중독 중환자에서의 초기 영양상태평가와 예후와의 관계
Assessment of early nutritional state in critical patients with intoxication and the effect of nutritional status on prognosis
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Purpose: Nutritional status and support in critically ill patients are important factors in determining patient recovery and prognosis. The aim of this study was to analyze the early nutritional status and the methods of nutritional support in critically ill patients with acute poisoning and to evaluate the effect of nutritional status on prognosis. Methods: A retrospective study was conducted in tertiary care teaching hospital from January 2018 to December 2020. in an emergency department of university hospital, 220 patients who were stayed more than 2 days of poisoning in intensive care unit were enrolled. Results: 155 (70.5%) of patients with acute poisoning had low-risk in nutritional risk screening (NRS). Patients with malignancy had higher NRS (low risk 5.2%, moderate risk 18.5%, high risk 13.2%, p=0.024). Patients of 91.4% supplied nutrition via oral route or enteral route. Parenteral route for starting method of nutritional support were higher in patients with acute poisoning of herbicide or pesticide (medicine 3.2%, herbicide 13.8%, pesticide 22.2%, p=0.000). In multivariate logistic regression analysis, herbicide or pesticide intoxication, higher risk in NRS and sequential organ failure assessment over 4.5 were affecting factor on poor recovery at discharge. Conclusion: NRS in patients intoxicated with herbicide or pesticide were higher than that in patients intoxicated with medicine intoxication. Enteral nutrition in patients intoxicated with herbicide or pesticide was less common. Initial NRS was correlated with recovery at discharge in patient with intoxication. It is expected to be helpful in finding patients with high-risk nutritional status in acute poisoning patients and establishing a treatment plan that can actively implement nutritional support.
Abstract
Purpose: Nutritional status and support in critically ill patients are important factors in determining patient recovery and prognosis. The aim of this study was to analyze the early nutritional status and the methods of nutritional support in critically ill patients with acute poisoning and to evaluate the effect of nutritional status on prognosis. Methods: A retrospective study was conducted in tertiary care teaching hospital from January 2018 to December 2020. in an emergency department of university hospital, 220 patients who were stayed more than 2 days of poisoning in intensive care unit were enrolled. Results: 155 (70.5%) of patients with acute poisoning had low-risk in nutritional risk screening (NRS). Patients with malignancy had higher NRS (low risk 5.2%, moderate risk 18.5%, high risk 13.2%, p=0.024). Patients of 91.4% supplied nutrition via oral route or enteral route. Parenteral route for starting method of nutritional support were higher in patients with acute poisoning of herbicide or pesticide (medicine 3.2%, herbicide 13.8%, pesticide 22.2%, p=0.000). In multivariate logistic regression analysis, herbicide or pesticide intoxication, higher risk in NRS and sequential organ failure assessment over 4.5 were affecting factor on poor recovery at discharge. Conclusion: NRS in patients intoxicated with herbicide or pesticide were higher than that in patients intoxicated with medicine intoxication. Enteral nutrition in patients intoxicated with herbicide or pesticide was less common. Initial NRS was correlated with recovery at discharge in patient with intoxication. It is expected to be helpful in finding patients with high-risk nutritional status in acute poisoning patients and establishing a treatment plan that can actively implement nutritional support.
