CRITICAL CARE / NUTRITION SUPPORT TEAM
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1) R-173: Backrest elevation in ICU. Hyun Sim Lee, A Reum Han, Ae Soon park, Eun A Kim, Jeong Yeon Kim, Eun Sook Lee, Young Woo Park, Ho Sun Lee (1), Shin Ok Koh (2). ICU Nursing Team, (1) Nutrition Team, (2) Department of Anesthesiology and Pain Medicine, Yonsei University College of medicine, Seoul, South Korea
2) R-308: The adequacy of nutrition intervention in intensive care unit. Jeannie Miu-Sim Poon. Dietetic Services and Intensive Care Unit; Hongkong Sanatorium and Hospital, Hongkong, PRC
3) R-319: Methenolone enathate (androgen) for critical care patients - in 2 cases experience. Tetsuro Tajiri, Ryozo Hayashida, Toshihiro Sato, Yasuhiko Ryu, Yutaka Nishimura, Kazuo Shirouzu. Department of surgery Kurume university school of medicine, Fukuoka, Japan
4) R-408: Nutrition support team supervision improves intake of critical care patients in a private tertiary care hospital in the Philippines: report from years 2000 to 2006. Sioson MS, Inciong JF, Reyes MCS, Navarrete DI, Llido LO. Clinical Nutrition Section, Center for Weight Management and Clinical Nutrition, St. Luke’s Medical Center, Metro Manila, Philippines
NUTRITION SUPPORT / MANAGEMENT (top)
1) R-184: Case study: Nutritional support in duodenal perforation. Ms. Vijayashree.N, Mrs. Jyanthi. v, Dr. Selva Kumar, Dr. Shanmuga Baskar, Ms. Jayanthi. V, Department of Nutrition and Dietetics, Chennai Transplant Centre, Madras Medical Mission Hospital, Chennai.
2) R-264: Extremely Low Caloric Nutrition for the Patients with Multiple Organ Failure. Meng-Chun Lu (1), Mei-Due Yang (1), Walter Chen (2). Department of Clinical Nutrition, China Medical University Hospital, Taichung, Taiwan (1), China Medical University Beigang Hospital, Yunlin County, Taiwan (2)
ABSTRACTS OF POSTER PRESENTATION
R - 173 (top)
Backrest elevation in ICU
Hyun Sim Lee, A Reum Han, Ae Soon park, Eun A Kim, Jeong Yeon Kim, Eun Sook Lee, Young Woo Park, Ho Sun Lee(1), Shin Ok Koh(2)
ICU Nursing Team(1), Nutrition Team(2) Department of Anesthesiology and Pain Medicine, Yonsei University College of medicine, Seoul, South Korea
Objectives: Backrest elevation has been suggested as a simple and cost-effi cient method to reduce the risk of aspiration pneumonia for ICU patients who are ventilated and receiving enteral nutrition support. The purpose of this survey was to document the level of backrest elevation in medical and surgical intensive care unit, and identify the correlation between backrest elevation and mechanical ventilator support, enteral nutrition support, and hemodynamic status.
Methods: Data was collected from the patients over 18 years old in MICU and SICU at YUMC from March 19th to April 22th in 2007. Data was
collected randomly in 5 week-period, resulting 435 observations in 109 patients. Randomly 2 days in a week, 2 times in a day, data of backrest elevation, position of patients, ventilator status, enteral nutrition status, hemodynamic status were collected. Data was analyzed by SPSS 12.0.
Results: Mean backrest elevation was 19.8°. 19.5% of observations were over 30.0° in backrest elevation. There was a signifi cant difference in backrest elevation between patients in ICU were ventilated(16.8±10.1°) and not ventilated(25.4± 16.1°)(p<0.001). In MICU, there was a signifi cant difference in backrest elevation between those receiving enteral nutrition support(19.3±8.9°)and not receiving(13.3±10.2°)(p<0.01). In MICU, signifi cant difference in backrest elevation between the patients whose mean arterial blood pressure was not more than 70mmHg(11.1±10.7°) and more than 70mHg(17.0±9.8°) was found (p<0.05). Correlation between backrest elevation and dosage of norepinephrine was found (p<0.05).
Conclusions: Backrest elevation was signifi cantly higher for the patients not ventilated than ventilated. In MICU, backrest elevation was
signifi cantly higher for the patients receiving enteral nutrition support and who was stabilized in hemodynamic status. However mean backrest elevation was less than 30.0°. From the results, we will develop a protocol for backrest elevation to prevent ventilator associated pneumonia in critically ill patients receiving ventilator support and enteral nutrition in ICU.
