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PhilSPEN Online Journal of Parenteral and Enteral Nutrition

(Article 143 | POJ_0135 | 2019-2020)

Original Clinical Investigation

Surgical Management, the experience at University of the East from 2016-2018

Abstract | Introduction | Methodology | Results | Discussion | Conclusion | References | Back to Total Name and Codes page2

Submitted: | Posted:

Authors:

Deo del Rosario MD, PCS, PSGS; Surgery Consultant, University of the East; Clinical Nutrition Specialist, St. Luke's Medical Center

Institution where research was conducted:

Intensive Care Unit, University of the East

 

ABSTRACT: | Back

Background:

Surgical selected patients admitted in the ICU in UERM (University of the East Medical Center) from years 2016-2018 were observed from day 4 onward and were either discharged or expired. The puropose of the study is to find out if the BMI of these patients were still within normal or depressed and also to find out if they will last their stay in the ICU or expired.

Objective:

The study aims to find out if patients especially of ages above 50 will stll be able to be discharged or go into expiration and also to find out if there will still be a good change of being discharged out of the ICU.

Methodology:

A total of 125 patients were collected and their data analyzed from age, BMI, diagnosis and hospital stay. The minimum days collected were from 4 days to the maximum days of 107 days. There were 16 patients who died (16/125) or 12.8% while in the ICU. 102 patients were 50-60 years above for a total of 68.9% of patients and 98 patients were 60 years old and above for a total of 66.2%. Essentially most of the patients were elderly from 50 years old and above (68.9%).

Results:

A major group of patients comprised the underweight status of 36.3% patients while the most number of patients comprised 50.4%. These patients had different modes of illness when admitted to the ICU (intensive care unit). The sex difference was at (Male : Female) 1.7:1 and the average stay in the ICU was 23 days (minimum of 4 days to a miximum of 107 days). Indicated here are the numbers who remained alive (109/125) and those who expired (16/125).

These are the Body Mass Index of these group of patients:

Nutritional Status
Percentage
Underweight
36.3%
Normal
50.4%
Overweight
8.2%
Obese
4.9%

General description of patients who were admitted:

Ages
Total N=125
BMI Died (n=18) Alive (n=109)
Average Hospital Stay
17-25 years old
6

15 to 20.3

0
6
17.65 days (2d)
26-38 years old
9
12.8 to 32.3
2
7
18.65 days (12d)
39-51 years old
24
14.34 to 43
2
22
21.09 days (20d)
52-64 years old
39
12.49 to 33.5
4
35
19.83 days (37d)
65-77 years old
21
12.7 to 35.5
6
15
20.42 days (24d)
78-90 years old
18
12.2 to 38
2
16
21.92 days (20d)
91-94 years old
8
19.5 to 25
0
8
22.42 days (7d)

It will be noted that a large portion of the patients were able to be dischaged from the ICU (108/125) or 86.4%.

Conclusion:

Out of the total of 125 patients, 86.4% were discharged alive, 12.8% (16/125) of patients died while in the ICU with a total underweight population of 36.3%.

 

KEYWORDS: Body mass index, admission dates, age during admission while in the ICU (intensive care units)

 

INTRODUCTION | Back

The Body Mass Index (BMI) is a very good and descriptive way of identifying patients with malnutrition/overnutrition who are admitted in the ICU (intensive care unit). With these data (BMI) we can immediately see if the patient can withstand the stay within a short period of time (4 days) or a prolonged one (107 days). We can immediately say that a major group of patients were in the underweight category or 36.3%.

Definitely well patients can have a shorter stay (with a body mass index of 18 and 29) and the patient with poor health will have a longer period of stay in the ICU (at less than 18 BMI) with the degree of malnutrition taking its toll of these patients. Thus patients with severe stresses (as in severe malnutrition ssues) will have a longer stay in the ICU or their reserves can last only for short periods of life due to greater stresses and short period of stay (thus shorter period of life). So in essence better nutrition seems to be better supportive of a better life leading to an easing and recovery from the ICU stint. Thus we can see here that there were more patients who were discharged from the ICU alive at 93.15% versus 6.85% deaths which may be an indicator of a good nutritional set up of this particular ICU.


METHODOLOGY | Back

There were more males than females in these cases (males 1.7 versus females 1). Most of the cases were more than 50 years old and above (72.8%) and the less than 40 years comprise only 28% of cases. There were several causes of illness thus making these ones a challenge to the residents. The stay of the patients was longer for those from ages 39 years old up to the 90 year old, which ranges from 8 to 35 days in total duration. Basically the total number of days was from 17 days to the maximum of 21 days and BMI ranges from 12.2 to 43, which tells us that patients have different states of nutrition.

 

RESULTS | Back

These are the Body Mass Index of the patients who were admitted in the ICU:

Nutritional Status
Percentage
Underweight
36.3%
Normal
50.4%
Overweight
8.2%
Obese
4.9%

A total of 109 patients were able to withstand the ICU stay except for the 16 who expired. The 109 patients who recovered are due to the quality of care given in this institution (Alive = 86%)

Ages
Total N=125
BMI

Discharged alive (n=109)

Died during stay in the ICU (n=18)
Average Hospital Stay
17-25 years old
6

15 to 20.3

6
0
17.65 days (2d)
26-38 years old
9
12.8 to 32.3
7
2
18.65 days (12d)
39-51 years old
24
14.34 to 43
22
2
21.09 days (20d)
52-64 years old
39
12.49 to 33.5
35
4
19.83 days (37d)
65-77 years old
21
12.7 to 35.5
15
6
20.42 days (24d)
78-90 years old
18
12.2 to 38
16
2
21.92 days (20d)
91-94 years old
8
19.5 to 25
8
0
22.42 days (7d)

Of the 16 patients who expired in the ICU, one was a 26 year old who had a multitude of illness primarily from malnutrition (sacral ulcer grade 2), pulmonary TB, diabetes, hypertension and COPD. Three patients in their 50's and 60's had problems of sepsis, electrolyte imbalance and the rest, all in their 60's and above had different modes of cancer which are considered terminal.

