• Korean Journal of Community Nutrition
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• v.23 no.1
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• pp.48-59
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• 2018

Objectives: This study was performed to investigate the effect of active nutrition care on feeding and nutritional status of elderly patients receiving long-term enteral tube feeding. Methods: Subjects included 77 elderly patients who had received enteral nutrition more than one week before admission. Nutrition care was provided to patients supplied less calories than required. Feeding intolerance was examined and managed every day and formula was adjusted to meet nutritional requirement during the first 3 months after admission. Patients were classified into under or over 80% of percent ideal body weight (PIBW) and medical records were used to compare changes in weight,, biochemical indices, and nutritional status during the study. Results: Weight, BMI, triglyceride and total cholesterol in blood, hemoglobin, and hematocrit levels were significantly lower in patients under 80% of the PIBW than in those over 80% of the PIBW at admission. The percentage of supply to required calories was also lower in patients under 80% of the PIBW. After 1 month of nutritional care, supplied volume of formula was significantly increased in patients under 80% of the PIBW. Weight, BMI, and PIBW were increased and there were no differences between groups after 6 months. In addition, the concentrations of triglyceride and total cholesterol in blood, hemoglobin, and hematocrit tended to increase in patients under 80% of the PIBW, leading to no difference between groups after 3 months. Conclusions: Personalized active nutrition care is effective to increase weight and improve feeding and nutritional status in underweight elderly patients receiving long-term enteral nutrition.

• Journal of Nutrition and Health
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• v.35 no.5
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• pp.512-523
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• 2002

The objective of this study was to investigate the nutritional status, biochemical parameters, lipid and electrolytes concentrations of the enteral nutrition patients according to the duration of enteral nutrition. Eighteen neurosurgery patients in the intensive care unit (ICU) at K University Hospital were subjected in this study. The duration of enteral nutrition was classified into under or over six month of period. Anthropometric, biochemical, clinical, and dietary assessments were performed. Patients' intakes of energy and protein were insufficient, from 82% to 95% of their requirements. Mid-arm muscle circumference (MAMC) and mid-am muscle area (MAMA) were significantly lower in patients over six months of enteral nutrition than those in patients under six months. The subjects were malnourished as indicated by nutrition-related parameters such as hemoglobin, albumin, total lymphocyte count (TLC), tricep skinfold thickness (TSF), mid-arm circumference (MAC), MAMC, and MAMA. Serum chloride level of the patients eve, six months of enteral nutrition was lower (94.7 $\pm$ 3.4 mmo1/1) significantly as compared to that of patients (99.3 $\pm$ 3.5 mmol/ 1) under six months. Urinary sodium and chloride levels were lower in the longer time of enteral nutrition patients than those of shorter period of enteral nutrition patients (p < .05). While serum phospholipid level was higher in the patients over six months of enteral nutrition, other blood biochemical parameters and electrolyte concentrations did not show any differences with the duration of enteral nutrition. Neurosurgery patients in the ICU undergoing long-term enteral nutrition tube-feeding were malnourished and had a variety of metabolic complications. The duration of enteral nutrition could affect the patients' nutritional status, biochemical parameters, and electrolytes balance. The patients who require nutritional support over an extended time need the continuous follow-up care and monitoring by the nutrition support team for laboratory, clinical, and nutritional assessments.

• Journal of Chest Surgery
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• v.51 no.1
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• pp.76-80
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• 2018

Early diagnosis followed by primary repair is the best treatment for spontaneous esophageal perforation. However, the appropriate management of esophageal leakage after surgical repair is still controversial. Recently, the successful adaptation of vacuum-assisted closure therapy, which is well established for the treatment of chronic surface wounds, has been demonstrated for esophageal perforation or leakage. Conservative treatment methods require long-term fasting with total parenteral nutrition or enteral feeding through invasive procedures, such as percutaneous endoscopic gastrostomy or a feeding jejunostomy. We report 2 cases of esophageal leakage after primary repair treated by endoscopic vacuum therapy with continuous enteral feeding using a Sengstaken-Blakemore tube.

