Evaluation of Vancomycin TDM Strategies: Prediction and Prevention of Kidney Injuries Based on Vancomycin TDM Results

The current guidelines for therapeutic drug monitoring (TDM) of vancomycin suggest a target 24-hour area under the curve (AUC 0-24 ) of 400 to 600 mg*h/L for serious methicillinresistant Staphylococcus aureus infections. In this study, the predictabilities of acute kidney injury (AKI) of various TDM target parameters, target levels, and sampling methods were evaluated in patients who underwent TDM from January 2020 to December 2020. The AUC 0-24 and trough values were calculated by both one- and two-point sampling methods, and were evaluated for the predictability of AKI. Among the AUC 0-24 cutoff comparisons, the threshold value of 500 mg*h/L in the two sampling methods was statistically significant (P = 0.042) when evaluated for the predictability of AKI. Analysis by an receiver operating characteristic curve estimated an AUC 0-24 cutoff value of 563.45 mg*h/L as a predictor of AKI, and was proposed as the upper limit of TDM target.

A comparison of serum lipid concentration by drinking habits based on the 7th Korea National Health and Nutrition Examination Survey (KNHANES VII) : a cross-sectional study / 대한지역사회영양학회지

Objectives@# This study compared serum lipid concentration according to drinking habits. @*Methods@# We analyzed data from the 7th Korea National Health and Nutrition Examination Survey (KNHANES VII). The study included 8,525 adults (3,651 males and 4,874 females), aged 30 – 59 years. @*Results@# There were differences in age, gender, education level, smoking status, physical activity, and waist circumference between drinkers and abstainers. The serum low-density lipoprotein-cholesterol (LDL-C) level of the drinkers was lower than those of the abstainers (P < 0.05). The serum triglyceride (TG) and high-density lipoprotein-cholesterol (HDL-C) concentrations were highest in the group that consumed alcohol ‘more than twice a week’ relative to the other groups (P < 0.001). The LDL-C and atherogenic index (AI) levels were lowest in the ‘more than twice a week’ drinking group compared to the other groups (P < 0.001). The serum TG and HDL-C concentrations were the highest in the ‘7 glasses/ time’ group (P < 0.001). The serum LDL-C concentration was the lowest in the ‘7 glasses/ time’ group (P < 0.001). Notably, the higher the frequency of binge drinking (7 glasses or more), the higher the concentration of TG (P < 0.001). The serum HDL-C concentration was significantly higher in the ‘no binge’ and ‘more than once a week’ groups compared to the other groups (P < 0.001). The serum LDL-C concentration and AI score were the lowest in the ‘more than once a week’ group (P < 0.001). @*Conclusions@# As the quantity and frequency of drinking increased, the serum TC concentration increased. Moreover, an increase in the serum HDL-C concentration led to a decrease in AI. The factors exacerbating cardiovascular disease increased simultaneously due to drinking. Our results suggest that for individuals with hypertriglyceridemia and patients with low HDL-cholesterolemia, separate guidelines based on the quantity and frequency of alcohol consumption are warranted.

Core Elements for Implementing Antimicrobial Stewardship Programs in Korean General Hospitals

Currently, antimicrobial resistance (AMR) is a major threat to global public health. The antimicrobial stewardship program (ASP) has been proposed as an important approach to overcome this crisis. ASP supports the optimal use of antimicrobials, including appropriate dosing decisions, administration duration, and administration routes. In Korea, efforts are being made to overcome AMR using ASPs as a national policy. The current study aimed to develop core elements of ASP that could be introduced in domestic medical facilities. A Delphi survey was conducted twice to select the core elements through expert consensus.The core elements for implementing the ASP included (1) leadership commitment, (2) operating system, (3) action, (4) tracking, (5) reporting, and (6) education. To ensure these core elements are present at medical facilities, multiple departments must collaborate as teams for ASP operations. Establishing a reimbursement system and a workforce for ASPs are prerequisites for implementing ASPs. To ensure that ASP core elements are actively implemented in medical facilities, it is necessary to provide financial support for ASPs in medical facilities, nurture the healthcare workforce in performing ASPs, apply the core elements to healthcare accreditation, and provide incentives to medical facilities by quality evaluation criteria.

