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Original Articles
Gastroenterology
The diagnostic accuracy of ultrasonography over manual aspiration for gastric reserve volume estimation in critically ill patients
Rahul Sharma, Ravi Kant Dogra, Jyoti Pathania, Arti Sharma
Acute Crit Care. 2023;38(1):134-141.   Published online February 22, 2023
DOI: https://doi.org/10.4266/acc.2022.00955
  • 454 View
  • 28 Download
AbstractAbstract PDF
Background
Although gastric reserve volume (GRV) is a surrogate marker of gastrointestinal dysfunction and feeding intolerance, there is ambiguity in its estimation due to problems associated with its measurement. Introduction of point-of-care ultrasound as a tool for anesthetists kindled interest in its use for GRV estimation. Methods: In this prospective observational study, we recruited 57 critically ill patients and analyzed 586 samples of GRV obtained by both ultrasonography (USG) and manual aspiration. Results: The analysis showed that USG-guided GRV was significantly correlated (r=0.788, P<0.001) and in positive agreement with manual aspiration based on Bland-Altman plot, with a mean difference of 8.50±14.84 (95% confidence interval, 7.389–9.798). The upper and lower limits of agreement were 37.7 and –20.5, respectively, within the ±1.96 standard deviation (P<0.001). The respective sensitivity and positive predictive value, specificity and negative predictive value, and area under the curve of USG for feeding intolerance were 66.67%, 98.15%, and 0.82%, with 96.49% diagnostic accuracy. Conclusions: Ultrasonographic estimation of GRV was positively, significantly correlated and in agreement with the manual aspiration method and estimated feeding intolerance earlier. Routine use of gastric USG could avoid clinical situations where feeding status is unclear and there is high risk of aspiration and could become a standard practice of critical care.
Nutrition
Effect of a nutritional support protocol on enteral nutrition and clinical outcomes of critically ill patients: a retrospective cohort study
Heemoon Park, Sung Yoon Lim, Sebin Kim, Hyung-Sook Kim, Soyeon Kim, Ho Il Yoon, Young-Jae Cho
Acute Crit Care. 2022;37(3):382-390.   Published online July 19, 2022
DOI: https://doi.org/10.4266/acc.2022.00220
  • 1,817 View
  • 200 Download
  • 2 Citations
AbstractAbstract PDFSupplementary Material
Background
Enteral nutrition (EN) supply within 48 hours after intensive care unit (ICU) admission improves clinical outcomes. The “new ICU evaluation & development of nutritional support protocol (NICE-NST)” was introduced in an ICU of tertiary academic hospital. This study showed that early EN through protocolized nutritional support would supply more nutrition to improve clinical outcomes.
Methods
This study screened 170 patients and 62 patients were finally enrolled; patients who were supplied nutrition without the protocol were classified as the control group (n=40), while those who were supplied according to the protocol were classified as the test group (n=22).
Results
In the test group, EN started significantly earlier (3.7±0.4 days vs. 2.4±0.5 days, P=0.010). EN calorie (4.0±1.0 kcal/kg vs. 6.7±0.9 kcal/kg, P=0.006) and protein (0.17±0.04 g/kg vs. 0.32±0.04 g/kg, P=0.002) supplied were significantly higher in the test group. Although EN was supplied through continuous feeding in the test group, there was no difference in complications such as feeding hold due to excessive gastric residual volume or vomit, and hyper- or hypo-glycemia between the two groups. Hospital mortality was significantly lower in the group that started EN within 1.5 days (42.9% vs. 11.8%, P=0.018). The proportion of patients who started EN within 1.5 days was higher in the test group (40.9% vs. 17.5%, P=0.044).
Conclusions
The NICE-NST may improve EN supply and mortality of critically ill patients without increasing complications.

