대한지역사회영양학회지 (Korean Journal of Community Nutrition)

대한지역사회영양학회 (The Korean Society of Community Nutrition)
권호 표지
DOI QR코드

DOI QR Code

영양집중지원팀 자문 의뢰 및 순응 여부에 따른 중환자실 환자의 영양상태 비교

Nutritional Status of Intensive Care Unit Patients According to the Referral to the Nutrition Support Team and Compliance with the Recommendations

  • Sohn, Yunjin (Nutrition Management Team, Chungbuk National University Hospital) ;
  • Hyun, Taisun (Department of Food and Nutrition, Chungbuk National University)
  • 투고 : 2022.04.09
  • 심사 : 2022.04.26
  • 발행 : 2022.04.30
PDF 다운로드
⟨ 이전 논문 다음 논문 ⟩

초록

본 연구에서는 충북대학교병원 NST의 중재활동 효과를 확인하기 위하여 중환자실에 7일 이상 입원하여 EN/PN을 공급 받은 성인 환자 176명을 대상으로 의무기록을 후향적으로 분석하였다. NST 자문 의뢰 여부에 따라 NST 의뢰군과 미의뢰군으로 분류하였고, NST 의뢰군은 자문순응 여부에 따라 자문순응군과 비순응군으로 분류하였다. NST 의뢰율은 56.8%, NST 자문 회신에 대한 순응율은 47.0%이었으며, 신경과의 NST 의뢰율이 93.8%로 가장 높았고, 자문순응 비율도 60%로 높았다. 진료과 및 주진단명에 따라 NST 의뢰율과 자문순응 비율에 큰 차이를 나타냈다. NST 의뢰군은 미의뢰군에 비해, 자문순응군은 비순응군에 비해 열량 및 단백질 공급률이 높았으며, 목표열량 도달 비율이 높았다. 또한 자문순응군은 비순응군에 비해 목표열량에 도달하는 기간도 유의적으로 짧았다. 중환자실 입실 시 보다 퇴실 시 영양상태가 전반적으로 악화된 것으로 나타났으며, 모든 집단에서 혈청 알부민과 헤모글로 빈 수치가 유의적으로 낮아졌으나, 자문순응군의 감소폭은 자문비순응군의 감소폭보다 적었다. 또한 퇴실 시 NST 의뢰군, 비의뢰군, 자문비순응군의 심한 영양불량은 입실 시에 비해 유의적으로 증가하였으나, 자문순응군은 입실 시와 퇴실 시에 차이가 없었다. 중환자실 재원기간은 NST 의뢰군이 미의뢰군보다 더 길었으나 자문순응군은 비순응군보다 유의적으로 짧게 나타났다. 결과적으로 NST 자문에 순응하여 제공된 영양지원은 중환자의 생화학적 지표에 긍정적인 효과를 나타내고, 재원기간 중 발생할 수 있는 영양불량을 지연시키고, 중환자실 재원 기간 또한 유의하게 단축시키는 것으로 나타났다. 따라서 NST 자문에 대한 순응률을 증가시키기 위해 중환자실 의료진과 NST와의 효과적인 의사소통이 필요할 것으로 생각되며, 중환자실 입실 초기부터 NST에 의한 중재활동이 진행될 수 있도록 자문 의뢰시스템의 개선이 필요할 것으로 생각된다. 또한 적절한 영양공급의 중요성 및 필요성에 대한 의료진 대상의 교육을 지속적으로 시행하여 영양공급 및 지원절차에 대한 프로토콜이 정착되어야 할 것으로 생각된다.

Objectives: This study aimed to examine the effectiveness of the intervention of the nutrition support team (NST) on the nutritional status of critically ill patients. Methods: The medical records of 176 adult patients who were admitted to the intensive care unit and received enteral or parenteral nutrition for more than 7 days were retrospectively analyzed. The patients were classified into the NST and non-NST groups according to whether they were referred to the NST or not. The NST group was further classified into the compliance and non-compliance groups depending on their compliance with the NST recommendations. Results: The NST referral rate was 56.8%, and the rate of compliance with the NST recommendations was 47.0%. Significantly higher energy and protein were provided to the NST and the compliance groups than to the non-NST and the non-compliance groups. The proportion of patients who reached the target calories after the initiation of enteral nutrition was significantly higher in the NST and the compliance groups than in the non-NST and the non-compliance groups. The serum albumin and hemoglobin levels significantly decreased in every group, but the changes were significantly lower in the compliance group. The nutritional status at discharge from the intensive care unit compared to the status at admission was significantly worse in the NST, non-NST, and non-compliance groups. However, the status was maintained in the compliance group. The length of stay in the intensive care unit was significantly shorter in the compliance group. Conclusions: Compliance with the NST recommendations was found to provide more calories and protein and prevent the deterioration of the nutritional status of critically ill patients. Therefore, effective communication between medical staff and the NST from the early stages of admission to the intensive care unit is needed to improve referrals to the NST and compliance with the recommendations.

