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Comparative assessment of nutritional characteristics of critically ill patients at admission and discharge from the neurosurgical intensive care unit in Korea: a comparison study
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Eunjoo Bae, Jinyoung Jang, Miyeon Kim, Seongsuk Kang, Kumhee Son, Taegon Kim, Hyunjung Lim
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Ann Clin Nutr Metab 2023;15(3):97-108. Published online December 1, 2023
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DOI: https://doi.org/10.15747/ACNM.2023.15.3.97
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 Abstract
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- Purpose: Patients in neurosurgical (NS) intensive care units (ICUs) experience considerable energy and protein deficits associated with adverse outcomes. This study aimed to compare the nutritional status of patients at admission to (baseline) and discharge from the NS ICU.
Methods: This was a single-center, retrospective, before and after study of patients admitted in the NS ICU of the CHA Bundang Medical Center, from January 31, 2019, to February 28, 2020. All anthropometric data, biochemical data, clinical data, and dietary data were collected during the NS ICU stay. Specifically, we investigated the cumulative caloric deficit rate, phase angle and skeletal muscle index as indicators of lean muscle mass, and nitrogen balance according to demographic and clinical characteristics.
Results: A total of 140 NS patients were studied. Calf circumference decreased from 31.4±4.2 cm at baseline to 30.2±4.0 cm at discharge (P<0.001). Energy supply rate increased from 44.4% at baseline to 89.2% at discharge. Phase angle (PhA) patients with an modified Nutrition Risk in the Critically ill (mNUTRIC) score≤5 group had significantly lower PhA values than those with an mNUTRIC score>5 (P=0.005).
Conclusion: Although clinical and dietary parameters of patients in the NS ICU improved from baseline to discharge, anthropometric and biochemical markers of lean muscle mass and nutritional status decreased. PhA and nitrogen balance difference values were significantly different between those with an mNUTRIC score≤5 and those with an mNUTRIC score>5. These data indicate that the nutritional risk of critically ill patients increases during hospitalization in the NS ICU.
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Comparison of Energy Requirements of Patients with Brain Injury of the Intensive Care Unit: Indirect Calorimetry vs. Predictive Equations
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EunJoo Bae, SeongSuk Kang, MiYeon Kim, JinYoung Jang, HyunJung Lim, TaeGon Kim
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J Clin Nutr 2020;12(2):41-47. Published online December 31, 2020
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DOI: https://doi.org/10.15747/jcn.2020.12.2.41
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Abstract
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- Purpose: The metabolic activity and demand usually increase in seriously ill patients, especially in patients with a brain injury (BI). These nutritional demands have been traditionally satisfied using predictive equations (PEs). Recently, indirect calorimetry (IC) has been used widely because it is more accurate than other methods. This study measured the energy expenditures (EE) using IC (GE, CARESCAPE B650, Helsinki, Finland) and calculated the PEs simultaneously in patients with BI.
Methods: This study was conducted on 55 patients with a BI for three years (2017.7∼2020.8), who were mechanically ventilated within a hospital for ≤seven days. The EE values using IC were measured once in each patient, and the EE values using PE were calculated using 5 PEs (ESPEN, Harris-Benedict, HB; Frankenfield, FK; Penn state, PS; and Faisy) at the same time. The 55 patients were divided into two groups, acute group (39 patients; ≤3 hospital days group, AG) and subacute group (16 patients; >3 hospital days group, SG) according to the time, and the values were obtained.
Results: There were no differences in the patient’s characteristics between the two groups, including age, gender, severity of the condition (Simplified Acute Physiology Score II), and anthropometric parameters. In AG, the energy expenditure values using PEs were significantly lower than those using IC in the three PEs (IC 1,712.0±476 kcal, ESPEN 1,558.6±324 kcal, P=0.038, HB 1,582.4±273 kcal, P=0.037, PS 1,530.8±340 kcal, P=0.005). In SG, the EE value using PEs did not differ significantly from that using IC.
Conclusion: An accurate assessment of EE is critical for seriously ill patients. These results showed that the previously well-known PEs might not be correct, particularly in acute patients with BI. Therefore, it is recommended that the EE values be obtained using IC, at least in acute patients with BI.
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