive care unit. JPEN J Parenter Enteral Nutr 2005; 29(2): 74-80 https://doi.org/10.1177/014860710502900274
  38. Umali MN, Llido LO, Francisco EM, Sioson MS, Gutierrez EC, Navarrette EG, Encarnacion MJ. Recommended and actual calorie intake of intensive care unit patients in a private tertiary care hospital in the Philippines. Nutrition 2006; 22(4): 345-349 https://doi.org/10.1016/j.nut.2005.09.002

Cited by

  1. Nutritional Support, Gastric Residual Volume and Nutritional Status during Enteral Nutrition in Intensive Care Unit Patients vol.26, pp.6, 2014, https://doi.org/10.7475/kjan.2014.26.6.621
  2. The effect of nutritional supply on clinical outcomes and nutritional status in critically ill patients receiving continuous renal replacement therapy vol.48, pp.3, 2015, https://doi.org/10.4163/jnh.2015.48.3.211
  3. 중환자실 환자의 욕창을 예측하는 영양 관련 요인 vol.21, pp.4, 2011, https://doi.org/10.7739/jkafn.2014.21.4.413
  4. Critical Care Nurses’ Perceptions of Parenteral and Enteral Nutrition at the End-of-Life in South Korea vol.35, pp.2, 2011, https://doi.org/10.1177/0825859719863811