Korean Journal of Community Nutrition (대한지역사회영양학회지)

The Korean Society of Community Nutrition (대한지역사회영양학회)
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Effects of the APACHEIII Score, Hypermetabolic Score on the Nutrition Status and Clinical Outcome of the Patients Administered with Total Parenteral Nutrition and Enteral Nutrition

경정영양과 중심정맥영양을 공급받는 환자에서 질병의 상태(APACHEIII Score), 과대사 정도가 영양상태 및 임상적 결과에 미치는 영향

  • Rha Mi yong (Department of Dietetics, Samsung Medical Center) ;
  • Kim Eun mi (Department of Dietetics, Samsung Medical Center) ;
  • Cho Young Y. (Department of Dietetics, Samsung Medical Center) ;
  • Seo Jeong Meen (Department of Surgery, Samsung Medical Center, SungkyunKwan University School of Medicine) ;
  • Choi Hay mie (Department of Food and Nutrition, Seoul National University)
  • 라미용 (삼성서울병원 영양파트) ;
  • 김은미 (삼성서울병원 영양파트) ;
  • 조영연 (삼성서울병원 영양파트) ;
  • 서정민 (성균관대학교 의과대학 삼성서울병원 외과학교실) ;
  • 최혜미 (서울대학교 식품영양학과)
  • Published : 2006.02.01
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Abstract

The aim of this study is to evaluate the clinical outcome. Between January 1,2002 to September 30, 2002, we prospectively and retrospectively recruited III hospitalized patients who received Enteral Nutrition (EN group n = 52) and Total Parenteral Nutrition (TPNgroup n = 59) for more than seven days. The factors of clinical outcomes are costs, incidences of infection, lengths of hospital stay, and changes in weight. The characteristics of patients were investigated, which included nutritional status, disease severity CAP ACHE III score) and hypermetabolic severity Chypermetabolic score). Hypermeta-bolic scores were determined by high fever (> $38^{\circ}C$), rapid breathing (> 30 breaths/min) , rapid pulse rate (> 100 beats/min), leukocytosis (WBC > 12000 $mm^{3}$), leukocytopenia (WBC > 3000 $mm^{3}$), status of infection, inflammatory bowel disease, surgery and trauma. There was a positive correlation between hypermetabolic score and length of hospital stay (ICU), medical cost, weight loss, antibiotics adjusted by age while APACHEIII score did not show correlation to clinical outcome. Medical cost was higher by $18.2\%$ in the TPN group than the EN group. In conclusion, there was a strong negative correlation between the clinical outcome (cost, incidence of infection, hospital stay) and hypermetabolic score. Higher metabolic stress caused more malnutrition and complications. For nutritional management of patients with malnutrition, multiple factors, including nutritional assessment, and evaluation of hypermetabolic severity are needed to provide nutritional support for critically ill patients.

