Annals of Clinical Nutrition and Metabolism

Refeeding Syndrome in Critically Ill Patients: Sang Woo Ha, Suk-Kyung Hong; Ann Clin Nutr Metab 2022;14(2):72-80. Published online December 1, 2022; DOI: https://doi.org/10.15747/ACNM.2022.14.2.72

Abstract PDF Supplementary Material: Purpose: The aim of this study is to demonstrate clinical characteristics of refeeding syndrome (RS) and clinical utility of several guidelines including American Society for Parenteral and Enteral Nutrition consensus recommendations for RS and National Institute for Clinical Excellence guidelines.
Materials and Methods: Eighty-six patients screened for RS based on two guidelines were enrolled in this study. We evaluated the severity of RS after the initiation of ‘dextrose infusion’ and ‘balanced nutrition support’ with calculation of 5-day electrolyte changes. The primary outcome was 6-month mortality and secondary outcomes were duration of intensive care unit stay in days, duration of mechanical ventilation in days, and ventilator-free days at the 28th day.
Results: We observed statistically different distributions in terms of prevalence of RS on the basis of two different start times of caloric support (P=0.021). There was no statistically significant relationship between the risk of RS and severity of RS based on both guidelines. Also, the relevance between severity of RS and outcomes was not significant in our study. In multivariable logistic regression analysis of factors associated with outcomes, the significant factor for primary outcome was the ‘patients with significant risk’ (odds ratio, 9.65; 95% confidence interval, 1.83~50.90; P=0.007).
Conclusion: We demonstrated that even initial administration of dextrose solution and propofol could cause severe RS in critically ill patients. In addition, significant risk of RS was a predictive factor for 6-month mortality. Thus, it is essential to monitor the occurrence of RS even during initial resuscitation in patients with unstable metabolism.

7 View
0 Download

Effect of Malnutrition Assessed by Comprehensive Nutritional Screening Tool on In-Hospital Mortality after Surgery for Gastrointestinal Perforation: Seung-Young Oh, Hannah Lee, Ho Geol Ryu, Hyuk-Joon Lee; Surg Metab Nutr 2021;12(1):1-6. Published online June 30, 2021; DOI: https://doi.org/10.18858/smn.2021.12.1.1

Abstract PDF: Purpose: This study examined the effects of malnutrition on in-hospital mortality after surgery for gastrointestinal (GI) perforation.
Materials and Methods: Patients who underwent surgery for GI perforation between 2010 and 2017 were analyzed retrospectively. The preoperative nutritional status was assessed by the Seoul National University Hospital-Nutrition Screening Index, a tool that comprehensively evaluates 11 factors that reflect the nutritional status. The risk factors for in-hospital mortality after surgery for GI perforation were evaluated by univariate and multivariate analyses.
Results: Four hundred and eighty-nine patients were divided into two groups: 439 patients in the survival group and 50 patients in the in-hospital mortality group. The risk of malnutrition was higher (93.6% vs. 65.9%, P<0.001) in the in-hospital mortality group than in the survival group. The preoperative albumin level was lower, and the blood urea nitrogen level was higher in the in-hospital mortality group than in the survival group. Emergency surgery, lymphoma as a cause of perforation, and fecal-contaminated ascites were also identified as factors associated with in-hospital mortality. Multivariate analyses demonstrated that a high risk of malnutrition (HR=5.71, 95% CI 1.38~26.02, P=0.017), lymphoma as a cause of perforation (HR=4.12, 95% CI 1.17~14.51, P=0.028), low preoperative albumin (HR=4.77, 95% CI 2.35~9.69, P<0.001), and high preoperative BUN (HR=1.03, 95% CI 1.01~1.05, P=0.001) had significant effects on the in-hospital mortality after surgery for GI perforation.
Conclusion: A high risk of malnutrition assessed by the composite index was associated with in-hospital mortality after surgery for a GI perforation.

7 View
1 Download

Usefulness of Bioelectrical Impedance Analysis as a Guidance of Fluid Management in Critically Ill Patients after Major Abdomen Surgery; a Single Center, Prospective Cohort Study: Yoon Ji Chung, Eun Young Kim; Surg Metab Nutr 2020;11(2):53-60. Published online December 30, 2020; DOI: https://doi.org/10.18858/smn.2020.11.2.53