키워드

참고문헌

  1. Chang DK. Hospital malnutrition. Intest Res 2013; 11(4): 238-242. https://doi.org/10.5217/ir.2013.11.4.238
  2. Barker LA, Gout BS, Crowe TC. Hospital malnutrition: Prevalence, identification and impact on patients and the healthcare system. Int J Environ Res Public Health 2011; 8(2): 514-527. https://doi.org/10.3390/ijerph8020514
  3. Sauer AC, Goates S, Malone A, Mogensen KM, Gewirtz G, Sulz I et al. Prevalence of malnutrition risk and the impact of nutrition risk on hospital outcomes: Results from nutritionDay in the U.S. J Parenter Enteral Nutr 2019; 43(7): 918-926. https://doi.org/10.1002/jpen.1499
  4. Lew CCH, Yandell R, Fraser RJ, Chua AP, Chong MFF, Miller M. Association between malnutrition and clinical outcomes in the intensive care unit: A systematic review. J Parenter Enteral Nutr 2017; 41(5): 744-758. https://doi.org/10.1177/0148607115625638
  5. Inciong JFB, Chaudhary A, Hsu HS, Joshi R, Seo JM, Trung LV et al. Hospital malnutrition in northeast and southeast Asia: A systematic literature review. Clin Nutr ESPEN 2020; 39: 30-45. https://doi.org/10.1016/j.clnesp.2020.06.001
  6. Korean Society of Critical Care Medicine. Guidelines for nutrition support in the adult critically ill patient. Seoul: Jin Publishing; 2013.
  7. Wesley JR. Nutrition support teams: Past, present, and future. Nutr Clin Pract 1995; 10(6): 219-228. https://doi.org/10.1177/0115426595010006219
  8. DeLegge MH, Kelly AT. State of nutrition support teams. Nutr Clin Pract 2013; 28(6): 691-697. https://doi.org/10.1177/0884533613507455
  9. Park Y, Park SJ. Organization and the role of nutrition support team. Korean J Gastroenterol 2015; 65(6): 342-345. https://doi.org/10.4166/kjg.2015.65.6.342
  10. Lee TH, Paik HU. The nutrition support team (NST) certification system. J Korean Soc Health-Syst Pharm 2010; 27(1): 1-4.
  11. Cho JY, Kim JT, Kim SR. Survey on the state of Nutrition Support Team (NST) activity: Comparison of the questionnaire survey 2016 vs. 2005 and the state of NST activity since the introduction of the medical insurance fee. J Clin Nutr 2016; 8(2): 38-44. https://doi.org/10.15747/jcn.2016.8.2.38
  12. Kang JH, Back HW, Sin DY, Sin DH, Son HJ, Jang SH et al. The outcomes of critically ill patients after following the recommendations of the nutritional support team. Korean J Parenter Enteral Nutr 2010; 3(1): 40-44.
  13. Im WS, Lee YM. Effect of nutrition support team management: Focusing on medical intensive care unit patients. J Korean Crit Care Nurs 2018; 11(3): 108-119.
  14. Kim SJ, Lee YM. Effect of nutrition support team (NST) management: In medical intensive care unit patients. J Korean Data Anal Soc 2015; 17(5): 2647-2660.
  15. Oh E, Shim H, Yon HJ, Moon JS, Kang DR, Jang JY. Effectiveness of a multidisciplinary team for nutrition support in a trauma intensive care unit. Acute Crit Care 2020; 35(3): 142-148. https://doi.org/10.4266/acc.2020.00318
  16. Kim BH, Kim HS, Kwon OR. A comparison of nutritional status by intensive nutritional support in enteral nutrition patients. J Nutr Health 2018; 51(2): 132-139. https://doi.org/10.4163/jnh.2018.51.2.132
  17. Mistiaen P, Van den Heede K. Nutrition support teams: A systematic review. J Parenter Enteral Nutr 2020; 44(6): 1004-1020. https://doi.org/10.1002/jpen.1811
  18. Kim EK, Kim JK, Park YJ, Baek SY, Lee JJ, Lee AH et al. Analysis of compliance with plan of nutritional support team in intensive care unit. Surg Metab Nutr 2016; 7(2): 29-31. https://doi.org/10.18858/smn.2016.7.2.29
  19. Park SJ, Park JE, Kwon NY, Kim JS, Son ES, Yu HJ et al. Effects of compliance with the nutrition support team in critically ill pediatric patients. J Clin Nutr 2016; 8(2): 51-57. https://doi.org/10.15747/jcn.2016.8.2.51
  20. Kwon JE, Park AR, Kim SJ. The comparison of improvement effect in patient's nutrition state according to the adaptation of nutrition support team's consultation. J Korean Soc Hosp Pharm 2017; 34(2): 147-156.
  21. Knaus WA, Draper EA, Wagner DP, Zimmerman JE. APACHE II: A severity of disease classification system. Crit Care Med 1985; 13(10): 818-829. https://doi.org/10.1097/00003246-198510000-00009
  22. Pablo AR, Izaga MA, Alday LA. Assessment of nutritional status on hospital admission: Nutritional scores. Eur J Clin Nutr 2003; 57(7): 824-831. https://doi.org/10.1038/sj.ejcn.1601616
  23. Lee SM, Kim SH, Kim Y, Kim EM, Baek HJ, Lee SM. Nutrition support in the intensive care unit of 6 Korean tertiary teaching hospitals. Korean J Crit Care Med 2012; 27(3): 157-164. https://doi.org/10.4266/kjccm.2012.27.3.157
  24. Seol EM, Suh YS, Ju DL, Bae HJ, Lee HJ. Characteristics and clinical course of patients who received enteral or parenteral nutrition in tertiary referral hospitals in Korea. J Clin Nutr 2016; 8(2): 58-65. https://doi.org/10.15747/jcn.2016.8.2.58
  25. Do Y, Cho M, Kim M, Kim J, Lee S. Parenteral nutrition support and NST management in ICU patients. Korean J Parenter Enteral Nutr 2010; 3(1): 54-59.
  26. Kim SM, Lee YH. Nutritional status and support of the critically ill patients in intensive care units of Chungbuk C University Hospital. J Korean Data Anal Soc 2014; 16(5): 2695-2709.
  27. Hwang HS. Effect of nutrition consult on nutritional status in critically ill surgical patients [master's thesis]. Ewha Womans University; 2014.
  28. Al-Dorzi HM, Arabi YM. Nutrition support for critically ill patients. J Parenter Enteral Nutr 2021; 45(S2): 47-59.