Citations

Citations to this article as recorded by  
  • Nutritional support for patients with abdominal surgical pathology: the view of a surgeon and an anesthesiologist — opponents or allies?
    Natalya P. Shen, Svetlana Yu. Mukhacheva
    Clinical nutrition and metabolism.2023; 3(4): 181.     CrossRef
  • Provision of Enteral Nutrition in the Surgical Intensive Care Unit: A Multicenter Prospective Observational Study
    Chan-Hee Park, Hak-Jae Lee, Suk-Kyung Hong, Yang-Hee Jun, Jeong-Woo Lee, Nak-Jun Choi, Kyu-Hyouck Kyoung
    Annals of Clinical Nutrition and Metabolism.2022; 14(2): 66.     CrossRef
Nursing
How do physicians and nurses differ in their perceived barriers to effective enteral nutrition in the intensive care unit?
Masoumeh Mirhosiny, Mansour Arab, Parvin Mangolian Shahrbabaki
Acute Crit Care. 2021;36(4):342-350.   Published online November 16, 2021
DOI: https://doi.org/10.4266/acc.2021.00185
  • 3,125 View
  • 167 Download
  • 2 Citations
AbstractAbstract PDF
Background
Patients hospitalized in intensive care units are susceptible to chronic malnutrition from changes in protein and energy metabolism in response to trauma. Therefore, nutritional support, especially enteral nutrition, is one of the most important treatment measures for these patients. However, there are several barriers in the hospitals in treating patients with enteral nutrition. This study was performed to compare the perceptions of care providers (physicians and nurses) on the barriers to enteral nutrition in intensive care units.
Methods
This was a cross-sectional descriptive and analytic study. This study included 263 nurses and 104 physicians in the intensive care units of XXXX southeast hospitals. A questionnaire of enteral nutrition barriers in intensive care units was used. IBM SPSS ver. 19 was used to analyze data.
Results
There was a significant difference between the two groups in the three subscales of intensive care units (P=0.034), dietician support (p=0.001>) and critical care provider attitudes and behavior (P=0.031). There was also a significant difference between having completed educational courses and the score of enteral nutrition barriers in the two groups (P<0.05); the people who received an educational course had a better perception of enteral nutrition barriers.
Conclusions
Physicians and nurses agreed with the perception of enteral nutrition barriers, but there was a difference in their perception on some barriers. Strategies such as in-service training and increasing the knowledge and skills of physicians and nurses can reduce these differences.

Citations

Citations to this article as recorded by  
  • Adequacy of protein and calorie delivery according to the expected calculated targets: a day‐by‐day assessment in critically ill patients undergoing enteral feeding
    Adam Fabiani, Lorella Dreas, Enzo Mazzaro, Elena Trampus, Michela Zanetti, Antonella Calabretti, Giuseppe Gatti, Gianfranco Sanson
    Journal of Human Nutrition and Dietetics.2023; 36(3): 697.     CrossRef
  • Barriers to Delivery of Enteral Nutrition in Intensive Care Settings in Saudi Arabia: A Comparative Study of the Perceptions of Health Care Providers Working in Adult and Paediatric ICUs
    Sara Zaher
    Risk Management and Healthcare Policy.2022; Volume 15: 2357.     CrossRef
Nutrition Support in the Intensive Care Unit of 6 Korean Tertiary Teaching Hospitals: A National Multicenter Observational Study
Song Mi Lee, Seon Hyeung Kim, Yoon Kim, Eunmee Kim, Hee Joon Baek, Seungmin Lee, Hosun Lee, Chul Ho Chang, Cheung Soo Shin
Korean J Crit Care Med. 2012;27(3):157-164.
DOI: https://doi.org/10.4266/kjccm.2012.27.3.157
  • 3,160 View
  • 63 Download
  • 4 Citations
AbstractAbstract PDF
BACKGROUND
Malnutrition is a frequent nutritional problem among ICU patients, and their nutritional status is known to affect clinical prognosis. We conducted this study to examine nutritional status and actual nutrition delivery in the ICU patients and its relations to clinical outcomes.
METHODS
This study was a multicenter retrospective observational study based on the medical records of 163 patients admitted to ICU of tertiary teaching hospitals in Korea. We included the patients who were treated with mechanical ventilation for 3 or more days and received enteral or parenteral nutrition.
RESULTS
According to albumin and total lymphocyte count levels, 54.6% of the subjects were moderately or severely malnourished. Mean percentage of calorie and protein delivery to estimated needs for 10 days were 55.8 +/- 29.3% and 46.1 +/- 30.1%, respectively. While parenteral nutrition (PN) started at 1.6 +/- 1.4 days after admission, enteral nutrition (EN) did at 3.6 +/- 2.1 days. Days to PN and EN start, the calorie and protein amount via EN or PN were significantly different among 6 hospitals. No clinical outcomes differed by the levels of calorie or protein delivery. In-hospital mortality was significantly higher in the severely malnourished group at admission as compared to the other 2 groups (54.3% vs. 31.2% vs. 27.7%, p < 0.05) CONCLUSIONS: Malnutrition prevalence is high among Korean intensive care unit patients, but current nutritional therapy practice is inconsistent across institutions and far below the international guidelines. Systematic efforts should be made to develop nutritional support guidelines for Korean ICU patients.

