PURPOSE: Enteral feeding remains controversial in patients receiving extracorporeal membrane oxygenation (ECMO), particularly in those treated with a high-dose vasopressor. This study examined the safety and feasibility of enteral nutritional support for patients undergoing ECMO in a cardiac care unit (CCU). METHODS: Adult patients admitted to the CCU undergoing ECMO from January 2014 to May 2015 were included. Patients with <48 hours of support, undergoing ECMO at another hospital, and inaccurate medical records were excluded. RESULTS: Among the 14 patients undergoing ECMO in the CCU, 2 patients were diagnosed with malnutrition and the others were in the normal state in the initial assessment. On the other hand, they had the malnutrition risk factors (anorexia, weight loss, fluid retention, and hypermetabolic state). Thirteen patients received enteral nutrition and 1 patient had possible oral intake. The average initiation day of enteral nutrition was 2.0±1.6 days on ECMO. The mean duration of enteral nutrition was 5.2±4.9 days and the target goal was achieved within 3 days. There were no serious adverse effects for enteral nutrition but 3 patients had gastrointestinal problems (diarrhea and anorexia), and gastrointestinal bleeding occurred in 1 patient. In 1 case, enteral nutrition had to be stopped due to the prone position. Overall, 5 patients were cured, 3 patients recovered through heart transplantation, and 6 patients died. CONCLUSION: Most CCU patients receiving ECMO were well nourished but had the malnutrition risk factors in progress. These results suggest that enteral feeding might be safe and feasible in patients treated with ECMO but there were minor side effects.
Adult ; Coronary Care Units* ; Enteral Nutrition* ; Extracorporeal Membrane Oxygenation ; Hand ; Heart Transplantation ; Hemorrhage ; Humans ; Malnutrition ; Medical Records ; Membranes* ; Nutritional Support ; Oxygen* ; Prone Position ; Risk Factors ; Weight Loss

Intestinal failure (IF) is a condition, in which the intestinal function or length remaining is below the minimum amount required for the absorption of sufficient nutrients and fluid to maintain normal life. The nutritional supply of IF depends on the anatomical site, length, and function of the remaining bowel. The goals of nutritional therapy for patients with IF are to achieve bowel adaptation to absorb nutrients sufficiently to live a healthy life with the current intestinal condition, and to promote the enteral autonomy to control nutrient digestion, absorption, excretion, and bowel movement. To stabilize and recover the patient's nutrition condition after a huge bowel resection, the intestinal rehabilitation team (IRT) for individual nutritional therapy should be established. IRT carefully monitors the changes in body weight, medication use, patient's symptoms, nutrient deficiency, hydration status, function of the remaining bowel, degree of bowel adaptation, adverse effects due to nutritional therapy, and enteral balance. To achieve intestinal adaptation and enteral autonomy through complicated and difficult nutritional intensive therapy in IF patients, it is essential to manage the patients through multidisciplinary collaboration involving physicians, pharmacists, dietitians, and nurses.
Absorption ; Adult* ; Body Weight ; Cooperative Behavior ; Digestion ; Humans ; Nutrition Therapy* ; Nutritionists ; Pharmacists ; Rehabilitation

No abstract available.

PURPOSE: Malnutrition is quite prevalent in hospitalized cancer patients, with a 40%~80% rate. Malnutrition in cancer patients can result in an increase in the number of complications, length of stay, mortality, and morbidity. Therefore, cancer patients with malnutrition must have the appropriate nutritional support to improve the prognosis of cancer. This study evaluated the appropriate time point to start parenteral nutrition (PN) after admission according to the nutrition support guidance in Samsung Medical Center. METHODS: This study enrolled patients diagnosed with the Korean standard classification of disease 6 (KCD6) code C00-C97 and discharged from March 1st to 31st, 2016. The following data were collected: patients'age, gender, diagnosis, length of stay, body mass index, nutritional status, and whether to consult nutrition support team (NST). RESULTS: Among a total of 2,944 patients, 381 patients (12.9%) were in a malnourished status upon admission. In the malnourished patients, 139 patients were prescribed PN for a median of 6 days (range, 1∼49) and moderate to severe malnourished patients were started on PN within 2 days after admission. The proportion of patients with a poor nutritional status was lower in the NST group than in the non-NST group (50.0% vs. 66.7%) on the 28th day after admission. Among the nourished patients, 229 patients were prescribed PN. Of them, 183 patients (79.9%) were started on PN within 7 days after admission. CONCLUSION: In moderate to severe malnourished cancer patients, the initiation of PN on the day after admission is appropriate.
Body Mass Index ; Classification ; Diagnosis ; Humans ; Length of Stay ; Malnutrition ; Mortality ; Nutritional Status ; Nutritional Support ; Parenteral Nutrition* ; Prognosis

