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복와위 상태 중환자에서의 영양공급에 따른 임상적 예후 분석
이연주 ( Yeonju Lee ),김형숙 ( Hyung-sook Kim ),남궁형욱 ( Hyungwook Namgung ),이은숙 ( Eun Sook Lee ),김은경 ( Euni Lee ),조영재 ( Young-jae Cho ),이연주 ( Yeon Joo Lee ) 한국정맥경장영양학회 2018 한국정맥경장영양학회지 Vol.10 No.1
Purpose: Enteral nutrition is recommended in critically ill patients. On the other hand, the recommendation of nutritional support is limited and often controversial in critically ill patients in the prone position. Therefore, this study evaluated the clinical outcomes of nutritional support in critically ill patients in the prone position. Methods: A retrospective evaluation of the electronic medical records was conducted, including adult patients who were in the medical intensive care unit (ICU) in the prone position in Seoul National University Bundang Hospital from May 1, 2015 to June 30, 2017. The patients’ characteristics, nutritional support status while they were in the prone position, mortality in ICU and during hospitalization, ICU length of stay, mechanical ventilation days, and complications, such as ventilator associated pneumonia (VAP) and vomiting were collected. Results: In total, 100 patients were included. Of these, 12 received enteral nutrition and parenteral nutrition and 88 received only parenteral nutrition. The groups were similar in terms of age, sex, number of comorbidity, weight, PaO<sub>2</sub>/FiO<sub>2</sub>, hours of prone position, Simplified Acute Physiology Score II (SAPS II), Acute Physiologic and Chronic Health Evaluation II (APACHE II) score, and Sequential Organ Failure Assessment (SOFA) score. No differences were observed in ICU mortality (75.0% vs. 46.6%; P=0.065), hospital mortality (83.3% vs. 58.0%; P=0.081), ICU length of stay (22.2±14.6 vs. 18.2±21.2; P=0.128) and mechanical ventilation days (19.3±14.8 vs. 14.5±19.1; P=0.098). In addition, there were no differences in the possible complications of the prone position, such as VAP (8.3% vs. 4.5%; P=0.480) and vomiting (8.3% vs. 1.1%; P=0.227). Conclusion: No significant differences in the clinical outcomes were observed. Further studies will be needed to confirm the way of nutrition support while in the prone position.
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외과계 중환자에서의 초기 정맥영양공급의 현황 분석과 열량대단백비의 임상적 의의
허은정 ( Eun Jeong Heo ),박가영 ( Ka Young Park ),전수정 ( Su Jeong Jeon ),남궁형욱 ( Hyungwook Namgung ),이은숙 ( Eun Sook Lee ),송인애 ( In Ae Song ) 한국정맥경장영양학회 2015 한국정맥경장영양학회지 Vol.7 No.3
Purpose: Surgical critically ill patients require adequate nutrition support and the American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.) guidelines recommend low non-protein calorie: nitrogen ratio (NPC:N ratio, 70∼100) for critically ill pateints. In this study, we assess the current use of early parenteral nutrition of surgical critically ill patients and analyze the clinical significance of NPC:N. Methods: This is a retrospective study of critically ill adult patients who remained in the intensive care unit (ICU) for over 3 days and could not receive enteral nutrition for the first 7 days. Data on parenteral intake of patients were collected from electronic medical records. Association of NPC:N scores with clinical outcome (length of ICU stay, length; of hospital stay, duration of ventilation, and mortality) were analyzed using Pearson correlation and multiple regression. Results: The study included 72 cases, average parenteral calorie intake was 14.6 kcal/kg/day and protein intake was 0.5 g/kg/day. We assessed the NPC:N scores to determine the patients’ NPC:N for the first 7 days in ICU close to the A.S.P.E.N guidelines. NPC:N scores showed weak negative correlation with length of hospital stay and duration of mechanical ventilation (r=-0.259, P=0.028; r=-0.495, P=0.001). Multiple regression adjusted with APACHE (Acute Physiology and Chronic Health Evaluation) II score, age, and body mass index showed correlation of higher NPC:N score with decreased length of hospital stay and shorter duration of ventilation (P=0.0001, P=0.035, respectively). However, length of ICU stay and mortality within 60 days showed no significant correlation with NPC:N scores. Conclusion: Parenteral calories and protein intakes of critically ill patients in ICU were lower in comparison to A.S.P.E.N. recommendation in this study. Low NPC:N scores might be related to shorter length of hospital stay, duration of mechanical ventilation. Consultation of a nutritional support team could have a positive effect in providing appropriate nutrition support.
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크레아티닌 클리어런스 60ml/min 이상 성인 환자에서 Vancomycin 임상약동학 자문업무의 유용성 평가
편보아,이유진,남궁형욱,이정화,이은숙,신완균 한국병원약사회 2009 병원약사회지 Vol.26 No.3
Abstract: It is now well established that the bactericidal activity of vancomycin is not temporal-ly stationary. As a result, clinical pharmacokinetics consultation service(CPCS) become necessary for the maintenance of the trough concentration of vancomycin to minimize adverse effect while maximizing therapeutic effect. In particular, CPCS was essential in geriatric, pediatric patients or patients over moderate stage kidney disease patients with creatinine clearance(CLcr) < 60ml/min(by National Kidney Foundation standards) for successful vancomycin therapy. However, in previous studies, CPSS was claimed to be not clinically relevant in adult patients with CLcr ≥ 60ml/min. Therefore, the objective of the present study was to evaluate the merit of CPCS and the factor(s) influencing the results of CPCS in adult patients with CLcr ≥ 60ml/min. Accordingly, the patients, from 18 to 65 years of age, with calculated CLcr values above of 60ml/min by Cockroft-Gault equation received vancomycin CPCS between January and June 2008 in Seoul National University Bundang Hospital; The electronic medical records(EMRs) of the patients were retrospectively reviewed. The patients were first classified into the maintenance dose group, the increased dose group or the reduced dose group according to CPCS results. A number of factors, such as gender, age, body weight, CLcr, duration of therapy, indication, dosage, combination of nephrotoxic drugs and occurrence of adverse effects, were studied for the potential impact on the results of CPCS. Among 132 cases, 83 cases were categorized as the maintenance dose group, 30 cases as the increased dose group, and 19 cases as the reduced dose group; The rate of patients having the dose adjustment was 37.1%. A significant(44.7%) number of patients received medications that potentially affected renal function(e.g., diuretics, amino-glycosides, amphotericin B). Approximately 6.1% of the patients experienced adverse effects(e.g., renal failure and thrombocytopenia) related to vancomycin administration. Statistical analysis indicate that age and CLcr show statistical significance between the three groups, suggesting vancomycin dose adjustment is necessary in the younger patients and/or patients having higher CLcr. When vancomycin was empirically administered in adult patients under 65 years of age with CLcr ≥ 60ml/min, the therapeutic trough range was not achieved depending on the age and the renal function, suggesting that CPCS is vital in the dose adjustment for the drug in the patient group.
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