Nutritional Assessment in Critically Ill Patients (original) (raw)
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Journal of Critical Care, 2019
Introduction and aim: Malnutrition is a complication of hospitalization in critically ill patients. This event is occurred because of disease and therapeutic processes for curing the patients. Determination of nutritional status helps physicians and clinical nutritionists decide on the best regimen which should be prescribed for a patient. In the current study, we aimed to report the nutritional status ofpatientshospitalizedin the intensive care unit (ICU). Method of study: We used three standard tolls, including Subjective global assessment (SGA), Nutrition Risk in the Critically Ill (NUTRIC) Score and nutrition risk screening (NRS) questionnaires via a multi-stage sampling for different ICU wards of 32 university hospitals in Iran. Frequencies and rates of nutritional scores, comparative studies, and determined agreement of scoring systems and nutritional status in any ward of hospitals were evaluated. Results: There were 771 males and 540 female Cancer and trauma patients had the best and worst nutritional scores, respectively. Using NRS and NUTRIC, the low-risk scores were more frequent than thehigh-riskscores among ICU patients. SGA showed that most patients were in grades A (well nutritional status) or B (moderate nutritional status), andfew caseswere in grade C (poor nutritional status).The high-risk nutritional score wasobtained for older patients. NUTRIC and NRS had better agreement for diagnosis and differentiation of malnutrition than NUTRIC-SGA or NRS-SGA pairs. However, there was no strong agreement between the mentioned pairs. Conclusion: Nutritional status of patients hospitalized in ICU wards in Iran wassomewhat better than other countries that this could be due to the highly observed guidelines of patient's care in Iran. Anyway,it is suggested that a more precise tool of nutritional scoresto be validated for patients hospitalized in ICU•In addition, better medical care needs a well evaluation of nutritional insufficiencies and what is necessary for compensation using complementary regimens.
Nutritional status in intensive care unit patients: a prospective clinical cohort pilot study
Mediterranean Journal of Nutrition and Metabolism, 2011
Previous researches have shown that the nutritional status of patients in the intensive care unit (ICU) was poor on admission and appears to decline during their stay in the ICU. Critically ill patients are prone to malnutrition because their hypermetabolic disorders lead to an increase in nutritional requirements that are not often met with the nutrition supplied. The aim of this study was to assess the nutritional status and hs-CRP of ICU patients on admission and discharge from the hospital. Twenty-nine neurological ICU patients (20-87 years old) underwent fasting blood sample collections, anthropometric measurements and impedance analysis on admission and discharge at Ghaem Teaching Hospital. NRS 2002 was used to determine malnutrition in ICU patients. Markers of nutritional status changed from admission into the ICU until discharge as follows: weight, BMI and triceps skinfold thickness decreased (p \ 0.001, p \ 0.001 and p \ 0.005, respectively). hs-CRP was decreased over the stay in the hospital (admission = 19.4 ± 16.3, discharge = 13.8 ± 14.5, p value = 0.11). The percent of patients at risk of malnutrition decreased during stay in ICU (not significant). Prevalence of malnutrition was as high as 47.6% on admission. The nutritional status of patients was slightly improved over the period of their stay in hospital using NRS 2002 method.
2008
The objective of this study is to assess the nutritional status of hospitalized patients and its effect on morbidity, mortality and length of hospital stay. Prospectively, 177 adult patients, admitted to units of Internal Medicine Department and ICU of Kasr Al-Aini Hospitals during the period from October, 2006 to March, 2007 were evaluated using the Subjective Global Assessment (SGA) questionnaire. Patients were followed to determine length of hospital stay, complications and inhospital mortality. The sample consisted of 100 men and 77 women. The mean age was 50.0110.37 years, with 29.9% over 60 years. Overall 87.6% were admitted to general wards and 12.4% were admitted to the ICU. According to the SGA, 41.8% of patients had moderate malnutrition or were at-risk of malnutrition and there were no severely malnourished patients. Men had increased risk of being malnourished compared with women (p= 0.002). A tendency to malnutrition was observed in older individuals, especially those ...