• Clinical and Experimental Pediatrics
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• v.48 no.7
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• pp.711-715
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• 2005

Purpose : With the recent improved survival of extremely low birth weight infants(ELBWI), enteral feeding has become a major issue. This study investigates the effects of early enteral feeding in ELBWI on their morbidity, duration of hospitalization, and mortality. Methods : ELBWI admitted to the neonatal intensive care unit at Samsung Medical Center from November 1994 to April 2004 who survived more than 14 days were enrolled. ELBWI were divided into two groups : an early feeding group(EF), in which enteral feeding was started within 3 days after birth; and a late feeding group(LF), in which enteral feeding was started beyond 3 days after birth. 80 ELBWI came under EF, and 131 ELBWI under LF. Results : Birth weight and gestational age did not differ between the two groups. In EF, the time to achieve full enteral feeding and the duration of parenteral nutrition were significantly shorter than in LF. The incidence of bronchopulmonary dysplasia was significantly lower in EF, but the incidences of sepsis, necrotizing enterocolitis, and cholestasis were not different between the two groups. There was no difference in the survival rate between the two groups, but the duration of hospitalization was significantly shorter in EF. Conclusion : Early enteral feeding in ELBWI did not increase the incidence of necrotizing enterocolitis and sepsis, but rather decreased the incidence of bronchopulmonary dysplasia and shortened the duration of hospitalization.

• Journal of Korean Academy of Fundamentals of Nursing
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• v.16 no.1
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• pp.21-29
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• 2009

Purpose: The purpose of this study was to identify the nutritional status and to compare nutritional indicators by caloric intake for intensive care unit patients, Methods: The participants for this descriptive investigation were 62 patients who were admitted to medical and surgical ICUs and started on enteral feeding. Data were collected in a tertiary hospital and the patients were followed for 7 days after enteral feeding was initiated. For analysis, patients who received 80% less calories than their required level were categorized as the underfed group and patients who received more than 80% to their required level, as the adequately fed group. Results: Compared to daily requirements, the prescribed calories and protein for patients overall were 77.39% and 64.75% respectively. The level of calories and protein given was less than their prescription. However, a comparison of the underfed group and the adequately fed group, showed that there was no significantly difference in albumin, prealbumin and transferrin. Only body weight was significantly different between the groups. C-reactive protein had a significant correlation with prealbumin and transferrin. Conclusion: Underfeeding is a common phenomenon among ICU patients. Nutritional indicators such as prealbumin, albumin and transferrin may not sensitive indicators to assess nutritional status of ICU patients.

• Journal of the Korean Dietetic Association
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• v.10 no.4
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• pp.442-451
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• 2004

Protein-calories malnutrition is common among patients in the hospital. In particular, elderly patients with neurologic disorders has more risk of nutritional deficiency due to swallowing difficulty. Enteral tube feeding is more economical, physiological and immunological than parenteral nutrition for patients who have adequate gastrointestinal function. This study was conducted patients with neurologic disorders who received enteral nutrition at Asan Medical Center from February 1 to October 10, 2002. The control group (48 patients) were given traditional feeding methods 4 times a day while the treatment group (45 patients) were given improved feeding methods 3 times a day. We assessed nutritional status of patients and compared to both groups. We investigated body weight, serum albumin, hemoglobin, total lymphocyte count by means of nutrition markers. The objectives of this study is to reduce the time needed for nutritional requirement of patients without an increase in gastrointestinal intolerances. The results of this study are as follows: 1. Nutritional status of many patients in both groups were either malnourished or at risk for malnutrition. 2. The time to arrive to the nutritional requirements were 6.21 $\pm$ 0.35 days for the control group and 4.24 $\pm$ 0.52 days for the treatment group. The treatment group showed a significantly shorter amount of time. 3. The changes of the nutritional marker in the control group showed a significant drop in body weight, serum albumin and serum hemoglobin while the treatment group experienced a significant increase in body weight, serum albumin and total lymphocyte count. 4. Feeding intolerane such as diarrhea, high residual volume, ileus, nausea and vomiting were investigated. Diarrhea found in 25.1% (12 patients) of the control group and 22.2% (10 patients) of the treatment group and these findings are not significant.

• Korean Journal of Adult Nursing
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• v.26 no.6
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• pp.621-629
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• 2014

Purpose: The purpose of this study was to investigate the nutritional support, gastric residual volume, and nutritional status of the intensive care unit (ICU) patients on enteral feeding. Methods: A descriptive longitudinal design was used to collect 5 day data on enteral nutrition of 52 ICU patients in an university hospital. Nutritional support was calculated with actual caloric intake compared to individual caloric requirement. Residual volumes were measured prior to routine feedings, and the serum albumin levels and the total lymphocyte counts were checked to evaluate nutritional status. The data were analyzed using one group repeated measures ANOVA, paired t-test, and Spearman's bivariate correlation analysis. Results: The subjects received their first enteral feeding on the $5.75^{th}$ day of ICU admission. The mean nutritional support rate was 49.1% of the requirement, however prescription rate and support rate were increased as time goes by. Gastric residual volumes were less than 10 cc in 95% cases. A significant negative correlation was found between nutritional support and nutritional status. Conclusion: The nutritional support for ICU patient was low compared to the requirement, and their nutritional status was worse than at the time of ICU admission. Further studies are necessary to develop nursing interventions for improving nutritional support for ICU patients.