PURPOSE: This study is a comparative evaluation of the incidence of parenteral nutrition-associated liver disease (PNALD) when administering intravenous fat emulsions containing fish oil. METHODS: The medical records of patients who were in the neonatal intensive care unit at Severance Hospital from January, 2012 to December 2015, were reviewed retrospectively. Patients who were administered either soybean oil (SO) or SMOF (containing soybean oil, medium chain triglycerides, olive oil, and fish oil) more than 14 days were included. The patients were excluded if they were administered both agents or had underlying hepatic disease. An increase in bilirubin to 2 mg/dL was defined as PNALD. RESULTS: PNALD occurred in only 8 out of a total of 77 patients: 6 out of 31 (19.4%) in the SO group and 2 out of 46 (4.3%) in the SMOF group (P=0.055). The number of patients, whose lab values, such as direct bilirubin, total bilirubin, asparate aminotransferase (AST), alanine amino-transferase, gamma-glutamyl transpeptidase, C-reactive protein, serum triglyceride, and alkaline phosphate, exceeded the normal range, were similar in both groups. The gestational age, birth body weight, and APGAR score at 1 min and 5 min were significantly higher in the SO group and the PN duration was significantly long in the SMOF group. Considering only term infants, there were no significant differences in baseline characteristics and incidence of PNALD. The number of patients whose AST exceeded the normal range was significantly higher in the SO group (P=0.034). CONCLUSION: The incidence of PNALD was similar in both groups. On the other hand, considering the tendency, there was a high correlation between the type of lipid emulsion and an increased direct bilirubin level in the SO group.
Alanine ; Apgar Score ; Bilirubin ; Body Weight ; C-Reactive Protein ; Emulsions* ; Fat Emulsions, Intravenous ; Fish Oils ; gamma-Glutamyltransferase ; Gestational Age ; Hand ; Humans ; Incidence ; Infant ; Infant, Newborn* ; Intensive Care, Neonatal ; Liver Diseases* ; Liver* ; Medical Records ; Olive Oil ; Parenteral Nutrition ; Parturition ; Reference Values ; Retrospective Studies ; Soybean Oil ; Triglycerides

PURPOSE: To evaluate the clinical manifestations of adverse drug reactions (ADRs) of parenteral nutrition (PN) use in Korea. METHODS: The Korean Adverse Event Reporting System (KAERS) database records in 2015 on PN-treated patients were used. ADRs classified as “certain,”“probable,” and “possible” based on the WHO-Uppsala Monitoring Centre criteria were analyzed. RESULTS: In total, 21,436 ADRs from 2,346 patients were included for analysis. The mean patient age was 57.1 years and the mean number of ADRs per patient was 9.1. ADRs were reported frequently with amino acids solutions (682 events, 40.8%), followed by combinations products (519 events, 31.1%), and fat emulsions (363 events, 21.7%). The frequent ADRs were gastrointestinal (507 events, 30.3%), skin (343 events, 20.5%), general disorders (239 events, 14.3%), and central/peripheral nervous system disorders (165 events, 9.9%). The common clinical symptoms were nausea (321 events, 19.2%), vomiting (105 events, 6.3%), and vein pain (102 events, 6.1%). Serious ADRs accounted for 220 patients (9.4%) and dyspnea was the most frequent clinical manifestation. CONCLUSION: This study analyzed the KAERS data in 2015 from patients treated with PN and revealed gastrointestinal and skin disorders to be the leading ADRs.
Amino Acids ; Drug-Related Side Effects and Adverse Reactions ; Dyspnea ; Emulsions ; Humans ; Korea* ; Nausea ; Nervous System Diseases ; Parenteral Nutrition* ; Skin ; Veins ; Vomiting

Total parenteral nutrition (TPN) therapy has advanced significantly during the recent half a century, from single bottle therapy to the combined therapy including macronutrients and micronutrients. The purposes of 3-chamber bag development are to reduce the restriction of total nutrient admixture, and increase the accessibility of therapy. This is also based on trial and errors during R&D activities, and the clinical experiences at the hospital compounding centers. The 3-chamber bag started with concerns regarding the mixture of fat and glucose and amino acids, but up to the present, it is used widely with clinical experience of more than 15 years. Therefore, it might be reasonable to ensure that its efficacy and safety is confirmed. The physicians have reported that it contributes to the convenient and efficient nutrition therapy, allowing enhanced patient compliance and convenience at hospital. In addition, depending on the further R&D works, 3-chamber bags are expected to advance further, opening a new landscape for advanced nutrition therapy.
Amino Acids ; Glucose ; Micronutrients ; Nutrition Therapy ; Parenteral Nutrition, Total* ; Patient Compliance

Sarcopenia, which is defined as a decrease in skeletal muscle mass and strength with aging, is an important risk factor in clinical medicine that is associated with mortality, and poor surgical and nonsurgical outcomes. Sarcopenia is now recognized as a multifactorial geriatric syndrome. Cachexia is defined as a metabolic syndrome with inflammation as the key feature, so cachexia can be an underlying condition of sarcopenia. Recently, cachexia has been defined as a complex metabolic syndrome associated with an underlying illness and characterized by the loss of muscle mass with or without a loss of fat mass. These two conditions overlap but are not the same. In clinical practice, many factors related to sarcopenia (decreased food intake, inactivity, and decreased hormones) are reported frequently in patients with cachexia. On the contrary, systemic inflammation, the core feature of cachexia, can also be present in apparently healthy older sarcopenic patients. This suggests that new therapeutic approaches, alone or in combination, may be appropriate in both conditions.
Aging ; Cachexia* ; Clinical Medicine ; Eating ; Humans ; Inflammation ; Mortality ; Muscle, Skeletal ; Nutrition Therapy ; Risk Factors ; Sarcopenia*

No abstract available.

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.
Body Mass Index ; Enteral Nutrition* ; Humans ; Intensive Care Units ; Length of Stay ; Male ; Mortality ; Nutritional Support ; Prognosis ; Retrospective Studies