Citations

Citations to this article as recorded by  
  • Nutritional Status of Intensive Care Unit Patients According to the Referral to the Nutrition Support Team and Compliance with the Recommendations
    Yunjin Sohn, Taisun Hyun
    Korean Journal of Community Nutrition.2022; 27(2): 121.     CrossRef
  • Comparison of the nutritional indicators of critically Ill patients on extracorporeal membrane oxygen (ECMO)
    Nah-Mee Shin, Suk Yeon Ha, Yoon Soo Cho
    Journal of Nutrition and Health.2021; 54(5): 489.     CrossRef
  • The impact of multidisciplinary nutritional team involvement on nutritional care and outcomes in a medical intensive care unit
    H J Jo, D B Shin, B K Koo, E S Ko, H J Yeo, W H Cho
    European Journal of Clinical Nutrition.2017; 71(11): 1360.     CrossRef
  • The effect of nutritional supply on clinical outcomes and nutritional status in critically ill patients receiving continuous renal replacement therapy
    Ju Yeun Kim, Ji-Myung Kim, Yuri Kim
    Journal of Nutrition and Health.2015; 48(3): 211.     CrossRef
Healthcare Professional's Knowledge, Perception and Performance on Early Enteral Nutrition for Critically Ill Patients
Sun Hee Yun, Sun Jung Kim, Eui Geum Oh
Korean J Crit Care Med. 2012;27(1):36-44.
DOI: https://doi.org/10.4266/kjccm.2012.27.1.36
  • 2,417 View
  • 58 Download
  • 5 Citations
AbstractAbstract PDF
BACKGROUND
Proper nutritional supplement is one of the fundamental management domains for critical ill patients. While it shows positive effect on processing and prognosis of critical ill patients, early enteral nutrition is overlooked. This study explored healthcare professional's level of knowledge perception and performance on early enteral nutrition for critically ill patients. Data was collected from a convenient sample of 319 registered doctors, nurses and nutritionists in ICU at seven university hospitals.
METHODS
A cross-sectional survey design was used. The participants were assessed by questionnaires, specifically designed for the study and verified for the content validity by professional reviewers related with critical ill patients.
RESULTS
While the level of the perception of early enteral nutrition is high, the level of knowledge and performance are relatively low. The nurses showed a statistically significant difference on the level of knowledge, by their educational backgrounds and clinical experiences. Regarding the hospital support system, the doctors showed a significant difference on the level of perception and performance, while the nurses only showed that difference on the level of performance. It was shown that with higher the level of knowledge regarding the early enteral nutrition, the higher the level of performance. Further, the higher the level of perception, the higher the level of performance was observed. The hospital support system and the perception of the healthcare professionals are two most influential factors to affect the performance of the healthcare professionals related with the early enteral nutrition for the critically ill patients.
CONCLUSION
To perform the proper early enteral nutrition, the hospital support system and the level of the healthcare professionals' perception, are two most important factors. Therefore, the efforts to build the hospital support system along with the educational provisions are needed.

