Analysis of Compliance and Clinical Outcomes by Expanding Physician's Departments in Pediatric Nutrition Support Team

PURPOSE@#Malnutrition in hospitalized children has an impact on growth, morbidity, and mortality. For this reason, the implementation of pediatric nutrition support team (PNST) has been suggested. On April 2017, in Severance Hospital, more PNST physician's departments participated in PNST, and a PNST physician assigning system was changed to be the same departments with the attending physician and PNST physician. This study performed a comparative analysis of the compliance and clinical outcomes after expanding the participation of the PNST physician's department.@*METHODS@#Pediatric patients, who were referred to a PNST consultant, were divided into two groups: an unmatched group (different departments with the attending physician and PNST physician [154 patients, 233 consultations from May 2016 to October 2016]), and a matched group (same departments with the attending physician and PNST physician [169 patients, 302 consultations from May 2017 to October 2017]). The PNST compliance and clinical outcomes, such as the total delivered/required caloric and protein ratio, % ideal body weight (%IBW), serum total protein, and serum albumin, in the two groups were compared.@*RESULTS@#The compliance was significantly higher in the matched group than the unmatched group (63.4% vs. 47.3%, P=0.005). Although there was no significant difference, the total delivered/required caloric and protein ratio, and %IBW in the matched group tended to increase. The serum total protein (0.7±0.7 g/dL vs. −0.4±1.3 g/dL, P=0.004) and serum albumin (0.5±0.5 g/dL vs. −0.1±0.6 g/dL, P=0.003) were significantly higher in the matched group.@*CONCLUSION@#After expanding the physician's departments in PNST, the compliance was significantly higher in the matched group and the clinical outcomes tended to better. The physician assigning system to be matched with the departments between the attending physician and the PNST physician may help increase the compliance of NST consultations, resulting in an improvement of the patient's clinical outcomes.

Changes of Hypoxic Pulmonary Vasoconstriction in Isolated Endotoxin-Treated Rat Lungs / 대한마취과학회지

BACKGROUND: Several investigations have studied hypoxic pulmonary vasoconstriction (HPV) during endotoxemia and there is an increase in nitric oxide (NO) in pulmonary vessels. However, these studies yielded conflicting or at times contradictory results, since reference has been made to both enhancement and inhibition of HPV. Our objective was to determine the changes of hypoxic pulmonary vasoconstriction on the isolated blood-perfused lung of endotoxemic rats. METHODS: Pulmonary arterial pressure (PAP) was measured in a blood-perfused lung preparation from Sprague-Dawley rats in normoxia (21% O2, 5% CO2, balanced N2) and hypoxia (5% O2, 5% CO2, balanced N2). We studied the effect of normoxia and hypoxia in a control group, Escherichia coli lipopolysaccharide group (LPS) and LPS with N omega-nitro-L-arginine methyl ester group (L-NAME). RESULTS: The Baseline PAP was higher in LPS (15.0+/-4.0 mmHg) compared with control group (10.9+/-2.9 mmHg) and L-NAME (11.1+/-3.6 mmHg). In hypoxia, HPV was higher in L-NAME (109.6+/-100.2%) compared with control group (59.9+/-31.6%) and LPS (58.8+/-33.8%)(P<0.05). CONCLUSIONS: We conclude that NO is an important factor to impair HPV during endotoxemia.

A case of juvenile form Pompe's disease manifested as chronic alveolar hypoventilation

We describe a case of the juvenile form of Pompe's disease that presented as primary alveolar hypoventilation due to respiratory muscle involvement. This 17-year-old girl had been asymptomatic until this admission, although she had a delayed puberty. Arterial blood gas analysis, pulmonary function test as well as physical findings were compatible with chronic alveolar hypoventilation syndrome. Since she had lower extremity muscle weakness and pseudomyotonic discharge on electromyography a muscle biopsy was done, which revealed glycogen storage disease. The patient was managed successfully with nasal intermittent positive pressure ventilation.