Development of the Korean Standardized Antimicrobial Administration Ratio as a Tool for Benchmarking Antimicrobial Use in Each Hospital

Background@#The Korea National Antimicrobial Use Analysis System (KONAS), a benchmarking system for antimicrobial use in hospitals, provides Korean Standardized Antimicrobial Administration Ratio (K-SAAR) for benchmarking. This article describes K-SAAR predictive models to enhance the understanding of K-SAAR, an important benchmarking strategy for antimicrobial usage in KONAS. @*Methods@#We obtained medical insurance claims data for all hospitalized patients aged ≥ 28 days in all secondary and tertiary care hospitals in South Korea (n = 347) from January 2019 to December 2019 from the Health Insurance Review & Assessment Service. Modeling was performed to derive a prediction value for antimicrobial use in each institution, which corresponded to the denominator value for calculating K-SAAR. The prediction values of antimicrobial use were modeled separately for each category, for all inpatients and adult patients (aged ≥ 15 years), using stepwise negative binomial regression. @*Results@#The final models for each antimicrobial category were adjusted for different significant risk factors. In the K-SAAR models of all aged patients as well as adult patients, most antimicrobial categories included the number of hospital beds and the number of operations as significant factors, while some antimicrobial categories included mean age for inpatients, hospital type, and the number of patients transferred from other hospitals as significant factors. @*Conclusion@#We developed a model to predict antimicrobial use rates in Korean hospitals, and the model was used as the denominator of the K-SAAR.

Pattern of Using Nutrition Supplements and Nutrition Quotient of Adults Who Practice Strength Exercise Regularly

This study compared the pattern of purchasing nutritional supplements and obtaining nutrition information and the Nutrition Quotient of adults who exercise regularly according to the frequency of muscle training (LM, muscle training less than two days/week; MM, 2∼3 days/week; HM, more than three days/week). Compared to the other groups, significantly more men in the HM group answered that they had purchased supplements and would repurchase them. They presented “increasing muscle mass” as the purpose of buying them and “types and contents” as the major factor to consider before buying. The supplements that significantly more subjects in the HM group purchased than in the other groups were protein supplements, BCAA (Branched-chain amino acid), arginine, and caffeine supplements for men and protein supplements, BCAA and carnitine for women. Compared to the other groups, significantly more men and women in the HM group reported “trainer” as the major source of nutrition information, and significantly more men in the HM group reported “increasing muscle mass” as the 1st topic of nutrition education that they wanted to receive and were satisfied with the information that they obtained. Most of all, males and females in the HM group had significantly a higher Nutrition Quotient than in the other groups. The differences between males and females in variables regarding exercise, the patterns of using supplements and acquiring nutrition information, and Nutrition Quotient were also found. These results can provide basic data for developing educational materials emphasizing the wise consumption of nutrition information, including supplement intake.

Food Behavior Using the Nutrition Quotient and Vegetable Preferences of Elementary School Students in the Metropolitan Area

The purpose of this survey was to investigate the food behavior and vegetable preferences of elementary school students in the metropolitan areas of, South Korea. Five hundred and eighty students (277 male and 303 female) studying in grades 5∼6 participated in the survey. We assessed food behavior by evauating the Nutrition Quotient (NQ). Through a questionnaire, which consisted of 20 food behavior checklist items. These items were grouped under five factors: balance, diversity, moderation, practice and environment. All data were analyzed using SPSS 25.0. The average NQ score weighted using the five factors was 61.32 points. Among the five factors, moderation showed the lowest score, whereas environment showed the highest score. The average score of the vegetable preference was 3.36 points out of a total of 5 points. The vegetable preference was found to be highest for bean sprouts and followed by tomatoes, lettuce, spinach, Chinese cabbage, sesame leaf, pumpkin, carrot, radish, chives, lotus roots, onions, broccoli, sweet peppers, and eggplant. The results of vegetable preferences by NQ grade were 4.13±0.63 points for the high grade, 3.68±0.75 points for the medium-high grade, 3.41±0.82 points for the medium-low grade, and 2.94±0.78 points for the low grade. There was a significant positive correlation between NQ and vegetable preferences (r=0.477, P＜0.001). If vegetables with high preference are frequently provided in school meals, it might contribute to improving overall food behavior.

Guidelines on Implementing Antimicrobial Stewardship Programs in Korea

These guidelines were developed as a part of the 2021 Academic R&D Service Project of the Korea Disease Control and Prevention Agency in response to requests from healthcare professionals in clinical practice for guidance on developing antimicrobial stewardship programs (ASPs). These guidelines were developed by means of a systematic literature review and a summary of recent literature, in which evidence-based intervention methods were used to address key questions about the appropriate use of antimicrobial agents and ASP expansion. These guidelines also provide evidence of the effectiveness of ASPs and describe intervention methods applicable in Korea.

Food Behavior Using the Nutrition Quotient and Vegetable Preferences of Elementary School Students in the Metropolitan Area

The purpose of this survey was to investigate the food behavior and vegetable preferences of elementary school students in the metropolitan areas of, South Korea. Five hundred and eighty students (277 male and 303 female) studying in grades 5∼6 participated in the survey. We assessed food behavior by evauating the Nutrition Quotient (NQ). Through a questionnaire, which consisted of 20 food behavior checklist items. These items were grouped under five factors: balance, diversity, moderation, practice and environment. All data were analyzed using SPSS 25.0. The average NQ score weighted using the five factors was 61.32 points. Among the five factors, moderation showed the lowest score, whereas environment showed the highest score. The average score of the vegetable preference was 3.36 points out of a total of 5 points. The vegetable preference was found to be highest for bean sprouts and followed by tomatoes, lettuce, spinach, Chinese cabbage, sesame leaf, pumpkin, carrot, radish, chives, lotus roots, onions, broccoli, sweet peppers, and eggplant. The results of vegetable preferences by NQ grade were 4.13±0.63 points for the high grade, 3.68±0.75 points for the medium-high grade, 3.41±0.82 points for the medium-low grade, and 2.94±0.78 points for the low grade. There was a significant positive correlation between NQ and vegetable preferences (r=0.477, P＜0.001). If vegetables with high preference are frequently provided in school meals, it might contribute to improving overall food behavior.

Guidelines on Implementing Antimicrobial Stewardship Programs in Korea

These guidelines were developed as a part of the 2021 Academic R&D Service Project of the Korea Disease Control and Prevention Agency in response to requests from healthcare professionals in clinical practice for guidance on developing antimicrobial stewardship programs (ASPs). These guidelines were developed by means of a systematic literature review and a summary of recent literature, in which evidence-based intervention methods were used to address key questions about the appropriate use of antimicrobial agents and ASP expansion. These guidelines also provide evidence of the effectiveness of ASPs and describe intervention methods applicable in Korea.

Comparison of Nutrient Intake between Hypercholesterolemic and Normal groups based on the 6th Korea National Health and Nutrition Examination Survey / 대한지역사회영양학회지

Objectives@#This study was conducted to compare the nutrient intake of normal healthy adults with those having hypercholesterolemia. @*Methods@#We analyzed data from the 6th Korea National Health and Nutrition Examination Survey (KNHANES VI). A total of 12,636 adults (5,223 males and 7,413 females) aged 19 or older were included in the study. @*Results@#Males with hypercholesterolemia were older and had a higher waist circumference, body mass index, fasting blood sugar levels (FBS) and serum triglyceride (TG) concentrations compared to the normal group. Females with hypercholesterolemia were older and had higher FBS levels and serum TG concentrations compared to the normal group. While comparing nutrient intake by the 24-hour recall method, the male normal group showed a higher intake of fat, saturated fatty acid (SFA), monounsaturated fatty acid (MUFA), vitamin A and thiamin compared to the hypercholesterolemic group. However, the male normal group had a lower intake of iron and vitamin C compared to the hypercholesterolemic group. The female normal group had a higher intake of energy, protein, fat, SFA, MUFA, polyunsaturated fatty acids, cholesterol, riboflavin, and niacin compared to the hypercholesterolemic group, but had a lower intake of iron compared to the hypercholesterolemic group. A comparison of nutrient intake by food frequency questionnaire (FFQ) showed the following: There was no significant difference in nutrient intake between the normal men and women and those with hypercholesterolemia. After adjustment for confounding factors, nutrient intake by FFQ of the male normal group showed higher levels of n-3 fatty acid and vitamin C compared to the group with hypercholesterolemia. However, there was no significant difference in nutrient intake between the two groups of women. @*Conclusions@#The average intake of n-3 fatty acids and vitamin C of the male group with hypercholesterolemia was lower than that of the normal group. However, since KNHANES is a cross-sectional study, prospective cohort studies are required to analyze the risk factors of hypercholesterolemia.

Recognition of Endocrine-Disrupting Chemicals and Behavior to ReduceExposure to Endocrine-Disrupting Chemicals in Cooking Staff Working atChild Care Center Located in Gyeonggi Province

Endocrine-disrupting chemicals (EDCs) are chemicals present in the environment that interfere with the normalhormone functions of various organisms and cause genetopathy, deformities, or cancer. This study surveyedthe awareness of EDCs with 242 cooking staff at 242 meal service facilities for children located in apart of Gyeonggi Province. To minimize infants’ exposure to EDCs, the subjects were provided with informationon EDCs for two months. The behavior of reducing exposure to EDCs was analyzed according tothe awareness of EDCs and work ethics. In addition, the effects before and after being provided with the informationwere evaluated. According to the results, the levels of awareness of EDCs and work ethics’ scoresof the cooking staff were high with 3.95 and 4.39 points, respectively, out of five points. In addition, a higherawareness of EDCs and a higher work ethics’ score were associated with an improved behavior of reducingexposure to EDCs (P＜0.05). The overall cooking and cleaning behavior for reducing exposure toEDCs showed improvement after providing information (P＜0.01). Therefore, these results suggest that it isimportant to provide continuous education to enhance the awareness of EDCs, work ethics, and behavior toreduce exposure to EDCs.

Mesenchymal Stem Cells Ameliorate Renal Inflammation in Adriamycin-induced Nephropathy

Mesenchymal stem cells (MSCs) ameliorate the renal injury in Adriamycin (ADR)-induced nephropathy, but the mechanisms underlying their efficacy remain incompletely understood. In this study, we demonstrated that MSCs increased the survival, recovered body weight loss, and decreased proteinuria and serum creatinine levels in ADR-treated mice. MSCs also prevented podocyte damage and renal fibrosis by decreasing the expression of fibronectin, collagen 1α1, and α-smooth muscle actin. From a mechanistic perspective, MSCs inhibited renal inflammation by lowering the expression of CCL4, CCL7, CCL19, IFN-α/β, TGF-β, TNF-α, and chitinase 3-like 1. In summary, our data demonstrate that MSCs improve renal functions by inhibiting renal inflammation in ADR-induced nephropathy.

Effects of Job Stress on Job Satisfaction in School Dieticians and Nutrition Teacher: Focus on the Moderating Effect of Interpersonal Relationship Type

The purpose of this study was to investigate the effects of job stress on job satisfaction according to interpersonal relationship type among school dieticians and nutrition teachers. The online survey was conducted from Oct. 26th to Nov. 7th, 2017 in 2,000 randomly selected dieticians and nutrition teachers in the capital area. A total of 453 collected questionnaires were used for analysis. SPSS v.21.0 Statistical Package Program was used for the statistical process. For the results regarding interpersonal relationship type of dieticians, open-type (73.3%) was the highest, followed by self-assertive-type (23.0%), isolated-type (2.6%), and careful-type (1.1%). Regarding overall job satisfaction, ‘human relation’ was the highest, followed by ‘job itself’, ‘working environment’, and ‘personal rating & welfare system’, in that order. According to interpersonal relationship type, in the case of ‘open-type’ or ‘careful-type’, job satisfaction was relatively high. Regarding overall job stress, ‘job demand’ was the highest, followed by ‘lack of reward’, ‘organizational system’, ‘interpersonal conflict’, ‘occupational climate’, ‘job insecurity’, and ‘insufficient job control’, in that order. In accordance with interpersonal relationship type, overall job stress index was high in terms of ‘self-assertive-type’ or ‘careful-type’. For the results of analyzing the correlation between job satisfaction and job stress index, all areas showed statistically significant negative correlations. Multiple regression analysis was performed to study the effects of job stress on job satisfaction mediating interpersonal relationship type. Job stress had different effects on job satisfaction in terms of ‘open-type’ and ‘self-assertive type’. In conclusion, different strategies are needed for dieticians with different interpersonal relationship types to improve job satisfaction and to reduce job stress.

Kidney transplantation using expanded criteria deceased donors with terminal acute kidney injury: a single center experience in Korea

PURPOSE: We investigated the clinical outcomes of deceased donor kidney transplantation (KT) using kidneys with terminal acute kidney injury (AKI). METHODS: Between February 2000 and December 2013, we performed 202 deceased donor renal transplants from 159 brain dead donors. According to the expanded criteria donor (ECD) and AKI network criteria, we divided 202 recipients into 4 groups: Group I: Non-AKI & standard criteria donor (SCD) (n = 97); group II: Non-AKI & ECD (n = 15); group III: AKI & SCD (n = 52); and group IV: AKI & ECD (n = 38). RESULTS: The incidence of delayed graft function (DFG) was significantly higher in patients with AKI than it was in the non-AKI group (P = 0.008). There were no significant differences among the 4 groups in graft survival (P = 0.074) or patient survival (P = 0.090). However, the long-term allograft survival rate was significantly lower in group IV than it was in other groups (P = 0.024). CONCLUSION: Allografts from deceased donors with terminal AKI had a higher incidence of DGF than did those from donors without AKI. However, there is no significant difference in graft and patient survival rates among the groups. So, the utilization of renal grafts from ECDs with terminal AKI is a feasible approach to address the critical organ shortage.

Clinical Outcomes of Nutritional Supply in Critically Ill Patients in the Prone Position

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, PaO₂/FiO₂, 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.

Impact of Intervention by an Antimicrobial Stewardship Team on Conversion from Intravenous to Oral Fluoroquinolones

BACKGROUND: Early conversion from intravenous to oral antibiotics plays an important role in lowering the risk of catheter-associated infections, reducing the workload of nurses, decreasing direct and indirect costs, and shortening hospital stays. In August 2015, an antimicrobial stewardship program (ASP) was implemented to facilitate conversion from intravenous to oral administration of fluoroquinolones in our institute. This study evaluated the clinical and economic impact of the intervention. MATERIALS AND METHODS: Data were retrospectively collected by reviewing electronic medical records. All hospitalized patients aged 18 and older who met the study inclusion criteria for the conversion were included between August and November 2015. We computed the physicians’ adherence rate to the ASP recommendations. We also measured the total use of fluoroquinolones, length of hospital stay, and medication costs. RESULTS: During 4 months, 129 cases were enrolled in the study. The adherence rate was 79.8%. The average total prescription volume of intravenous fluoroquinolones, the length of hospital stay, and the total cost of the fluoroquinolones statistically significantly decreased in the intervention-adherent group. CONCLUSION: Intervention to facilitate conversion from intravenous to oral administration has reduced excess use of intravenous fluoroquinolones and length of hospital stay. With these findings, further implementations of the ASP extending to other antibiotics may be warranted.

