A 69-year-old man was consulted to our Home Health Care department for home parenteral enteral nutrition. He was diagnosed with Kennedy disease. He had swallowing difficulty and bowel ischemia. We provided nutritional support in a variety of ways in order to suit his condition. The role of the home care nurse involves training methods depending on changes in the nutritional support to patient and care giver. However, in the case of Kennedy disease, increasing the target patient's nutritional requirements as calculated was difficult.
Aged ; Bulbo-Spinal Atrophy, X-Linked* ; Caregivers ; Deglutition ; Delivery of Health Care ; Enteral Nutrition* ; Home Care Services ; Humans ; Ischemia ; Nutritional Requirements ; Nutritional Support ; Parenteral Nutrition

PURPOSE: IV-lipid emulsion can be a nutritional supplement to provide essential fatty acids and energy for patients who need total parenteral nutrition support. The recommended administration dose of lipid emulsion is less than 2.5 g/kg/d and the rate should not exceed 0.15 g/kg/h for adult patients. The purpose of this study is to evaluate the adequacy of the currently prescribed administration rate of IV-lipid emulsion in a single center. METHODS: We analyzed 1,739 lipid emulsion administration prescriptions in 1,095 patients over 18 years old at Ajou University Hospital from January 1, 2014 to March 31. RESULTS: The median prescription rate of total lipid emulsion was 0.134 (0.012~1.125) g/kg/h, and the exceeding portion of maximum recommended infusion rate was 36.9%. The median administration prescription rate of lipid emulsion was faster in 500 mL emulsions, compared to 250 mL emulsion (0.146 g/kg/h vs. 0.075 g/kg/h; P<0.001) and at emergency room (ER), compared to general ward (0.154 g/kg/h vs. 0.123; P<0.001). The exceeding portion of maximum recommended infusion rate of lipid emulsion was also higher in 500 mL emulsion, compared to 250 mL emulsion (52.2% vs. 30.4%; P<0.001) and at ER, compared to general ward (52.1% vs. 30.4%; P<0.001). Triglyceride level was higher in exceeding recommended infusion rate compared to less, but not statistically significant (119 mg/dL vs. 261 mg/dL; P=0.202). CONCLUSION: Administration prescription rate of lipid emulsion exceeded the recommended rate and this feature was dominant in 500 mL emulsion and at ER. Education and monitoring of lipid emulsion prescription is needed for appropriate lipid administration and prevention of fat overload syndrome.
Adult ; Education ; Emergency Service, Hospital ; Emulsions ; Fatty Acids, Essential ; Humans ; Parenteral Nutrition, Total ; Patients' Rooms ; Prescriptions* ; Triglycerides

PURPOSE: Intestinal failure (IF) is a complex clinical condition requiring a multi-disciplinary team approach. Our objective was to set up the treatment protocols and education documents for IF patients for development of intestinal rehabilitation programs in our hospital. METHODS: We compared the number of inpatients, length of hospital stay, mode of nutrition and calorie supply at discharge, and the frequency of blood transfusions before and after quality improvement of multidisciplinary activities, in order to evaluate the indirect effects of new protocols and training materials and for development of the intestinal rehabilitation system. RESULTS: We integrated eleven protocols for treatment and monitoring and seven educational materials for patients and caregivers. We compared indirect effects before and after the quality improvement activities. The number of IF patients hospitalized was reduced from 12 to 9. The mean days of hospital stay was decreased from 322 days to 73 days, the average number of monthly blood transfusions was also reduced from 1.8 to 0.3. In addition, the percentage of patients administered enteral nutrition and calories supplied was increased at discharge. CONCLUSION: By integrating IF protocols and education materials for IF patients, we found possible indirect effects of intestinal rehabilitation using a multidisciplinary team approach.
Blood Transfusion ; Caregivers ; Clinical Protocols ; Education ; Enteral Nutrition ; Humans ; Inpatients ; Length of Stay ; Quality Improvement* ; Rehabilitation*

