Acute and Critical Care

Original Articles

Nutrition
Higher caloric intake through enteral nutrition is associated with lower hospital mortality rates in patients with candidemia and shock in Taiwan: Chen-Yu Wang, Tsai-Jung Wang, Yu-Cheng Wu, Chiann-Yi Hsu; Acute Crit Care. 2024;39(4):573-582. Published online November 20, 2024; DOI: https://doi.org/10.4266/acc.2024.00843

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Abstract PDF: Background
Candidemia is associated with markedly high intensive care unit (ICU) mortality rates. Although the Impact of Early Enteral vs. Parenteral Nutrition on Mortality in Patients Requiring Mechanical Ventilation and Catecholamines (NUTRIREA-2) trial indicated that early enteral nutrition (EN) did not reduce 28-day mortality rates among critically ill patients with shock, the European Society for Clinical Nutrition and Metabolism (ESPEN) guidelines recommend avoiding EN in cases of uncontrolled shock. Whether increased caloric intake from EN positively impacts clinical outcomes in patients with candidemia and shock remains unclear.
Methods
We retrospectively collected data from a tertiary medical center between January 2015 and December 2018. We enrolled patients who developed shock within the first 7 days following ICU admission and received a diagnosis of candidemia during their ICU stay. Patients with an ICU stay shorter than 48 hours were excluded.
Results
The study included 106 patients, among whom the hospital mortality rate was 77.4% (82 patients). The median age of the patients was 71 years, and the median Acute Physiology and Chronic Health Evaluation II score was 29. The Cox regression model revealed that a higher 7-day average caloric intake through EN (hazard ratio, 0.61; 95% CI, 0.44–0.83) was significantly associated with lower hospital mortality rates. Our findings suggest EN as the preferred feeding route for critically ill patients with shock.
Conclusions
Increased caloric intake through EN may be associated with lower hospital mortality rates in patients with candidemia and shock.

Meta-analysis
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

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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

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8 Crossref

Abstract 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

Nutrition practices in critically ill adults receiving noninvasive ventilation: A quantitative survey of Australian and New Zealand intensive care clinicians
Kaitlyn Page, Elizabeth Viner Smith, Mark P. Plummer, Emma J. Ridley, Kristy Burfield, Lee-anne S. Chapple
Australian Critical Care.2024; 37(1): 43. CrossRef
El hambre invisible en la Unidad de Cuidados Intensivos. Estrategias de Cuidado y Consideraciones Esenciales
Ignacio Zaragoza-García
Enfermería Intensiva.2024; 35(1): 1. CrossRef
Invisible hunger in the Intensive Care Unit: Care strategies and essential considerations
I. Zaragoza-García
Enfermería Intensiva (English ed.).2024; 35(1): 1. CrossRef
Evidence-Based Investigation of Nurses' Nutrition Interventions in Intensive Care Patients Regarding Enteral Nutrition
Mensure Turan, Zeliha Cengiz, Dilek Olmaz
Dimensions of Critical Care Nursing.2024; 43(3): 123. CrossRef
Contribution to the Validation of the Portuguese Version of the “Barriers to Enterally Feeding Critically Ill Patients” Questionnaire and Its Application in a Hospital Context
Mário Rui Abade, Noémia Lopes, José de Santo Amaro
Topics in Clinical Nutrition.2024; 39(3): 184. CrossRef
What influences the implementation of clinical guidelines related to enteral nutrition in the intensive care unit: A mixed‐methods systematic review
Jia Qi Li, Ting Sun, Jun Tao Zuo, Yao Xu, Li Na Cai, Heng Yu Zheng, Xiang Hong Ye
Journal of Advanced Nursing.2024;[Epub] CrossRef
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

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Abstract 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

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6 Crossref

Abstract 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

Effects of a video-based enteral nutrition education program using QR codes for intensive care unit nurses: a quasi-experimental study
Won Kee Seo, Hyunjung Kim
Journal of Korean Biological Nursing Science.2024; 26(1): 16. CrossRef
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

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Abstract 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

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Abstract 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 Article

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

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12 Crossref

Abstract 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

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