Relationship between Food Behavior and Level of Attention Deficit Hyperactivity Disorder in Elementary School Students in Suwon-si, Korea

The purpose of this study was to investigate the correlation between food behavior and Attention Deficit Hyperactivity Disorder (ADHD) score in elementary students in Suwon-si, Gyeonggi-do. Two hundreds and thirty two students (113 male and 119 female) in grades 4~6 participated. We assessed food behavior by using Nutrition Quotient (NQ). NQ was examined by an NQ questionnaire, which consisted of 19 food behavior checklist items. Their items were grouped into five categories: balance, diversity, moderation, regularity, and practice. All data were statistically analyzed by SPSS 18.0. Among the five factors, NQ for food behavior and balance factor showed the lowest score, whereas that of diversity factor showed the highest score. The final Nutrition Quotient (NQ) score weighted on such five factors was 62.59 points. The average level of ADHD by Conners-Wells Adolescent Self-Report Scale (Short Form) [CASS(S)] was 17.02 points out of a total of 81 points. Six students (2.2%) who scored more than 41 points were classified as ADHD risk. By gender, male students (19.76 points) showed a higher CASS(S) score than female students (14.41 points) did. There was a significant negative correlation between NQ and CASS(S) score (r=-0.445, P<0.001). Multiple regression determined the effects of moderation (Exp(beta)=-0.193, P<0.01) and practice (Exp(beta)=-0.345, P<0.001) on CASS(S) score. In conclusion, distinctive nutritional education is needed for students with a high level of ADHD to help their understanding considering their different levels of attention.

A Comparison of Salty Taste Assessment, Dietary Attitude and Dietary Behavior among Adult and Senior Women by Region and by Age in Korea / 대한지역사회영양학회지

OBJECTIVES: The purpose of this study was to compare and analyze the results of salty taste assessment, dietary attitudes, and dietary behaviors among adult and senior women by region and by age. The results generated from this was expected to provide fundamental data for implementing a nationwide salt reduction education program. METHODS: The salty taste assessment tool was applied to 4,064 subjects from 15 areas in Korea. Also, a survey of dietary attitude and dietary behavior related to salt intake was conducted for all subjects participated in this study. RESULTS: The salty taste assessment scores by region and by age were the lowest in capital (p < 0.01) and was highest among the 70+ year age group (p < 0.01). The dietary attitude scores and dietary behavior scores showed that Gyeongsang was the highest (p < 0.001) and the capital was the lowest. The dietary attitude scores were highest at 20&30's followed by 40's and 70's group (p < 0.001). Dietary behavior scores showed that 20's~30's and 40's groups were higher than the other age groups (p < 0.001). The score of 'I like kimchi' was 3.46 +/- 0.88, which was the highest among 10 dietary behavior questions. The score of 'I eat a lot of kimchi' was 3.30 +/- 0.90, which was the highest among 10 dietary behavior questions related to salt intake. The scores of salty taste assessment had significant positive correlations between the scores of dietary attitude (p < 0.001), dietary behavior (p < 0.001) and self-awareness (p < 0.001). CONCLUSIONS: Based on the results of salty taste assessment, we observed a tendency that older people and regions except the capital had higher preference for salty taste. Our results suggested the necessity for a nationwide salty reduction education program tailored for regions and for different age groups.

Clinical Application of Bioelectrical Impedance Analysis and its Phase Angle for Nutritional Assessment of Critically Ill Patients

PURPOSE: Phase angle (PA) is objectively determined from resistance and reactance measured by bioelectrical impedance analysis (BIA)-a quick, noninvasive method. The aim of this study was to evaluate the clinical application of PA by BIA for nutritional assessment of critically ill patients. METHODS: Eighty nine adult patients admitted to a medical intensive care unit (ICU) of a tertiary academic hospital from August 2012 to September 2013 were analyzed. PA values were measured by direct segmental multi-frequency BIA. As traditional nutrition assessment tools, body mass index (BMI), serum albumin levels, total lymphocyte counts, and our hospital's nutrition screening index (NSI) were also recorded. Correlations between the results of BIA and other traditional parameters were analyzed. RESULTS: PA showed correlation with traditional nutritional parameters, including BMI (r=0.479), serum albumin (r=0.347), and NSI score (r=0.483). Patients with PA lower than the median value (3.5degrees) had significantly lower nutritional status, increased duration of mechanical ventilation (P=0.039), and increased length of ICU stay (P=0.041). CONCLUSION: PA, as a reflection of body cell mass, measured by BIA could be a potentially useful parameter for nutritional assessment in critically ill patients.

Drug-induced Gastrointestinal Hypomotility and Current Issues on Safety of Prokinetics in Critically Ill Patients

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.