PURPOSE: The effectiveness of enteral nutrition for patients with anastomotic leakage after gastric cancer surgery is controversial. The purpose of this study is to compare effectiveness between combined enteral nutrition with parenteral nutrition (EPN) and total parenteral nutrition (TPN). METHODS: Patients who underwent gastric cancer surgery for primary gastric cancer from April 2010 to August 2012 were reviewed. Clinicopathologic characteristics, complication, laboratory tests, and body weight (Bwt) were compared between EPN and PN. RESULTS: Among patients with postoperative leakage within postoperative 1 month (n=43), 13 patients were supported by EPN and 23 patients by TPN. Clinicopathologic characteristics, including preoperative Bwt, body mass index, nutritional status, other complications, and TNM stage were similar. Preoperative serum albumin and Bwt were similar between EPN and TPN. However, after 1 week of nutritional support, albumin at EPN was significantly higher than that of PN (3.52+/-0.3 and 3.25+/-0.3; P=0.010). Adjusted by preoperative Bwt, preoperative nutritional status, and difference in Bwt between preoperative and pre-nutritional support period, decrease of Bwt between pre-nutritional support and discharge was significantly less at EPN than at TPN (-4.5+/-5.4% and -6.3+/-4.1%; P=0.001). CONCLUSION: In terms of the maintenance of serum albumin and Bwt during nutritional support, EPN may be a better supportive option than TPN for patients with anastomotic leakage after gastric cancer surgery.
Anastomotic Leak* ; Body Mass Index ; Body Weight ; Enteral Nutrition ; Gastrectomy ; Humans ; Nutritional Status ; Nutritional Support ; Parenteral Nutrition* ; Parenteral Nutrition, Total ; Serum Albumin ; Stomach Neoplasms*

Impaired gastrointestinal (GI) motility is extremely common in the intensive care unit (ICU), affecting up to 50% of mechanically ventilated patients and up to 80% of patients with traumatic brain injury. This includes disturbances in esophageal, gastric, small intestinal, and colonic function; alone or in combination. Impaired upper GI motility can lead to reflux, aspiration, vomiting, high gastric residuals, and interruptions in enteral nutrition. In critically ill patients, prolonged constipation may cause delayed weaning from mechanical ventilation, lengthened ICU stay, and inability to take in enteral nutrition; at least one study has suggested an association between delayed defecation and both increased bacterial infections and mortality. Drugs used for analgesia and sedation are commonly associated with impaired gastric and small intestinal motility in critically ill patients. Drugs frequently impair gastric motility via one or more mechanisms, and the precise mechanisms of drug-induced hypomotility are often unknown. Therefore, measures to prevent drug-induced motility disturbances include correction of fluid and electrolyte imbalances, early enteral feeding, and judicious use of drugs known to alter motility. Prokinetic agents are currently the mainstay of therapy for impaired GI motility in the critically ill. Of the available prokinetic agents, current information, while limited, suggests that erythromycin or metoclopramide (alone or in combination) are effective in management of feeding intolerance for the critically ill in terms of evidence-based practice. Based on the current evidence evaluating the adverse effects of prokinetic agents in critical illnesses and the lack of prokinetic agents with a safer adverse effect profile, the ongoing need for prokinetic drugs in these patients should be reviewed daily in order to minimize avoidable adverse effects.
Analgesia ; Bacterial Infections ; Brain Injuries ; Colon ; Constipation ; Critical Illness* ; Defecation ; Enteral Nutrition ; Erythromycin ; Evidence-Based Practice ; Gastrointestinal Motility ; Humans ; Intensive Care Units ; Metoclopramide ; Mortality ; Respiration, Artificial ; Vomiting ; Weaning

No abstract available.

PURPOSE: Omega-3 fatty acid is known for immunonutrition in that it has anti-inflammatory properties and improves the patients' immune function. The objective of this study was to determine the effects of a fish oil-based lipid emulsion for adult patients undergoing allogeneic hematopoietic stem cell transplantation (HSCT). METHODS: This was a retrospective study of 90 adult allogeneic HSCT patients from July 2011 to June 2015. The patients were divided into two groups according to the lipid type provided; fish oil group (FO group, n=55) and non-fish oil group (NFO group, n=35). The demographics, parenteral nutrition and lipid emulsion duration, length of hospital stay (LOS), weight change, 30 day mortality, survival period, incidence of acute graft-versus-host disease (aGVHD), neutropenic fever, sepsis, and re-hospitalization were collected from the electronic medical records. RESULTS: The patients' characteristics including age, sex, body mass index, and underlying disease were similar in the two groups. The incidence of aGVHD and infectious complications, mortality, LOS, re-hospitalization were also similar. The FO group showed weight gains, whereas the NFO group showed weight loss (FO vs. NFO=0.34% vs. -1.08%, P=0.245). CONCLUSION: The clinical outcomes were similar in the two groups but there was a tendency for gain weight in the FO group. A large, well designed study, and a dosing study will also be needed to determine the optimal dose range for HSCT patients.
Adult ; Body Mass Index ; Demography ; Electronic Health Records ; Fatty Acids ; Fever ; Fish Oils ; Graft vs Host Disease ; Hematopoietic Stem Cell Transplantation* ; Hematopoietic Stem Cells* ; Humans ; Incidence ; Length of Stay ; Mortality ; Parenteral Nutrition* ; Retrospective Studies ; Sepsis ; Weight Gain ; Weight Loss

