Effect of Nutrition Support Team Management - Focusing on Medical Intensive Care Unit Patients -

영양집중지원에 따른 결과 비교 - 내과계 중환자실 대상으로 -

  • Im, Waon Sun (Inje University Haeundae Paik Hospital) ;
  • Lee, Yun Mi (Department of Nursing, Institute of Health Science, Inje University)
  • 임완순 (인제대학교 해운대백병원) ;
  • 이윤미 (인제대학교 간호학과, 건강과학연구소)
  • Received : 2018.08.31
  • Accepted : 2018.10.08
  • Published : 2018.10.31

Abstract

Purpose : This study evaluated the nutritional status and effect of nutritional support team (NST) management in critically ill patients. Methods : From January 2015 to August 2017, the study retrospectively investigated 128 patients aged above 19 years admitted to a medical intensive care unit (MICU). The patients were divided into two groups: NST (n=65) and non-NST (n=63) groups. Nutritional status, classification of bedsore risks, incidence rate of bedsore and clinical outcomes were compared. Results : The study found a higher rate of the use of enteral nutrition in the NST group (${\chi}^2=45.60$, p < .001). The prescription rate of parenteral nutrition (PN) was found to be lower in the NST group (4.6%) compared to the non-NST group (60.3%). There was a higher PN of total delivered/required caloric ratio in the NST, compared to the non-NST, group (${\chi}^2=3.33$, p=.025). There were significant differences for higher albumin levels (t=2.50, p=.014), higher total protein levels (t=2.94, p=.004), and higher proportion of discharge with survival rates (${\chi}^2=18.26$, p < .001) in the NST group. Conclusions : Providing NST management to critically ill patients showed an increase in the nutrition support. Further, to achieve effective clinical outcomes, measures such as nutrition education and continuous monitoring and management for the provision of nutritional support by the systemic administration of a nutritional support team should be considered.