R – 308 * (top) / Oral presentation
The adequacy of nutrition intervention in intensive care unit
Jeannie Miu-Sim Poon
Dietetic Services and Intensive Care Unit; Hongkong Sanatorium and Hospital, Hongkong, PRC
Background/Objective(s): To determine the prevalence and the risk level of malnutrition in patients admitted to intensive care unit (ICU) and to examine the adequacy of current doctor’s referral as an early nutrition therapy for patient with mild to severe malnutrition risk.
Methods: Despite the concept of early nutrition in periods of stress being well documented, it is often neglected or not appropriately practiced in the critically ill. Dietetic referrals of patient in ICU were studied during the period from March 15 to June 14, 2006 to assess the adequacy of nutrition intervention. Nutritional screening using a modifi ed format of the subjective global assessment was performed on all patient admitted or transferred to the ICU. The risk level of malnutrition was determined and he prevalence of dietetic referrals recorded.
Results: A total of 41 ICU patients screened. Results indicated 56 percent of the ICU patients examined had mild to severe malnutrition risk (27% with mild, 22% with moderate, 7 percent with malnutrition risk). Of the malnourished patients, only three were referred for nutrition assessment and intervention, whereas two patients with no malnutrition risk level were referred for medical nutrition therapy, thus showing no correlation between the degree of malnutrition risk and dietetic referrals.
Conclusion: Due to the complications of the disease and illness, the nutrition needs of ICU patients were often overlooked; malnutrition
can delay the length of recovery. Unless assertive nutrition intervention is given in the early stage of management, patient recovery will eventually be compromised.
R - 319 (top)
Methenolone enathate (androgen) for critical care patients - in 2 cases experience
Tetsuro Tajiri, Ryozo Hayashida, Toshihiro Sato, Yasuhiko Ryu, Yutaka Nishimura, Kazuo Shirouzu.
Department of surgery Kurume university school of medicine, Fukuoka, Japan
Objectives: In critical care patients, would be caused catabolism as hypoalbuminemia after major surgery. Androgen well known that may fix catabolism in critical care patients. The aims of this study are whether the androgen can fix catabolism, and whether it can affect cost performance. Moreover, we discussed its each injection phase.
Methods: We used androgen injection for 2 critical care patients in our institute. Case 1 patient is panperitonitis caused from esophagojejunal anastomosis leakage. And case 2 patient is panperitonitis caused from spontaneous rectum perforation. Case 1 patient used androgen injection from 35 days after surgery. And case 2 patient used it from 6 days after surgery. Each case used Methenolone Enathate as androgen 100mg once per week. We evaluated the nutrition status by the value of the albumin in serum at day 0, 3, 5, 7, 10 and 14.
Results: Albumin increased after 3days androgen injection in case 1 (from 2.3 to 2.7). And albumin had been held about 3.0. In case 2, albumin did not increase (from 2.7 to 2.3). But albumin had been held about 2.4 during androgen injection. In each case, we did not use albumin products after using androgen injection. In this result, we were able to reduce cost performance from 46,000 yen to 2,800 yen per month for treatment of hypoalbuminemia.
Conclusion: Androgen injection can hold albumin in serum. And it is effective for cost performance in critical care patients. Moreover, it is suggested that androgen injection is effectively in withdrawal from after major surgical catabolism. In addition, androgen should use with other nutrition treatments in early after surgical phase.
The value of the albumin in serum:
Day 0 |
Day3 |
Day5 |
Day7 |
Day10 |
Day14 |
|
| Case1 | 2.3 |
2.7 |
2.6 |
2.5 |
3.1 |
2.9 |
| Case2 | 2.7 |
2.4 |
2.3 |
2.3 |
2.6 |
2.5 |
R - 408 (top)
Nutrition support team supervision improves intake of critical care patients in a private tertiary care hospital in the Philippines: report from years 2000 to 2006
Sioson MS, Inciong JF, Reyes MCS, Navarrete DI, Llido LO
Clinical Nutrition Section, Center for Weight Management and Clinical Nutrition, St. Luke’s Medical Center, Metro Manila, Philippines
Background/Objective(s): To determine if a nutrition support team can improve nutrient intake of critical care patients and if positive outcome is sustained in the long term.
Methods: Calorie intake for one week was measured in three periods of the study: P1 (yr 2000-2001), P2 (yr 2003-2004), and P3 (yr 2005- 2006) and percentage intake was compared in these different periods. Type of nutrition support was also documented. Kruskal Wallis ANOVA was used with post-hoc analysis using Tukey-Kramer with signifi cance set at P < 0.05.