Citations

Citations to this article as recorded by  
  • Critical Care Nurses’ Perceptions of Enteral Nutrition: A Descriptive Cross-Sectional Study
    Khaled Mohammed Al-Sayaghi, Talal Ali Hussein Saad Alqalah, Sameer Abdulmalik Alkubati, Gamil Ghaleb Alrubaiee, Sultan Abdulwadoud Alshoabi, Masouda Hassan Atrous, Farida Khalil Ibrahim Mohamed, Kamal Dahan Alsultan, Awadia Greeballah Suliman, Moawia Bush
    The Open Nursing Journal.2022;[Epub]     CrossRef
  • Factors Influencing the Occurrence of Diarrhea in Patients Admitted to Intensive Care Units
    Hanna Lee, Rhayun Song
    Journal of Korean Academy of Fundamentals of Nursing.2019; 26(4): 221.     CrossRef
  • Critical Care Nurses’ Perception, Knowledge, and Practices of Enteral Nutrition
    Hyunjung Kim, Eunjin Soun
    Journal of Korean Academy of Fundamentals of Nursing.2016; 23(4): 383.     CrossRef
  • Nutritional Assessment of ICU Inpatients with Tube Feeding
    Yu-Jin Kim, Jung-Sook Seo
    Journal of the Korean Dietetic Association.2015; 21(1): 11.     CrossRef
  • Nutritional Support, Gastric Residual Volume and Nutritional Status during Enteral Nutrition in Intensive Care Unit Patients
    Minju Lee, Jiyeon Kang
    Korean Journal of Adult Nursing.2014; 26(6): 621.     CrossRef
Implementation of the Head of Bed (HOB) Elevation Protocol on Clinical and Nutritional Outcomes in Critically Ill Patients with Mechanical Ventilator Support
Se Hee Na, Hosun Lee, Shin Ok Koh, Hyun Sim Lee, Sung Won Na
Korean J Crit Care Med. 2011;26(3):128-133.
DOI: https://doi.org/10.4266/kjccm.2011.26.3.128
  • 3,266 View
  • 56 Download
  • 1 Citations
AbstractAbstract PDF
BACKGROUND
Although head of bed (HOB) elevation is an important strategy to prevent ventilator associated pneumonia (VAP), some observational studies have reported that the application of the semi-recumbent position was lower in patients receiving mechanical ventilator support. We performed this study to assess the effect of implementation of the HOB elevation protocol in the intensive care unit (ICU) on clinical and nutritional outcomes.
METHODS
We developed a HOB elevation protocol including a flow chart to determine whether the HOB of newly admitted patients to ICU could be elevated. We measured the level of HOB elevation in patients with mechanical ventilator twice a day and 2 days a week for 5 weeks before and after the implementation of the protocol, respectively. Hemodynamic, respiratory and nutritional data were also collected, resulting in 251 observations from 35 patients and 467 observations from 66 patients before and after implementation.
RESULTS
After implementing the protocol, the level of HOB elevation (16.7 +/- 9.9 vs. 23.6 +/-1 2.9, p < 0.0001) and observations of HOB elevation > 30degrees increased significantly (34 vs. 151, p < 0.0001). There was no significant difference in the incidence of VAP. Arterial oxygen tension/fraction of inspired oxygen ratio improved (229 +/- 115 vs. 262 +/- 129, p = 0.02). Mean arterial blood pressure decreased after the implementation of the protocol, but remained within the normal limits. Calorie intake from tube feeding increased significantly (672 +/- 649 vs. 798 +/- 670, p = 0.021) and the events of high gastric residual volume (> 100 ml) occurred less frequently after implementing the protocol (50% vs. 17%, p = 0.001) CONCLUSIONS: Implementation of the protocol for HOB elevation could improve the level of HOB elevation, oxygenation parameter and enteral nutrition delivery.