Keywords

References

  1. Askanazi J, Carpentier YA, Elwyn DH, Nordenstrom J, Jeevanandam M, Rosenbaum SH, Gump FE, Kinney JM (1980): Influence of total parenteral nutrition on fuel utilization in injury and sepsis. Ann Surg 191: 40-46 https://doi.org/10.1097/00000658-198001000-00008
  2. Askanazi J, Hensle TW, Starker PM, Lockhart SH, LaSala PA, Olsson C, Kinney JM (1986): Effect of immediate postoperative nutritional support on length of hospitalization. Ann Surg 203: 236-239 https://doi.org/10.1097/00000658-198603000-00002
  3. Bastow MD, Rawlings J, Allison SP (1993): Benefits of supplementary tube feeding after fractured neck of femur: a randomized control trial. BMJ 287: 1589-1592 https://doi.org/10.1136/bmj.287.6405.1589
  4. Bower RH, Talamini MA, Sax HC, Hamilton F, Fischer JE (1986): Postoperative enteral vs parenteral nutrition. A randomized controlled trial. Arch Surg 121: 1040-1045 https://doi.org/10.1001/archsurg.1986.01400090070011
  5. Christopher S, Caroline A, Gordon LJ (1997): Malnutrition and related complications. In: Shikora, S. A., Blackburn G. l., Nutrition support, pp.21-29, Chapman & Hall
  6. Dark DS, Pingleton SK (1993): Nutrition and nutritional support in critically ill patients. J Int Care Med 8: 16-33 https://doi.org/10.1177/088506669300800102
  7. De Jonghe B, Appere-De-Vechi C, Fournier M, Tran B, Merrer J, Melchior JC, Outin H (2001): A prospective survey of nutritional support practices in intensive care unit patients: what is prescribed? What is delivered? Crit Care Med 29: 8-12 https://doi.org/10.1097/00003246-200101000-00002
  8. Dinarello CA (1984): Interleukin-1 and the pathogenesis of actue-phase response. N Engl J Med 311: 1413-1418 https://doi.org/10.1056/NEJM198411293112205
  9. Giner M, Laviano A, Meguid MM, Gleason JR (1996): In 1995 a correlation between malnutrition and poor outcome in critically ill patients still exists. Nutrition 12: 23-29 https://doi.org/10.1016/0899-9007(95)00015-1
  10. Heyland DK (1998): Nutritional support in the critically ill patient: A critical review of the evaluation. Crit Care Clin 14: 423-440 https://doi.org/10.1016/S0749-0704(05)70009-9
  11. Heyland DK, Cook DJ, Schoenfeld PS, Frietag A, Varon J, Wood G (1999): The effect of acidified enteral feeds on gastric colonization in critically ill patients: results of a multicenter randomized trial. Canadian Critical Care Trials Group. Crit Care Med 27: 2399-2406 https://doi.org/10.1097/00003246-199911000-00013
  12. Heyland DK, Schroter-Noppe D, Drover JW, Jain M, Keefe L, Dhaliwal R, Day A (2003): Nutrition support in the critical care setting: current practice in canadian ICUs--opportunities for improvement? JPEN J Parenter Enteral. Nutrition 27: 74-83
  13. Hill GL, Blackett RL, Pickford I, Burkinshaw L, Young GA, Warren JV, Schorah CJ, Morgan DB (1977): Malnutrition in surgical patients. An unrecognised problem. Lancet 1: 689-692
  14. Hill L Graham (1991): Nutritional assessment. In: total parenteral nutrition 2nd., pp.139-151
  15. Hill GL, Monk D, Plank LD (1993): Measuring body composition in intensive care patients. In: Metabolic Support of the Critically Ill Patient. Wilmore DW, CarpnetierA (Eds). Berlin, Springer-Verlag, pp.3-18
  16. Gardiner KR, Kirk SJ, Rowlands BJ (1995): Novel substrates to maintain gut integrity. Nutr Res Rev 8: 43-66 https://doi.org/10.1079/NRR19950006
  17. Ginger M, Laviano A, Meguid MM, Gleason JR (1995): In 1995 a correlation between malnutrition and poor outcome in critically ill patients sill exists. Nutrition 12: 23-29
  18. Hopkins B (1993): Assessment of nutritional status. In Gottschlich MM, Matarese, LE, Shronts, EF, eds, Nutrition support dietetics core curriculum. Silver Spring, MD: ASPEN, pp.15-70
  19. Kinney JM (1995): Metabolic response to starvation, injury and sepsis. In; Payne-James J, Grimble G, Silk D, eds. Artificial Nutrition Support in Clnical Practice. London: Edward Arnold/Hodder Headline Group, pp.1-11
  20. Knaus WA, Wagner DP, Draper EA, Zimmerman JE, Bergner M, Bastos PG, Sirio CA, Murphy DJ, Lotring T (1991): The APACHE III prognostic system. Risk prediction of hospital mortality for critically ill hospitalized adults. Chest 100: 1619-1636 https://doi.org/10.1378/chest.100.6.1619
  21. Kudsk KA, Croce MA, Fabian TC, Minard G, Tolley EA, Poret HA, Kuhl MR, Brown RO (1992): Enteral versus parenteral feeding. Effects on septic morbidity after blunt and penetrating abdominal trauma. Ann Surg 215: 503-511; discussion 511-503 https://doi.org/10.1097/00000658-199205000-00013
  22. Kudsk KA, Minard G, Wojtysiak SL, Croce M, Fabian T, Brown RO (1994): Visceral protein response to enteral versus parenteral nutrition and sepsis in patients with trauma. Surgery 116: 516-523
  23. Kudsk KA (1994): Gut mucosal nutritional support-enteral nutrition as primary therapy after multiple system trauma. Gut 35(suppl 1): S52-S54 https://doi.org/10.1136/gut.35.1_Suppl.S52
  24. Mentec H, Dupont H, Bocchetti M, Cani P, Ponche F, Bleichner G (2001): Upper digestive intolerance during enteral nutrition in critically ill patients: frequency, risk factors, and complications. Crit Care Med 29: 1955-1961 https://doi.org/10.1097/00003246-200110000-00018
  25. Moore EE, Jones TN (1986): Benefits of immediate jejeunostomy feeding aftermajor abdominal trauma-a prospective, randomized study. J Trauma 26:874-881 https://doi.org/10.1097/00005373-198610000-00003
  26. Moore EE, Moore FA (1991): Immediate enteral nutrition following multisystemtrauma: a decade perspective. J Am Coll Nutr 1991; 10:633-648 https://doi.org/10.1080/07315724.1991.10718183
  27. Moore FA, Feliciano DV, Andrassy RJ, McArdle AH, Booth FV, Morgenstein-Wagner TB, Kellum JM, Jr, Welling RE, Moore EE (1992): Early enteral feeding, compared with parenteral, reduces postoperative septic complications. The results of a meta-analysis. Ann Surg 216: 172-183 https://doi.org/10.1097/00000658-199208000-00008
  28. Peterson VM, Moore EE, Jones TN, Rundus C, Emmett M, Moore FA, McCroskey BL, Haddix T, Parsons PE (1988): Total enteral nutrition versus total parenteral nutrition after major torso injury: attenuation of hepatic protein reprioritization. Surgery 104:199-207
  29. Petersson B, Hultzman E, Andersson K, Wernerman J (1995): Human skeletal muscle protein: effect of malnutrition, elective surgery and total parenteral nutrition. Clin Sci 88: 479-484 https://doi.org/10.1042/cs0880479
  30. Sax HC, Souba WW (1998): Nutritional goals and mac-ronutrient requirements, In: the ASPEN Nutrition Support Practice Manual, pp.2(1)-2(5) ASPEN
  31. Shilkora SA, Blackburn GL, Frse RA (1994): Nutrition and immunology: clinician' sapproach. In Diet, nutrition and immunology. Boca Raton, FL: CRC Press, pp.9-20
  32. Shronts EP, Lacy JA (1993): Metabolic support. In: Gottschlich MM, Matarese LE,Shronts EP, eds. Nutrition Support Dietetics Core Curriculum. Silverspring, pp.351-366 ASPEN, MD
  33. Skipper A (1995): Energy and Protein Requirements. In: Nutrition Support Policies, Procedures, Forms, and Formulas, ASPEN
  34. Skipper A (1998): Keith W. Millikan, MD, FACS: Parenteral Nutrition Implementation and Management. In: The ASPEN Nutrition Support Practice Manual, ASPEN