PURPOSE: In surgical procedures under general anesthesia, 6 to 8 hours of a nulla per os (NPO; nothing by mouth) has been regarded as essential for prevention of respiratory complication such as aspiration. However, recent studies have reported that oral intake of water and other clear fluids up to 2 hours before induction of anesthesia does not increase respiratory problems. The purpose of this pilot study is to investigate the safety and efficacy of a newly developed carbohydrate-rich solution in elective hernia repair surgery patients. METHODS: A group of 30 adult patients scheduled for elective surgeries under general anesthesia were enrolled. The enrolled study group of patients was permitted to drink a carbohydrate-rich solution until two hours before the operation without volume limitation. Respiratory complication was investigated in the patients using the carbohydrate-rich solution until two hours before induction of general anesthesia. The feelings of thirst, hunger sense were measured pre- and post-operatively. In addition, hoarseness of voice, nausea and vomiting were investigated post-operatively. Satisfaction regarding the short time of fasting was measured. Visual analogue scale (VAS) was used for measurement of these six variables. RESULTS: No patients showed serious respiratory complication such as dyspnea, desaturation. Eight of 30 study group patients complained of mild hoarseness. Most symptoms of hoarseness were mild, with VAS score less than 3 out of 10. Two patients complained 5 out of 10. Six patients felt nausea and 1 patient had vomiting. Pre/post-operative hunger sense and thirst feeling were 1.63/1.60 and 1.90/5.76, respectively. The satisfaction score was 3.00 out of 4. CONCLUSION: Allowing the administration of an oral carbohydrate-rich solution in elective surgery patients requiring general anesthesia is safe without serious respiratory complications and effective in providing satisfaction.
Adult* ; Anesthesia ; Anesthesia, General ; Dyspnea ; Fasting ; Herniorrhaphy ; Hoarseness ; Humans ; Hunger ; Nausea ; Pilot Projects* ; Thirst ; Vomiting ; Water

The restricted resources on healthcare highlights the importance of clinical and cost effectiveness. The social and economic costs of chronic diseases are increasing. Home total parenteral nutrition (home TPN) for the patients with intestinal failure is a life-sustaining therapy until intestinal transplantation. An economic evaluation of home TPN has not been conducted in Korea. Three types of economic evaluations for home TPN are cost benefit analysis, cost effectiveness analysis, and cost utility analysis. Korea's medical market is competitive due to the limited health care resources. A health care delivery system from hospital to home needs to be established under the supervision of professional Nutrition Support Team staff including the systematic policies and social recognition.
Chronic Disease ; Cost-Benefit Analysis ; Delivery of Health Care ; Humans ; Korea ; Organization and Administration ; Parenteral Nutrition, Home Total* ; Quality-Adjusted Life Years

Underweight and specific nutrient deficiencies are frequent in adult patients with inflammatory bowel disease (IBD). In addition, a significant number of children with IBD, particularly Crohn's disease (CD) have impaired linear growth. Nutritional support is important in patients with IBD and nutritional problems. Enteral nutrition (EN) can reduce CD activity and maintain remission in both adults and children. Given that the ultimate goal in the treatment of CD is mucosal healing, this advantage of EN over corticosteroid treatment is valuable in therapeutic decision-making. EN is indicated in active CD, in cases of steroid intolerance, in patient's refusal of steroids, in combination with steroids in undernourished individuals, and in patients with inflammatory stenosis of the small intestine. EN should be the first choice compared to total parenteral nutrition. However, EN does not have a primary therapeutic role in ulcerative colitis. In conclusion, it appears that the role of nutrition as supportive care in patients with IBD should not be underestimated. The aim of this comprehensive review is to provide the reader with an update on the role of nutritional support in IBD patients.
Adult ; Child ; Colitis, Ulcerative ; Constriction, Pathologic ; Crohn Disease ; Disulfiram ; Enteral Nutrition ; Humans ; Inflammatory Bowel Diseases* ; Intestine, Small ; Nutritional Support* ; Parenteral Nutrition, Total ; Steroids ; Thinness