A critical approach to nutritional assessment in critically ill patients
Clinical Nutrition, 2002
Nutritional assessment enhances quality of nutritional care, however, its practice bemuses professionals. This prospective study aimed to identify a feasible/informative nutritional parameter in intensive care. Methods: 44 patients (APACHE II: 23.8710.1), age 58.4718.6 years, were evaluated at admission: clinical data, height, weight, body mass index (BMI), tricep skinfold thickness, mid-arm circumference (MAC), mid-arm muscle circumference (MAMC), albumin, total protein and lymphocyte count. Anthropometric parameters'performance was evaluated isolated or assembled according to Blackburn and McWhirter criteria. Results: Oedema increased %IW and BMI (Po0.01); muscle depletion was frequent and agreed with MAC or MAMC ranked by both criteria, P = 0.02. %IW and BMI overestimated well-nourished/overweight patients, whilst arm anthropometry, mostly MAC/MAMC, shifted towards750% malnutrition. Patients were not equally ranked by both criteria; McWhirter's by using percentiles clarified the distribution and showed agreement between MAC and MAMC, P = 0.007, unlike Blackburn's. Mortality was higher in patients with MAC o 5th percentile, P = 0.003; MAC o15th percentile was able to predict mortality and major complications. In invasive ventilated patients, severe muscle depletion was associated with mortality, P = 0.05. Conclusion: In intensive care most nutritional assessment methods are useless; MAC is simple, feasible and if classified by percentiles may prove functional with prognostic value.
Nutritional Care in Iranian Intensive Care Units
Clinical Nutrition Research
Intensive care units (ICUs) provides intensive treatment medicine to avoid complications such as malnutrition, infection and even death. As very little is currently known about the nutritional practices in Iranian ICUs, this study attempted to assess the various aspects of current nutrition support practices in Iranian ICUs. We conducted a cross-sectional study on 150 critically ill patients at 18 ICUs in 12 hospitals located in 2 provinces of Iran from February 2015 to March 2016. Data were collected through interview with supervisors of ICUs, medical record reviews and direct observation of patients during feeding. Our study showed that hospital-prepared enteral tube feeding formulas are the main formulas used in Iranian hospitals. None of the dietitians worked exclusively an ICU and only 30% of patients received diet counselling. Regular monitoring of nutritional status, daily energy and protein intake were not recorded in any of the participating ICUs. Patients were not monitored for anthropometric measurements such as mid-arm circumference (MAC) and electrolyte status. The nasogastric tube was not switched to percutaneous endoscopic gastrostomy or jejunostomy (PEG/PEGJ) in approximately 85% of patients receiving long-term enteral nutrition (EN) support. Our findings demonstrated that the quality of nutritional care was inappropriate in Iranian ICUs and improvement of nutritional care services within Iranian ICUs is necessary.
Zenodo (CERN European Organization for Nuclear Research), 2023
Background: This study was to determine the adequacy of nutritional support by assessing energy and protein intake for the first four days after initiation of enteral nutrition among critically ill patients. Methods: The prospective, cross sectional study carried out in a medical intensive care unit in King Abdulaziz hospital Al Ahsa from September 2020 to November 2020. 130 patients were enrolled. Patients were scheduled to receive their ordered enteral nutritional requirements. Their intake was compared with their requirement based on ASPEN guidelines for critically ill patients. Results: Majority of respondents were (54.5%) in the age group of 50 to 75 years, males with mean height of 163.9(± 7.098)cms and weight of 69.87 (± 8.862). Infection, wound, and Sepsis were major metabolic stressor with high number of respondents were having cancer (49.2%), PEG tube was inserted (64.4 %), During the first 4 days of tube insertion, the mean intake of calories and fluid (1432.31±176.24 versus 1704 ±175.01 k.cal p< .05) and fluid(1432.31±176.24 versus 1704 ±175.01 ml p< .05) was statistically lower and protein (117.99 +/-18.05 g versus 87.98 +/-22.14 g; p < .05) fat (66.25±16.25 versus 56.82 ±5.83 g, p< .05) was statistically greater for patients. Carbohydrate was (121.04±40.96 versus 180.32 ±27.07 g, p> .05) is statistically non-significant Conclusions: The study result showed that under feeding was seen for energy and fluid among critically ill ICU patients and overfeeding was seen for protein, and fat. It is important to correct enteral nutrition intervention because that will help in tolerability of eternal feeding, duration of stay, economic burden on individuals and societies.