Results: 55 patients were seen (P1, N = 13; P2, N = 28; P3, N = 14) with male/female ratio of 1.8:1. Mean age was 70.7 yrs with 38% admitted in ICU, 1.8% in cardiac unit, 54.5% in geriatric high risk and 1.8% in stroke unit. P1: D1 intake was 26.8% of computed, D3 was 74%, and adequate on D5 to D7 (81-85%); P2: D1 intake was 76% of computed, gradually increasing to 99% on D7, with no intake below 75%. P3: D1 to D5 intake were adequate (76% to 89%). D1 intake comparison in all three periods was 462.5 kcal < 1,271 and 1118 kcal: P < 0.001,Tukey-Kramer). Enteral nutrition was 86% in P1, 64% in P2, and 54.8% on P3. Parenteral nutrition was 2.2% on P1, 17.2% on P2, and 14% on P3. Oral intake was 0% on P1, 16.4% on P2, and 18.2% in P3.
Conclusion: Nutrition support team supervision improves intake in critical care patients and this was sustained in the long term.
R – 184 (top)
Case study – Nutritional support in duodenal perforation
Ms. Vijayashree.N, Mrs. Jyanthi. v, Dr. Selva Kumar, Dr. Shanmuga Baskar, Ms. Jayanthi. V,
Department of Nutrition and Dietetics, Chennai Transplant Centre, Madras Medical Mission Hospital, Chennai.
Introduction: Good nutritional care can make important contribution in the management of critically ill patients. During illness and recovery nutrition plays a vital role in the healing process and return back to normalcy. Duodenal ulcer perforation is a life threatening injury. Patients with duodenal ulcer perforation frequently develop complication and have the risk of developing malnutrition and other nutritional deficiencies.
Case: 36 years old male underwent duodenal perforation closure. He developed complications with bile leak and was re-operated twice. He underwent Gastro-Jejunostomy and Roxy loop closure of the ulcer with drains to make it controlled fi stula. Naso jejunal feeding tube was during surgery . Patient developed ARDS post op and ventilated in ICU. To begin with patient was started with TPN and fed with 13 K.cals/kg body weight and protein 0.5gm/kg body weight. On 5th day enteral nutrition was initiated along with TPN and as the patient tolerated the feeds well, the rate and the strength of the feed was increased. Gradually TPN was withdrawn. Through enteral nutrition patient was meeting the recommended calories and protein. Multivitamin and trace minerals were supplemented. L-glutamine was initiated to improve the gut integrity. Biochemical parameters were observed; there was improvement in the serum Albumin levels (Initial-1.7gm/dl; After 22 days-03.4gm/dl). It shows there is improvement in the patient’s nutritional status.
Conclusion: This case study illustrates the success of nutritional management. Though complications of various dimensions were encountered at every stage aggressive nutrition support brought back the critically ill patient into normalcy. The patient progressed from TPN to normal diet and got discharged on 40 th post operative day.
R - 264 (top)
Extremely Low Caloric Nutrition for the Patients with Multiple Organ Failure
Meng-Chun Lu1, Mei-Due Yang1, Walter Chen2
Department of Clinical Nutrition, China Medical University Hospital, Taichung, Taiwan1 China Medical University Beigang Hospital, Yunlin County, Taiwan2
Background: The traditional or exceeding calorie requirement may compound the metabolic alteration of the stress response, especially in
critically ill. Studies have shown hypocaloric nutrition support to be safe and to achieve nitrogen balance comparable with traditional regimens for the critically ill. Though benefi ts shown include improved glycemic control, decreased intensive care unit length of stay, decreased ventilator days and infection rate for this group of patients, the benefi ts have not been proved yet in multiple organ failure patients.
Method: We have experienced with ten patients with MOF receiving extreme low calorie parental nutrition formula (15-20 kcal/kg /day). Serum prealbumin, transferrin and total lymphocyte count were used as measurements of nutritional status.
Result: Our investigation demonstrated that an extreme low calorie parental nutrition regimen is safe for the MOF patients and also can improve nutritional status and avoid being a burden to patients’ liver and kidney.
Conclusion / Recommendation: Further prospective, randomized study is mandatory for the MOF patients, concerning clinical outcomes such as mortality, intensive care unit length of stay, decreased ventilator days and infection rate.
Key word: extreme low caloric, multiple organ failure (MOF)