중환자에서 영양상태 평가지표로서의 골격근량 측정 : 골격근량 측정의 유용성을 중심으로
Measurement of Muscle Mass as a Nutritional Assessment Tool in Critically Ill Patients
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Malnutrition in critically ill patients is common and causes negative clinical outcome. A valid nutrition assessment is essential and facilitates optimal nutrition support for patients. However, the application of traditional nutrition assessment tools is inappropriate in critically ill patients who have acute phase response characteristics. Therefore, the purpose of this study is to identify the clinical effectiveness of skeletal muscle measurement in critically ill patients as a nutrition assessment tool. The data were collected from adult patients who stayed in a medical intensive care unit (MICU) of Seoul National University Bundang Hospital (SNUBH) from August 25th to October 13th, 2011. Muscle mass, mid-arm muscle circumference (MAMC) and mid-arm muscle area (MAMA) as muscle mass were calculated by a math formula that was expressed midarm circumference and skinfold thickness which were prospectively measured on the right arm. As traditional nutrition assessment tools, the percent of ideal body weight (PIBW), serum albumin level, total lymphocyte count (TLC), and SNUBH-nutrition screening index (NSI) were collected. As a result, in the initially measured group (n=57), a significant correlation was observed between PIBW and MAMC, MAMA. However, there were no correlations among other traditional assessment tools. In the re-measured group (n=25), whose nutritional status was reassessed after a week, weak correlation was observed between the change of weight and MAMC, MAMA. We concluded that PIBW is related with the skeletal muscle mass in critically ill patients. However, we did not identify the availability of MAMC, MAMA as a valid nutrition assessment tool. Further studies with larger sample size would be necessary to perform.
Abstract
Malnutrition in critically ill patients is common and causes negative clinical outcome. A valid nutrition assessment is essential and facilitates optimal nutrition support for patients. However, the application of traditional nutrition assessment tools is inappropriate in critically ill patients who have acute phase response characteristics. Therefore, the purpose of this study is to identify the clinical effectiveness of skeletal muscle measurement in critically ill patients as a nutrition assessment tool. The data were collected from adult patients who stayed in a medical intensive care unit (MICU) of Seoul National University Bundang Hospital (SNUBH) from August 25th to October 13th, 2011. Muscle mass, mid-arm muscle circumference (MAMC) and mid-arm muscle area (MAMA) as muscle mass were calculated by a math formula that was expressed midarm circumference and skinfold thickness which were prospectively measured on the right arm. As traditional nutrition assessment tools, the percent of ideal body weight (PIBW), serum albumin level, total lymphocyte count (TLC), and SNUBH-nutrition screening index (NSI) were collected. As a result, in the initially measured group (n=57), a significant correlation was observed between PIBW and MAMC, MAMA. However, there were no correlations among other traditional assessment tools. In the re-measured group (n=25), whose nutritional status was reassessed after a week, weak correlation was observed between the change of weight and MAMC, MAMA. We concluded that PIBW is related with the skeletal muscle mass in critically ill patients. However, we did not identify the availability of MAMC, MAMA as a valid nutrition assessment tool. Further studies with larger sample size would be necessary to perform.
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