Keywords

References

  1. Alberda, C., Gramlich, L., Jones, N., Jeejeebhoy, K., Day, A. G., Dhaliwal, R., & Heyland, D. K. (2009). The relationship between nutritional intake and clinical outcomes in critically ill patients: Results of an international multicenter observational study. Intensive Care Medicine, 35 (10), 1728-1737. https://doi.org/10.1007/s00134-009-1567-4
  2. Bak, S. J., Yun, S. J., Kang, E. H., & Hong, S. K. (2010, August). Enteral nutrition in surgical intensive care unit supply status. Paper presented at the meeting of Korean Society for Parenteral and Enteral Nutrition, Seoul.
  3. Barr, J., Hecht, M., Flavin, K. E., Khorana, A., & Gould, M. K. (2004). Outcomes in critically ill patients before and after the implementation of an evidencebased nutritional management protocol. Chest, 125 (4), 1446-1457. https://doi.org/10.1378/chest.125.4.1446
  4. Braden, B. J., & Maklebust, J. (2005). Preventing pressure ulcers with the braden scale: An update on this easy-to-use tool that assesses a patient's risk. The American Journal of Nursing, 105 (6), 70-72. https://doi.org/10.1097/00000446-200506000-00031
  5. Correia, M. I., & Waitzberg, D. L. (2003). The impact of malnutrition on morbidity, mortality, length of hospital stay and costs evaluated through a multivariate model analysis. Clinical nutrition, 22 (3), 235-239. https://doi.org/10.1016/S0261-5614(02)00215-7
  6. Do, Y., Cho, M., Kim, M., Kim, J., & Lee, S. (2010). Parenteral nutrition support and NST management in ICU patients. Journal of the Korean Society for Parenteral & Enteral Nutrition, 3 (1), 54-60.
  7. Health Insurance Review & Assessment Service. (2014). Coverage standards of therapy by nutrition support team. Retrieved September 1, 2018, from http://www.hira.or.kr/rd/insuadtcrtr/InsuAdtCrtrPopup.do?mtgHmeDd=20140730&sno=3&mtgMtrRegSno=0044
  8. Kawai, M., Hirono, S., Okada, K., Sho, M., Nakajima, Y., Eguchi, H., . . . Yamaue, H. (2016). Randomized controlled trial of pancreaticojejunostomy versus stapler closure of the pancreatic stump during distal pancreatectomy to reduce pancreatic fistula. Annals Surgery, 264 (1), 180-187. https://doi.org/10.1097/SLA.0000000000001395
  9. Kim, B. H., Kim, H., & Kwon, O. (2018). A comparison of nutritional status by intensive nutritional support in enteral nutrition patients. Journal of Nutrition and Health, 51 (2), 132-139. https://doi.org/10.4163/jnh.2018.51.2.132
  10. Kim, S. J., & Lee, Y. M. (2015). Effect of nutrition support team (NST) management in medical intensive care unit patients. Journal of the Korean Data Analysis Society, 17 (5), 2647-2660.
  11. Kim, S. M., & Yi, Y. H. (2014). Nutritional status and support of the critically ill patients in intensive care units of Chungbuk C University Hospital. Journal of the Korean Data Analysis Society, 16 (5), 2695-2709.
  12. Kim, Y. K., Min, J. Y., Song, S. J., Yang, J. A., Park, S. H., Hur, J. W., . . . Kim, K. M. (2014). Characteristic of malnutrition risk patients who admitted in intensive care unit. Paper presented at the meeting of the Korean Society for Parenteral and Enteral Nutrition, Seoul.
  13. Kitson, A. L., Schultz, T. J., Long, L., Shanks, A., Wiechula, R., Chapman, I., & Soenen, S. (2013). The prevention and reduction of weight loss in an acute tertiary care setting: Protocol for a pragmatic stepped wedge randomized cluster trial (the PRoWL project). BMC Health Services Research, 13, 299-307. https://doi.org/10.1186/1472-6963-13-299
  14. Korean Society of Critical Care Medicine. (2013). Guidelines for nutrition support in the adult critically ill patient. Seoul: Korean Society of Critical Care Medicine.
  15. Kyle, U. G., Genton, L., & Pichard, C. (2005). Hospital length of stay and nutritional status. Current Opinion in Clinical Nutrition & Metabolic Care, 8 (4), 397-402. https://doi.org/10.1097/01.mco.0000172579.94513.db
  16. Lee, Y. J. (2016). Results comparison of nutritional interventions by nutrition support team of ICU enteral nutrition patients (Unpublish maser's thesis). Yonsei University, Seoul, Korea.
  17. Lee, J. S., Cho, M. R., & Lee, G. J. (2010). Validation of the developed nutritional screening tool for hospital patients. Korean Journal of Nutrition, 43 (2), 189-196. https://doi.org/10.4163/kjn.2010.43.2.189
  18. Lee, S. M., Kim, S. H., Kim, Y. R., Kim, E., Baek, H. J., Lee, H., . . . Shin, C. S. (2012). Nutrition support in the intensive care unit of 6 Korean tertiary teaching hospitals: A national multicenter observational study. Korean Journal of Critical Care Medicine, 27 (3), 157-164. https://doi.org/10.4266/kjccm.2012.27.3.157
  19. Lee, S. M., Lee, S. M., & Sin, S. J. (2006, September). The effect of cumulative energy and protein balances on lengths of ventilation and ICU stay in critically ill patients. Paper presented at the meeting of Korean Society for Parenteral and Enteral Nutrition, Seoul.
  20. Moon, S. S., Lim, H., Choi, J. W., Kim, D. K., Lee, J. W., Ko, S., & Kim, D. C. (2009). Analysis of nutritional support status in the intensive care unit. Korean Journal of Critical Care Medicine, 24 (3), 129-133. https://doi.org/10.4266/kjccm.2009.24.3.129
  21. Pablo, A. R., Izaga, M. A., & Alday, L. A. (2003). Assessment of nutritional status on hospital admission: Nutritional scores. European Journal of Clinical Nutrition, 57 (7), 824-831. https://doi.org/10.1038/sj.ejcn.1601616
  22. Park, K. W., Son, H. R., Kim, J. H., Kim, M. H., & Choi, E. J. (2016). The Effects of early enteral nutrition in patients: A role of nutrition support team. Journal of clinical nutrition, 8 (2), 66-70. https://doi.org/10.15747/jcn.2016.8.2.66
  23. Prittie, J., & Barton, L. (2004). Route of nutrient delivery. Clinical Techniques in Small Animal Practice, 19 (1), 6-8. https://doi.org/10.1053/S1096-2867(03)00078-1
  24. Reuben, D. B., Greendale, G. A., & Harrison, G. G. (1995). Nutrition screening in older persons. Journal of the American Geriatrics Society, 43 (4), 415-425. https://doi.org/10.1111/j.1532-5415.1995.tb05818.x
  25. Takashi, H., Akihiro, I., Toshio, I., Miyo, M., & Shugo, M. (2005, June). Nutritional support team; The present status of nutritional support team in Japan. Paper presented at the meeting of the Korean Society for Parenteral and Enteral Nutrition, Seoul.
  26. Weijs, P. J., Stapel, S. N., de Groot, S. D., Driessen, R. H., de Jong, E., Girbes, A. R., . . . Beishuizen, A. (2012). Optimal protein and energy nutrition decreases mortality in mechanically ventilated, critically ill patients: A prospective observational cohort study. Journal of Parenteral and Enteral Nutrition, 36 (1), 60-68. https://doi.org/10.1177/0148607111415109
  27. Woien, H., & Bjork, I. T. (2006). Nutrition of the critically ill patient and effects of implementing a nutritional support algorithm in ICU. Journal of Clinical Nursing, 15 (2), 168-177. https://doi.org/10.1111/j.1365-2702.2006.01262.x
  28. Ziegler, T. R. (2009). Parenteral nutrition in the critically ill patient. New England Journal of Medicine, 361 (11), 1088-1097. https://doi.org/10.1056/NEJMct0806956