These are the patients who expired:

Age
Diagnosis
BMI

Admission duration

Outcome
26
Sacral ulcer grade II; AF; PTB; DM; hypertension; CKD; COPD
16.5
43
Expired
31
CAP; SepsisĀ 
17.7
9
Expired
48
Electrolyte Imbalance; Status post EGD with PEG insertion under TIVA; Hypertension
24.9
17
Expired
50
Gastric AdenoCA
22.18
39
Expired
53
L Frontoparietal Lobe parasagittal mass t/c high grade glioma r/o Mets
33.5
-
DAMA
56
S/P Open Cholecystectomy; T-tube insertion
19.5
14
Expired
60
Painless jaundice sec to HCC or malignancy
14.63
11
Expired
63
Rectosigmoid Mass T/c Consider Malignancy R/o Metastasis; T/c Pulmonary Metastasis Hypokalemia sec to dec intake; Chronic Hyponatremia sec to SIADH; Hypoalbuminemia sec to Malnutrition
15
13
Expired
65
Upper GI obstruction sec to external compression
16.9
24
Expired
66
Dislocated Left Hip Prosthesis; Supero-lateralĀ 
18
47
Expired
67
CAP-MR, MDR risk / COPDIAE
22
55
Expired
71
RF sec to unsecured airway sec to seizure; NSTEMI; Shock sec to Acute CUTI vs CAP MR vs Cardiogenic Shock; AKI sec to Infection vs CRS on top prob CKD sec to HNS
15.47
48
Expired
76
B Cell Lymphoma
20.6
32
Expired
77
Breast CA Stage IV; HAP Resolved
-
30
Expired
79
Left Temporo-parietal mass
16
60
DAMA
84
Bronchiectasis in exacerbation, PTB; emphysema; S/P tracheostomy
21
28
Expired

 

DISCUSSION: | Back

The underweight group was at 36.36% while the normal group was at 50.4%. Starting from age 38 and onwards the number of patients who are alive amounted to 22 which reached 35 in number which is the highest in terms of living while in the ICU. This then started to get less at 15 and 16 from ages 65 to 90 and lowest in terms of living at age 97, the highest age possible in this state.

Overall the capacity of patients to undergo these different stresses are mainly due to their whole being and nutritional capacity. One can help but notice that most of those who succumbed to death are basically at the lower state of their BMI which ranged from 14 to 21. The greatest number of patients who were not able to survive are those in the 52 to 77 age category (4 and 6 patients). Therefore the number of patients who were led alive are quiet large - 86%. In essence there are two areas which can be deduced from these states: BMI which essentially is the nature of the wellness and quality of care which if not available would lead to more problems and more deaths in the patients.


CONCLUSION: | Back

The quality of life is very much dependent on two areas - abilty of the patient to respond well to nutrition and nature of the disease process to adapt to changes especially in quality care - in this case the majority of underweight patients at 36.3% and with the normal cases at 50.4%.

 

REFERENCES: | Back

  1. Llido LO, Sioson M, Inciong JF, and Manuales G. Nutrition team supervision on nutrient intake in critical care patients: report of a ten year experience in the Philippines (years 2000 to 2011). Philippine Online Journal of Parenteral and Enteral Nutrition. Article 2; POJ-0007; Jan 2010-2012: 9-16 pages.
  2. Llido LO, Parenteral nutrition practice from years 1994 to 1996 in St. Luke's Medical Center. A locel study - unpublished (1997).
  3. Llido LO. Nutrition support team: impact on parenteral nutrition implementation practice, 2004. Local study - unpublished (2004)
  4. Igasan K MD, Turalba G MD, Calamba PJ MD, Sy M MD, Cajayon JT RND and Navarette B RND. Clinical nutrition service program - report from a nutrition team in a private tertiary care hospital in the Philippines from January to August 2017. Philippine Journal of Parenteral and Enteral Nutrition. Art _; 2016-17: _ pages.
  5. Clinical Nutrition Service Report: parenteral nutrition utilization in SLMC, QC from May 2016 to June 2017. Philippine Online Journal of Parenteral and Enteral Nutrition. Art _; POJ_0133; _2018-19: _ pages.
  6. Calamba PJ MD and Llido LO MD. Critical care nutrition update: does the nutrition team still achieve adequate intake? Philippines Online Abstract of Parenteral and Enteral Nutrition. Abstract ID (81). PENSA 2017 Congress.
  7. Elke et al. Clinical outcome of critically ill septic patients: secondary analysis of a large international nutrition database: analysis of daily intake within one week. Critical Care 2014; 18: R29.
  8. Wischmeyer et al. A randomized trial of supplemental parenteral nutrition in underweight and overweight critically ill patients: the TOP-UP pilot trial. Critical Care 2017; 21: 142 pages.
  9. The Unrisk Study Group, Philippine Society of Parenteral and Enteral Nutrition. The Undernutrition Risk and Underfeeding Status among in-patients and out-patients n hospital in the Philippines ("The Unrisk Study"), Art 28; POJ_0022; Issue Jan 2016 - June 2016: 121-133 pages.

 

Abstract | Introduction | Methodology | Results | Discussion | References | Back to Total Name and Codes page2