Acute and Critical Care

Song Mi Lee

3 Articles

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

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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

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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

Energy Deficiency Aggravates Clinical Outcomes of Critically Ill Patients: Hye Kyung Chung, Song Mi Lee, Jae Hoon Lee, Cheung Soo Shin; Korean J Crit Care Med. 2005;20(1):49-53.

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Abstract PDF: BACKGROUND
Adequate nutrition support reduces infectious complications, mortality and length of hospitalizationin intensive care unit. However, there are multi factors like frequent null per os (NPO) due to examination, intolerance to tube feeding, complication of TPN (total parenteral nutrition) and ineffective recognition by medical staff. The purpose of this study is to identify detrimental effects of cumulative energy deficiency in critically ill patients.
METHODS
The patients who were received tube feeding or total parenteral nutrition for more than 5 days were investigated. Daily and cumulative energy deficiency was tabulated until oral intake was achieved or until they discharged or died. Patients were divided into two groups, severe energy deficient group (>10, 000 kcal) or mild energy deficient group (<5, 000 kcal). Then we compared clinical outcomes between two groups. RESULTS: Total 150 patients were studied. 48 (32%) patients were severe energy deficient group and 42 (28%) patients were mild energy deficient group. Mortality and nosocomial infection were significantly higher in severe energy deficient group than in mild group. Hospital day and ICU day were significantly higher in severe energy deficient group than in mild group. CONCLUSIONS: Severe energy deficiency was very common in critically ill patients and it deteriorated the clinical outcomes such as mortality, nosocomial infection, hospital day and ICU day.

Oropharyneal Bezoar in a Patient with Amyotrophic Lateral Sclerosis under Mechanical Ventilation: A case report: Cheung Soo Shin, Jin Mo Ahn, Gab Soo Kim, Song Mi Lee; Korean J Crit Care Med. 1998;13(1):97-100.

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Abstract PDF: Bezoars are not uncommonly found during upper gastrointestinal investigations (UGI), are known to be associated with conditions causing stasis changes in gastrointestinal tract. We described here a curious presentation of an oropharyngea bezoar associated with medication and tube feeding. Only few cases of regurgated esophageal bezoar have been reported. A 54 years old man with amyotropic lateral sclerosis required ventilatory support. Nasogastric tube was placed, enteral feeding with special liquid diet (Geenvia TF) was begun. In addition, almagate was given via the feeding tube. Tracheotomy was done for long term mechanical ventilation support. On the 10th day of ICU stay, he complained of foreign body sensation in oral cavity. We could find a white brown colored 15cm solid mass in deep oropharynx. Some factors including sucralfate and the peripheral neuropathy have been suspected to be ascribed forming the esophageal bezoar. Gastrointestinal motility was decrease in patients with peripheral neuropathy. In this case, aluminum hydroxides, one of the aluminium substance like sucralfate, was given to the patient with the peripheral neuropathy. From this experience, we became to know that it is necessary to use the aluminium compound anti-ulcer drug with caution in the patients with the gastrointestinal depression.

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