Abstract PDF: Purpose: We evaluated the patterns and changes in bioelectrical impedance analysis parameters of patient who underwent abdominal surgery throughout the early period in surgical intensive care unit stay.
Materials and Methods: From May 2019 to April 2020, patients admitted to surgical intensive care unit for more than 48 hours after surgery were enrolled. Body composition and volume status of patients were measured prospectively using portable bioelectrical impedance analysis device every morning for three days from the day of intensive care unit admission. Overhydration was defined as the case where the value of extracellular water ratio is above 0.390, and the participants were daily classified into overhydration or normohydration group. Relationship between daily volume status measured by bioelectrical impedance analysis and outcomes was assessed.
Results: 107 patients who underwent abdominal surgery and 26 patients who underwent endovascular surgery were reviewed as control group. During the first postoperative 48 hours, most of them showed overhydration status, while the rate of overhydaration was significantly lower in the control group. Overhydration status on day 3 was significant predictors of postoperative morbidities (OR 5.709, 95% CI 2.199~14.819, P<0.001) and in-hospital mortality (OR 4.244, 95% CI 1.398~12.883, P<0.001).
Conclusion: Overhydration status by extracellular water ratio on postoperative day 3 needs careful monitoring and appropriate interventions to improve the postoperative morbidities and in-hospital mortality. Bioelectrical impedance analysis could be a simple, easy and useful tool to monitor the volume status of patients who requiring intensive fluid resuscitation after abdominal surgery.

6 View
1 Download

Nutritional Support Team Approach Decreases the In-Hospital Mortality Rate after Deceased Donor Liver Transplantation: Sang-Oh Yun, Jong Man Kim, Sangjin Kim, Jinsoo Rhu, Hyun Jung Kim, Soo Hyun Park, Hyo Jung Park, Eunmi Gil, Wonseok Kang, Gyu-Seong Choi, Won Hyuck Chang, Jeong-Meen Seo, Jae-Won Joh; Surg Metab Nutr 2020;11(1):7-11. Published online June 30, 2020; DOI: https://doi.org/10.18858/smn.2020.11.1.7

Abstract PDF: Purpose: This study compared the mortality rates between a period of time without employing a nutritional support team (NST) and a period of time with an NST.
Materials and Methods: Forty-six patients underwent adult deceased donor liver transplantation (DDLT) in 2016, and their medical records were prospectively collected. All the donor recipients underwent routine enteral feeding after liver transplantation. An NST cared for twenty-one patients after September 2016. The NST consisted of transplant surgeons, hepatologists, a critical care team, a rehabilitation team, dietitians, pharmacists, and nurses. We defined the patients within the time period without an NST as the control group and those patients within the time period with an NST as the case group.
Results: There were no statistically significant differences in baseline or perioperative characteristics between the two groups. The median model for the end-stage liver disease (MELD) score was 36 (range: 21∼40) for the control group and 36 (range: 23∼40) for the case group (P=0.596). The 30-day mortality rate was 24.0% (6/25) for the control group, but it was 4.8% (1/20) for the case group. The patient survival rates at 1-year and 2-year were 68.0% and 64.0% in the control group and 85.7% and 81.0% in the case group, respectively. However, there were no statistically significant differences of the 30-day mortality rate and 1∼2 year patient survival rate between the two groups.
Conclusion: The present study suggests that an NST should be required to prevent 30-day mortality and increase patient survival of adult DDLT patients with a high MELD score.

6 View
0 Download

Effect of Obesity on 30-Day Mortality in Critically Ill Surgical Patients: Jung Yeob Ko, Yun Tae Jung, Jae Gil Lee; J Clin Nutr 2018;10(2):51-55. Published online December 31, 2018; DOI: https://doi.org/10.15747/jcn.2018.10.2.51

Abstract PDF: 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.

5 View
0 Download

The Effects of Early Enteral Nutrition in Patients: A Role of Nutrition Support Team: Kye Wol Park, Hee Ryoung Son, Ji Hoon Kim, Myoung Hee Kim, Eun Jin Choi; J Clin Nutr 2016;8(2):66-70. Published online August 31, 2016; DOI: https://doi.org/10.15747/jcn.2016.8.2.66

Abstract PDF: Purpose:
The study examined the effects of early enteral nutrition on the patients’ length of stay in an intensive care unit (ICU), length of stay and mortality rate.
Methods:
A retrospective design was employed with a total of 461 patients (mean age=69.9±15.6 years; 253 males; 208 females). They were divided into two groups according to when they received enteral feeding: an “early enteral nutrition” (EEN) group of 148 patients (32.1%) who received enteral feeding within 48 hours of their arrival at the hospital and a “delayed enteral nutrition” (DEN) group of 313 patients (67.9%) who received enteral feeding at some point after 48 hours of their arrival at the hospital. The EEN group and control group were similar in terms of age, sex, body mass index, and underlying diseases.
Results:
The EEN group’s total length of stay in hospital was shorter (23.29±27.19 days) than that of the control group (36.74±32.24 days); the difference was significant (P<0.001). The EEN group also showed a shorter length of stay in the ICU (13.67±22.77 days) than the DEN group (17.46±21.02 days) and a lower mortality rate (17.6%) than the control group (18.8%), but these differences were not significant.
Conclusion:
The study found that early enteral nutrition treatment reduced total length of stay in hospital significantly. The findings suggest that early enteral nutrition treatment plays an important role in the patients’ recovery and prognosis.

5 View
0 Download

Search

Purpose:

Methods:

Results:

Conclusion:

Purpose:

Methods:

Results:

Conclusion: