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Nutritional support for critically ill patients by the Korean Society for Parenteral and Enteral Nutrition — part I: a clinical practice guideline
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Seung Hwan Lee, Jae Gil Lee, Min Kwan Kwon, Jiyeon Kim, Mina Kim, Jeongyun Park, Jee Young Lee, Ye Won Sung, Bomi Kim, Seong Eun Kim, Ji Yoon Cho, A Young Lim, In Gyu Kwon, Miyoung Choi, KSPEN Guideline Committee
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Ann Clin Nutr Metab 2024;16(3):89-111. Published online December 1, 2024
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DOI: https://doi.org/10.15747/ACNM.2024.16.3.89
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 Abstract
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- Purpose: Nutritional support for adult critically ill patients is essential due to the high risk of malnutrition, which can lead to severe complications. This paper aims to develop evidence-based guidelines to optimize nutritional support in intensive care units (ICUs).
Methods: The Grading Recommendations, Assessment, Development and Evaluation process was used to develop and summarize the evidence on which the recommendations were based. Clinical outcomes were assessed for seven key questions.
Results: We recommend the following: (1) initiate enteral nutrition (EN) within 48 hours after treatment as it is associated with improved outcomes, including reduced infection rates and shorter ICU stays; (2) early EN is preferred over early parenteral nutrition due to better clinical outcomes; (3) the use of supplementary parenteral nutrition to meet energy targets during the first week of ICU admission in patients receiving early EN is conditionally recommended based on patient-specific needs; (4) limited caloric support should be supplied to prevent overfeeding and related complications, particularly in the early phase of critical illness; (5) higher protein intake is suggested to improve clinical outcomes, such as muscle preservation and overall recovery; (6) additional enteral or parenteral glutamine is conditionally recommended against due to the lack of significant benefit and potential harm; and (7) fish oil-containing lipid emulsions is conditionally recommended due to their potential to enhance clinical outcomes, including reduced infection rates and shorter ICU stays.
Conclusion: These evidence-based recommendations can improve clinical outcomes and support healthcare providers in making informed decisions about nutritional interventions in the ICU.
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Effect of Obesity on 30-Day Mortality in Critically Ill Surgical Patients
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Jung Yeob Ko, Yun Tae Jung, Jae Gil Lee
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J Clin Nutr 2018;10(2):51-55. Published online December 31, 2018
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DOI: https://doi.org/10.15747/jcn.2018.10.2.51
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Purpose:This study was conducted to assess how extreme obesity affects 30-day mortality in this patient group. Methods:A total of 802 patients who underwent emergency gastrointestinal surgery from January 2007 to December 2017 were retrospectively reviewed. Patients were divided into three groups according to their body mass index (BMI): group 1, normal weight (BMI: 18.5∼22.9 kg/m2); group 2, overweight (BMI: 23.0∼29.9 kg/m2); and group 3, obesity (BMI≥30 kg/m2). Patients with a BMI under 18.5 were excluded from the analysis. Chi-squared test, Fisher’s exact test, Kaplan-Meier survival analysis, and the log-rank test were used to assess and compare 30-day mortality rates between groups. Results:The mortality rates of group 1, group 2, and group 3 were 11.3%, 9.0%, and 26.9%, respectively (P<0.017). The mortality rate did not differ significantly between group 1 and 2 (11.3% vs. 9.0%; P=0.341), but group 1 and 2 showed better survival rates than group 3 (11.3% vs. 26.9%; P=0.028, 9.0% vs. 26.9%; P=0.011). Kaplan-Meier survival analysis revealed that group 3 had higher mortality than the other two groups (P=0.001). Conclusion:Obesity (BMI≥30 kg/m2) was one of the risk factors influencing critically ill patients who underwent emergency surgery.
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Sequential Changes in Body Composition Using Bioelectrical Analysis during the Metabolic Response in Critically Ill Surgical Patients
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Seok Rae Park, Seung Hwan Lee, Kyung Sik Kim, Hosun Lee, Tae Hwa Hong, Jae Gil Lee
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Surg Metab Nutr 2017;8(1):13-16. Published online June 30, 2017
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DOI: https://doi.org/10.18858/smn.2017.8.1.13
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Purpose: Assessment of sequential changes in body composition during the metabolic response in critically ill surgical patients is essential for optimal nutritional support and management. Bioelectrical impedance analysis (BIA) is an easy, portable, and quick way to assess body composition. Thus, the aim of this study was to evaluate the sequential changes in body composition and the validity of Direct segmental Multi-frequency BIA in critically ill surgical patients. Materials and Methods: Twenty-three patients admitted to the intensive care unit (ICU) after major surgery were measured for body composition by multiple-frequency BIA after intensive care unit admission as well as 3 and 7 days later. Repeated-measures analysis of variance (ANOVA) was used to detect significant changes over time. Results: The average length of intensive care unit stay was 4.3 days. Total body water, extracellular water, skeletal muscle mass (SMM), soft lean mass, and fat-free mass (FFM) increased during the first 72 h of intensive care unit admission, after which they decreased slightly. On the other hand, fat mass decreased during the first 72 h of intensive care and then increased. However, arm circumference (AC), arm muscle circumference (AMC), and waist circumference (WC) gradually decreased by day 7 (P<0.001). Conclusion: In this study, AC, AMC, WC, and direct segmental Multi-frequency BIA were less affected by initial resuscitation in the intensive care unit (ICU). Therefore, segmental BIA may be useful for critical ill patients in altered hydration states.
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Effects of Nutrition Consultation on Nutritional Status in Critically Ill Surgical Patients
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Hee Sook Hwang, Seung Hwan Lee, Hosun Lee, Kyung Sik Kim, Seo Jin Chung, Jae Gil Lee
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J Clin Nutr 2015;7(1):28-34. Published online April 30, 2015
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DOI: https://doi.org/10.15747/jcn.2015.7.1.28
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Purpose:The aim of this study was to investigate nutritional support status and effects of nutrition consultation in critically ill surgical patients. Methods:The medical records of 76 patients, admitted between June 1 and November 30, 2013, were reviewed retrospectively. Patients were divided into 2 groups: the nutrition consultation group (n=17) and the no consultation group (n=59). Patients were also divided into 3 groups: the enteral nutrition (EN) group (n=8), the parenteral nutrition (PN) group (n=25), and the enteral and parenteral mixed nutrition (ENPN) group. Total delivered/required caloric ratio and serum albumin, serum total protein, hemoglobin and other biochemical variables were compared in each group. Results:Mean daily required and delivered caloric/protein amount were EN group 60.0%, PN group 64.6%, and ENPN group 86.9%. ENPN group showed statistically significant difference when compared with EN group, PN group (P=0.005). When the proportion of patients who were fed more than 75% of the daily required calories was calculated, EN, PN, and ENPN showed 37.5%, 25.0% and 81.8%, respectively. ENPN group were significantly more supplied (P=0.007). Although neither the nutrition consultation group nor the non-consultation group received more than 80% of the daily required calories, the nutrition consultation group received 73% of the daily required calories whereas the no consultation group only received 46% (P=0.007). The total delivered/required protein ratio was approximately 69% of the nutrition consultation group and approximately 42% of the no consultation group (P=0.006). Conclusion:The results of providing nutritional consultation to intensive care unit patients showed an increase in the nutrition support. Nutrition education, continuous monitoring and management for nutritional support by systemic administration of a nutritional support team should be considered in order to achieve effective clinical outcomes in critically ill surgical patients.
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General Categorization and Application of EN Formula
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Jae Gil Lee
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Surg Metab Nutr 2015;6(2):17-22. Published online December 30, 2015
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DOI: https://doi.org/10.18858/smn.2015.6.2.17
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Enteral nutrition is a method of nutritional support. If the gut works, its use is recommended for nutritional support. Enteral nutrition has several advantages; low cost, more physiologic, and prevention of mucosal atrophy and maintenance of gastrointestinal immunity. Enteral formula is the medical food used for enteral nutrition. Several types of enteral formula are used in clinical practice. I will hereby introduce the types and selection of enteral formula.
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