Citations

Citations to this article as recorded by  
  • Nutrition Support in the Intensive Care Unit of 6 Korean Tertiary Teaching Hospitals: A National Multicenter Observational Study
    Song Mi Lee, Seon Hyeung Kim, Yoon Kim, Eunmee Kim, Hee Joon Baek, Seungmin Lee, Hosun Lee, Chul Ho Chang, Cheung Soo Shin
    Korean Journal of Critical Care Medicine.2012; 27(3): 157.     CrossRef
Case Report
A Case of Wernicke's Encephalopathy in a Postoperative Patient with Parenteral Nutrition and Temporary Oral Feeding: A Case Report
Hannah Lee, Eun Hye Lee, Sang Chul Lee, Hee Pyoung Park
Korean J Crit Care Med. 2010;25(3):186-189.
DOI: https://doi.org/10.4266/kjccm.2010.25.3.186
  • 2,312 View
  • 19 Download
  • 2 Citations
AbstractAbstract PDF
Wernicke's encephalopathy is an acute neurological disorder, caused by thiamine deficiency, which is clinically characterized by a triad of ophthalmoplegia, ataxia and disturbances of consciousness. Most frequently, the encephalopathy is a consequence of chronic alcoholism, but it may occur in other forms of malnutrition or malabsorption, such as in prolonged parenteral nutrition without the addition of thiamine, total gastrectomy, gastrojejunostomy, severe anorexia or hyperemesis gravidarum. Thiamine requirement increases during critical illness and in chronically depleted patients, and its supplementation may influence the outcome of the disease. We report a case of a 73-year-old man, who presented with recurred colon cancer, who was affected by Wernicke's encephalopathy while undergoing oral feeding and parenteral nutrition. This case suggests that we should be more aware of potential thiamine deficiency in critically ill patients, even those undergoing parenteral nutrition and temporary oral feeding.

Citations

Citations to this article as recorded by  
  • Two Cases of Wernicke's Encephalopathy That Developed during Total Parenteral Nutrition in Colon Cancer Patients Treated with 5-Fluorouracil-based Chemotherapy
    Kyung Pyo Cho, Jae Sung Lee, Ji Seok Seong, Yong Moon Woo, Young Jun Cho, Beom Jin Jeong, Jee Hoon Sohn, Su-Jung Kim
    The Korean Journal of Gastroenterology.2014; 64(3): 158.     CrossRef
  • Experiences of Wet Beriberi and Wernicke's Encephalopathy Caused by Thiamine Deficiency in Critically Ill Patients
    Ji Young Jang, Hongjin Shim, Jae Gil Lee
    Korean Journal of Critical Care Medicine.2013; 28(2): 156.     CrossRef
Original Articles
Analysis of Nutritional Support Status in the Intensive Care Unit
Seong Shin Moon, Hyungsun Lim, Jin Wook Choi, Deok Kyu Kim, Jeong Woo Lee, Seonghoon Ko, Dong Chan Kim
Korean J Crit Care Med. 2009;24(3):129-133.
DOI: https://doi.org/10.4266/kjccm.2009.24.3.129
  • 2,579 View
  • 51 Download
  • 12 Citations
AbstractAbstract PDF
BACKGROUND
Nutritional support is important in intensive care for critically ill patients in an effort to decrease the mortality and morbidity. This study was conducted to evaluate the propriety of nutritional support and to understand the effect of a nutrition consultationin critically ill patients to assess and analyze nutritional status.
METHODS
Between January and December 2006, patients who were admitted to the intensive care unit (ICU) > or = 7 days and between 20 and 80 years of age were included. Patients transferred to another hospital, patients discharged against medicine advice, and patients with unknown weight were excluded. Two hundred sixty-two patients were enrolled. The demographic data of patients and the state of nutritional support were reviewed by medical records.
RESULTS
Two hundred sixty-two patients stayed in the ICU a mean of 16.0 +/- 9.8 days and received nutrition support for 11.0 +/- 8.4 days. Except 15 patients who did not receivenutritional support, the mean daily calculated caloric requirement of 247 patients was 1,406.2 +/- 253.8 kcal, the mean daily delivered caloric amount was 899.5 +/- 338.7 kcal, and the total delivered/required caloric ratio was 66.4 +/- 28.1%. The total delivered/required caloric ratio of the patients who received a nutritional consultation and the patients who did not receive nutritional consultation were 72.6 +/- 25.8% and 55.9 +/- 33.3%.
CONCLUSIONS
In this study, we identified that critically ill patients received insufficient nutritional support. We recommend continuous monitoring and management for nutritional support by systematic administration of nutritional support teams.