Journal of the Pakistan Medical Association
Objective: To assess the nutritional risk of critically ill patients. Method: The single-centre, prospective, observational study was conducted at the Shifa International Hospital, Islamabad, Pakistan, from November 9, 2020, to May 8, 2021, and comprised critically ill patients of either gender admitted to pulmonology, neurology, nephrology, cardiology, gastroenterology and general intensive care units. They were subjected to screening using the Nutritional Risk of Critically Ill tool, and the risk was categorised as moderate and high. Data was analysed using SPSS 23. Results: Of the 88 patients, 58 (66%) were males. The overall mean age of the sample was 62.71±12.62 years. The nutritional risk was moderate in 39(44%) patients and high in 49(56%). The mean Acute Physiology, Age and Chronic Health Evaluation II score, Sequential Organ Failure Assessment score and Nutritional Risk of Critically Ill was 16.73±4.34, 5.91±1.92 and 5.71±1.41, respectively. There was a significant associat...
Background: Critically ill patients admitted to the intensive care unit (ICU) are often hyper-metabolic and hyper-catabolic and at risk of malnutrition. This study aimed to evaluate the amount of energy and protein intake and its correlation with the required amount in critically ill patients. Method: Seventy patients with critical conditions who were admitted to ICU were eligible (age ≥18 years and over a 3-day stay in ICU). Basic characteristics, medical history, and laboratory test results were extracted from the patients' medical records. Anthropometric indices and APACHE II questionnaire were assessed by an expert nurse. The calorie and protein requirement of patients were considered 25 kcal/kg/day and 1.2 g/kg/day, respectively. Result: Mean age in the target population was 57.69 ± 20.81 years, and 48.6% were men. The mean actual energy intake was significantly lower than the requirement (531.27 ±365.40 vs. 1583.77 ± 329.36 Kcal/day, P˂0.001). The mean actual protein intak...
Importance of nutritional assessment tools in the critically ill patient: A systematic review
Frontiers in Nutrition, 2023
Background: Among the risks of the critically ill patient, one of the aspects to be taken into account is the high probability of occurrence of malnutrition risk (40-50%). This process leads to increased morbimortality and worsening. The use of assessment tools allows the individualization of care. Objective: To analyze the different nutritional assessment tools used during the admission of critically ill patients. Methods: Systematic review of the scientific literature related to the nutritional assessment of critically ill patients. Between January 2017 and February 2022, articles were rescued from the electronic databases "Pubmed," "Scopus," "CINAHL" and "The Cochrane Library"; which will analyze which instruments are used during nutritional assessment in the ICU, as well as their impact on mortality and comorbidity of patients. Results: The systematic review was made up of 14 scientific articles that met the selection criteria, obtained from seven different countries. The instruments described were: mNUTRIC, NRS 2002, NUTRIC, SGA, MUST and the ASPEN and ASPEN criteria. All the included studies demonstrated beneficial effects after nutritional risk assessment. mNUTRIC was the most widely used assessment instrument, with the best predictive validity for mortality and adverse outcomes. Conclusion: The use of nutritional assessment tools makes it possible to know the real situation of patients, and by objectifying situations, to allow different interventions to improve the nutritional level of patients. The best effectiveness has been achieved using tools such as mNUTRIC, NRS 2002 and SGA.