The Japanese Society of Surgical Metabolism and Nutrition launched the ESSENSE project in 2012. A prospective multicenter study was conducted in 2014 to examine whether the project measures actually improve patient satisfaction and promote physical recovery. Esophagectomy, total gastrectomy or gastrectomy, pancreatoduodenal resection, hepatectomy, and colectomy were the target surgical procedures. As a control period, the perioperative period management at each facility was set to 6 months. After that, the intervention period was 6 months for perioperative management by ESSENSE intervention, and a prospective cohort study comparing before and after the intervention for each surgical procedure. Quantitative evaluation of patient satisfaction using the question method QoR40 on the 3rd and 7th postoperative days showed no improvement in QoR40 in the intervention group in 5 target surgical procedures. There were no differences between the two groups in biochemical laboratory data, postoperative complication rate according to Clavien‐Dindo classification, length of stay, and medical expenses for each surgical procedure. One of the reasons why better perioperative management results could not be obtained in the ESSENSE intervention group was that the patient’s own ESSENSE diary was insufficient for patient satisfaction in QoR40. It was speculated that the QoR40 result itself in the non‐intervention group was not low, and that the setting of the additional effect itself was a problem. It was also considered that this intervention was insufficient for early independence of physical activity and early independence of nutrition intake.

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[in Japanese]

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[in Japanese]

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[in Japanese]

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We have improved perioperative care with the ERAS protocol, and have performed perioperative management based on the ESSENSE protocol in patients undergoing resection of hepatocellular carcinoma. We examined perioperative management based on the ESSENSE protocol in 206 patients from January 2018 to December 2020. In “No drainage of peritoneal cavity” in the care plan for patients in the ESSENSE protocol, drain detention was performed in 94.2％, and in “Restart oral intake of rice gruel from the day after surgery”, only 38.7％ of the cases were able to eat more than 50％ of the food. Drain detention leads to suppression of physical activity, but in hepatectomy, there are many cases in which drain detention is necessary for intractable ascites and postoperative bile leakage, and it is necessary to accurately extract cases in which drain detention is essential. In addition, it is difficult to restart oral intake of rice gruel from the day after surgery, and it is necessary to make efforts to restart oral intake according to the patient’s willingness to eat and abdominal symptoms.

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[in Japanese]

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Evaluation of the effective dosage of lipid emulsion in glucose-amino acid solution-based peripheral parenteral nutrition （PPN）：An experimental study in ratsDaisuke Harada1）, Mitsuo Nakayama2）Objective：We investigated how much 20％ lipid emulsion （IL20） should be administered to rats in combination with 7.5％ glucose / 3％ amino acid solution （AF） to improve the nutritional effects of PPN. Methods：One hundred to 500 mL of IL20 was added to 2000 mL of AF to prepare test solutions of AFL20, 40, 60, 80, and 100 {numbers are lipid content （g）}. Test solutions were administered to normal or surgically stressed rats under fasting conditions by continuous infusion for 5 days. The dosage of glucose and amino acids was identical among groups. Urine was retrieved every day and blood was collected at the end of 5-day infusion. Results：Body weight change （pre/post） and nitrogen balance recovered according to the amount of added lipids. Significant improvements in the body weight and early post-surgical nitrogen balance were observed with least 40 g of lipids （AFL40） in surgically stressed rats. In association with the increase in lipid dose, an increase in serum free fatty acids, serum bilirubin and water balance, and decrease in the platelet number were observed. Conclusion：The nutritional effects of PPN were improved by adding 40 g of lipids to the daily dose of AF （150 g of glucose and 60 g of amino acids）. Dose-dependent improvement was observed with up to 100 g of additional lipids.

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In the current study, we assessed whether sufficient nutrition was administered in the postoperative period following colorectal surgery. We compared the total energy and protein intakes from the postoperative diet and intravenous fluid in colorectal surgery patients in the following 4 groups；conventional care （C） open surgery （OC） group （C‐OC）, laparoscopic surgery （LAC） group （C‐LAC）, enhanced recovery after surgery （ERAS） （E） OC group （E‐OC）, and E‐LAC group. To evaluate the effects of ERAS on postoperative intake, we compared the C‐OC group and E‐OC group, and C‐LAC group and E‐LAC group. To evaluate the effects of surgical stress on postoperative dietary intake, we compared the E‐OC group and E‐LAC group. The energy and protein intakes from food in the early postoperative period were higher in the E‐OC and E‐LAC groups than in the C‐OC and C‐LAC groups. However, the E‐OC and E‐LAC groups did not reach their estimated requirements of 25 kcal/kg/day for energy and 1.5 g/kg/day for protein. Comparing the E‐OC and E‐LAC groups, there were no significant differences in the energy or protein intake from food and intravenous fluid, but neither group met the estimated energy and protein requirements. ERAS increased the energy and protein intake from the postoperative diet, but diet alone was not sufficient. Therefore, it is necessary to develop a new postoperative diet with a low non‐protein calorie nitrogen ratio by selecting ingredients and creating a menu. We did not provide oral nutritional supplements （ONS） in this study；however, ONS administration may be beneficial to increase the postoperative energy and protein intake. Moreover, in the early postoperative period, parenteral nutrition may be required to supplement the nutritional energy and protein intake, as they are insufficient in the postoperative diet and ONS.

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Abstract：Skeletal muscle mass is an important indicator of clinical outcomes in critically ill patients. However, limb muscle atrophy occurs in approximately 18％ ten days after admission to the intensive care unit. Moreover, atrophy of the respiratory muscles, including the diaphragm, occurs in patients on mechanical ventilation. As muscle atrophy in the acute phase is associated with mortality and impaired physical function, skeletal muscle assessment is important in critically ill patients. Skeletal muscle mass can be assessed using computed tomography （CT）, ultrasound, bioelectrical impedance analysis （BIA）, and biomarkers. CT is useful for accurately measuring the muscle mass and measurement is conducted at the level of the third lumbar vertebra as the gold standard. However, muscle mass assessment using CT is retrospectively conducted because CT accompanies radiation exposure and requires the patients to be transported to the examination room. On the other hand, ultrasound and BIA are noninvasive and available at the bedside, and can be used for longitudinal skeletal muscle assessment. However, these methods require accurate knowledge and skills. Assessments using BIA should be carefully interpreted because critically ill patients exhibit dynamic fluid changes. These methods can be used for qualitative and quantitative skeletal muscle assessments. Furthermore, several biomarkers have been reported to be useful for the assessment of skeletal muscle mass. This review provides appropriate methods for skeletal muscle assessment, thereby widening clinical and research applications to improve the clinical outcomes of critically ill patients.

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