• Child Health Nursing Research
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• v.22 no.4
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• pp.326-335
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• 2016

Purpose: It is crucial to provide adequate enteral nutrition for postoperative recovery, wound healing and normal growth in infants in pediatric cardiac ICUs. This study was done to develop a feeding protocol using the vaso-active inotropic (VAI) score and to evaluate the impact of nutritional outcomes following the new feeding protocol for infants who underwent cardiac surgery. Methods: This study consisted of three phases. First, a feeding protocol was developed based on a literature review. Second, ten experts rated the content validity. Third, a comparison study was conducted to evaluate the impact of the new feeding protocol. Data were analyzed using SPSS Version 20. Results: Twenty-nine infants were enrolled in the pre-protocol group, and 22 infants in the post-protocol group. Patients in the 2 groups were similar. Time to reach feeding goal was significantly decreased from 56.0 (27-210) hours to 28.5 (10-496) hours in the post-protocol group (Z=-4.22, p<.001). Level of enteral feeding knowledge among nurses increased significantly after implementation of the protocol. Conclusion: The feeding protocol using VAI score facilitates the achievement feeding goal to decrease feeding interruptions and help nurses in their practice. Larger studies are necessary to examine clinical outcomes following the implementation of this feeding protocol.

• Korean Journal of Adult Nursing
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• v.25 no.4
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• pp.444-453
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• 2013

Purpose: The purpose of this study was to describe the differences between early and delayed enteral nutrition on nutritional intake. Methods: A pilot cohort study was conducted with 45 critically ill adult patients who had a primary medical diagnosis. Energy prescribed and received were collected during the four days after initiation of enteral nutrition. Adequate feeding was defined as the energy intake more than 90% of required energy. Results: A total of 23 patients (52%) were received early enteral nutrition (within 48 hours of admission). Energy intake of early enteral nutrition was less than intake of delayed enteral nutrition during the four days of the study. Although the difference on day one was significantly greater than the differences on day two, the differences on day two were not different from days three or four. No statistical differences in the adequacy of nutritional intake were found between patients in the early and the delayed group. Conclusion: In critically ill patients receiving early enteral nutrition, more aggressive administration from the beginning will improve the nutritional intake. Additional studies including a large multi-centre, randomized clinical trial are recommended.

• Korean Journal of Community Nutrition
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• v.3 no.5
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• pp.729-738
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• 1998

In order to investigate the types of enteral nutrition formulas currently used in hospitals and evaluate and categorize the commercially prepared enteral nutrition formulas formulas available in the domestic market, we asked dietitians working in 6 hospitals in Seoul to complete the questionnaire and obtained compositional characteristics of 12 commercially prepared enteral nutrition formulas. The average proportion of patients receiving the commercially prepared enteral nutrition formulas(60.6%) was greater than that of patients receiving the in-hospital preparations(31.9%). In the group of patients receiving the in-hospital prepared formulas, the enteral feeding was mainly administered orally, whereas, in the group of patients receiving the commercially prepared formulas, tube feeding was the primary route of formula administration. In both groups, however, a greater proportion of patients received the formulas as total replacements of their meals and for the purpose of dietary supplementation. On the basis of major criteria for evaluation of the commercially prepared enteral nutrition formulas, the 6 products out of the 9 nutritionally complete products formulated for the purpose of dietary supplementation were grouped into the same category(standard protein, caloric density of 1kcal/ml, and tube/oral), so they were considered therapeutically comparable. However, the remaining 3 products were different in protein content(high protein) or route of administration(tube only). Of the 3 nutritionally complete products formulated specifically for the purpose of dietary therapy, 2 products were formulated for patients with renal disease, and the one product was formulated for diabetic patients. Therefore, the data in this study showed that the commercially prepared enteral nutriton formulas became an important part of the enteral nutrition for hospitalized patients in Korea, but the domestic market has not yet generated a wide variety of the formulas, not providing many choices for clinicians to manage the diets for their patients. The results of this study would be helpful for clinicians in choosing appropriate products for their patients, for manufactures in developing new products, and for regulatory authorities to establish the regulation for the broad group of heterogeneous products that are marketed and will be developed as medical foods. In addition, the process of maintaining the categories for evaluation of the commercially prepared enteral nutrition formulas should be dynamic because new products may not reasonably fit any of the existing categories.