참고문헌 (29)
- McClave SA, "Guidelines for the Provision and Assessment of Nutrition Support Therapy in the Adult Critically Ill Patient: Society of Critical Care Medicine (SCCM) and American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.)", JPEN J Parenter Enteral Nutr, 40, pp.159~211 (2016)
- Singer P, "ESPEN guideline on clinical nutrition in the intensive care unit", Clin Nutr, 38, pp.48~79 (2019)
- Reintam BA, "Early enteral nutrition in critically ill patients : ESICM clinical practice guidelines", Intensive Care Med, 43, pp.380~398 (2017)
- Wleklik M, "The Role of Nutritional Status in Elderly Patients with Heart Failure", J Nutr Health Aging, 22, pp.581~588 (2018)
- Kishimoto H, "Nutritional improvement is associated with better functional outcome in stroke rehabilitation:A cross-sectional study using controlling nutritional status", J Rehabil Med, 52, pp.jrm00029~ (2020)
- Vranesic BD, "Nutritional issues and considerations in the elderly : an update", Croat Med J, 61, pp.180~183 (2020)
- Alvaro Sanz E, "Nutritional risk and malnutrition rates at diagnosis of cancer in patients treated in outpatient settings : Early intervention protocol", Nutrition, 57, pp.148~153 (2019)
- Ko Y, "Emergency department visits due to pesticide poisoning in South Korea, 2006-2009", Clin Toxicol (Phila), 50, pp.114~119 (2012)
- Sung AJ, "Multicenter Survey of Intoxication Cases in Korean Emergency Departments: 2nd Annual Report, 2009", J Korean Soc Clin Toxicol, 10, pp.22~32 (2012)
- Association AP, "Diagnostic and statistical manual of mental disorders (DSM-5®)" (2013), American Psychiatric Pub
- Zhang Y, "Acute poisoning in Shenyang, China: a retrospective and descriptive study from 2012 to 2016", BMJ Open, 8, pp.e021881~ (2016)
- Connors NJ, "Tintinalli’s Emergency Medicine A Comprehensive Study Guide", pp.1296~1300 (2020), McGraw Hill
- Greene S, "Tintinalli’s Emergency Medicine A Comprehensive Study Guide", pp.1300~1309 (2020), McGraw Hill
- Kondrup J, "ESPEN guidelines for nutrition screening 2002", Clin Nutr, 22, pp.415~421 (2003)
- Jung YH, "The association of body mass index with outcomes and targeted temperature management practice in cardiac arrest survivors", Am J Emerg Med, 35, pp.268~273 (2017)
- Chandra RK, "Nutritional status and immune responses", Clin Lab Med, 13, pp.455~461 (1993)
- Kim BK, "Characteristics of elderly patients with acute poisoning", J Korean Soc Clin Toxicol, 8, pp.61~68 (2010)
- Kim K, "A nationwide study of patients hospitalised for poisoning in Korea based on Korea National Hospital Discharge In-Depth Injury Survey data from 2005 to 2009", BMJ Open, 5, pp.e008823~ (2015)
- Seungho Ham, "Epidemiology and regional differences of acute poisonings of eight cities in Gyeonggi-do province in Korea using data from the National Emergency Department Information System of Korea", Clinical and Experimental Emergency Medicine, 7(1), pp.43~51 (2020), 대한응급의학회[DOI]
- McMillan DC, "Systemic inflammation, nutritional status and survival in patients with cancer", Curr Opin Clin Nutr Metab Care, 12, pp.223~226 (2009)
- Sertaridou E, "Gut failure in critical care : old school versus new school", Ann Gastroenterol, 28, pp.309~322 (2015)
- 박종욱, "Assessment and Methods of Nutritional Support during Atropinization in Organophosphate and Carbamate Poisoning Cases", 대한임상독성학회지, 18(2), pp.123~129 (2020), 대한임상독성학회[DOI]
- Moses V, "Early hypocaloric enteral nutritional supplementation in acute organophosphate poisoning--a prospective randomized trial", Clin Toxicol(Phila), 47, pp.419~424 (2009)
- "Zhonghua Yi Xue Za Zhi", 2019, 442~446
- Wolf JH, "Preoperative Nutritional Status Predicts Major Morbidity After Primary Rectal Cancer Resection", J Surg Res, 255, pp.325~331 (2020)
- Schmidt SB, "Nutritional situation of enterally fed patients in neurological early rehabilitation and impact of nutritional status on functional outcome", Clin Nutr, 39, pp.425~432 (2020)
- Alwarawrah Y, "Changes in Nutritional Status Impact Immune Cell Metabolism and Function", Front Immunol, 9, pp.1055~ (2018)
- Das UN, "Nutritional factors in the prevention and management of coronary artery disease and heart failure", Nutrition, 31, pp.283~291 (2015)
- Study in Osaka, Japan), "Am J Cardiol", 2018, 156~161