Citations

Citations to this article as recorded by  
  • Analysis of Current Status and Predisposing Factors for Nutritional Support of Patients in Surgical Intensive Care Unit
    Byung Chul Kim, In Kyu Lee, Eun Young Kim
    Surgical Metabolism and Nutrition.2016; 7(2): 32.     CrossRef
  • The effect of nutritional supply on clinical outcomes and nutritional status in critically ill patients receiving continuous renal replacement therapy
    Ju Yeun Kim, Ji-Myung Kim, Yuri Kim
    Journal of Nutrition and Health.2015; 48(3): 211.     CrossRef
  • Nutritional Assessment of ICU Inpatients with Tube Feeding
    Yu-Jin Kim, Jung-Sook Seo
    Journal of the Korean Dietetic Association.2015; 21(1): 11.     CrossRef
  • Nutrition-Related Factors Predicted Pressure Ulcers in Intensive Care Unit Patients*
    Ha Nee Lee, Jeong Sook Park
    Journal of Korean Academy of Fundamentals of Nursing.2014; 21(4): 413.     CrossRef
  • Comparison of nutritional status indicators according to feeding methods in patients with acute stroke
    Sanghee Kim, Youngsoon Byeon
    Nutritional Neuroscience.2014; 17(3): 138.     CrossRef
  • Nutritional Support, Gastric Residual Volume and Nutritional Status during Enteral Nutrition in Intensive Care Unit Patients
    Minju Lee, Jiyeon Kang
    Korean Journal of Adult Nursing.2014; 26(6): 621.     CrossRef
  • Development and Evaluation of an Enteral Nutrition Protocol for Dysphagia in Patients with Acute Stroke
    Sung-Hee Yoo, So-Sun Kim
    Journal of Korean Academy of Nursing.2014; 44(3): 280.     CrossRef
  • Nutrition Support in the Intensive Care Unit of 6 Korean Tertiary Teaching Hospitals: A National Multicenter Observational Study
    Song Mi Lee, Seon Hyeung Kim, Yoon Kim, Eunmee Kim, Hee Joon Baek, Seungmin Lee, Hosun Lee, Chul Ho Chang, Cheung Soo Shin
    Korean Journal of Critical Care Medicine.2012; 27(3): 157.     CrossRef
  • Healthcare Professional's Knowledge, Perception and Performance on Early Enteral Nutrition for Critically Ill Patients
    Sun Hee Yun, Sun Jung Kim, Eui Geum Oh
    Korean Journal of Critical Care Medicine.2012; 27(1): 36.     CrossRef
  • Effects of Nutrition Support Team Services on Outcomes in ICU Patients
    Yeon Hwa MO, Jinnie RHEE, Eui-Kyung LEE
    YAKUGAKU ZASSHI.2011; 131(12): 1827.     CrossRef
  • Degree of Nutritional Support and Nutritional Status in MICU Patients
    Soo Na Chi, Jea Young Ko, Su Ha Lee, Eun Hwa Lim, Kuk Hwan Kown, Mi Seon Yoon, Eun Sook Kim
    The Korean Journal of Nutrition.2011; 44(5): 384.     CrossRef
  • Physician Compliance with Tube Feeding Protocol Improves Nutritional and Clinical Outcomes in Acute Lung Injury Patients
    Sungwon Na, Hosun Lee, Shin Ok Koh, Ai Soon Park, A Reum Han
    The Korean Journal of Critical Care Medicine.2010; 25(3): 136.     CrossRef
Decreased Phenytoin Absorption in Patients with Continuous Enteral Feedings
Eun Kyong Roe, Hye Kyung Kim, Sung Hui Lim, Bo Sook Ahn, Chang Gyoo Byun, Jung Goo Cho, Cheung Soo Shin
Korean J Crit Care Med. 2000;15(2):102-107.
  • 1,603 View
  • 26 Download
AbstractAbstract PDF
This report supports interactions between phenytoin and both enteral feeding products and nasogastric feeding tube. Five patients in ICU were treated with intravenous phenytoin, which yield detectable therapeutic serum concentrations. After switching to a comparable phenytoin capsule administered by nasogastric feeding tube, their serum phenytoin concentration fell to below assay sensitivity concentrations. Two of them experienced seizures. They were administered by intravenous phenytoin again or another antiepileptic drug, so the seizures were controlled. Some fact of decreased phenytoin absorption in enteral feeding patients is that phenytoin interact enteral feeding product and adhere the nasogastric feeding tube itself. We conclude that it is necessary to use phenytoin with caution in enteral feeding patients.

ACC : Acute and Critical Care