Nutritional Assessment in the Critically Ill Patients
,
Abstract
Background: Malnutrition is a prevalent complication among critically ill patients. It has very detrimental effects on the patients' clinical course. This study aimed to investigate the impact of nutrition in the intensive care unit (ICU) patients.
Methods: In this epidemiologic-analytic study conducted in the surgical ICU of Imam Khomeini hospital, Ahvaz, Iran, 34 patients were selected and divided into two groups. The first group of patients received the appropriate nutrition. The second group received an inappropriate diet, and the nutritional risk was evaluated according to the modified- Nutrition Risk in Critically ill (m-NUTRIC) score. The energy was calculated by using 25 Kcal/kg, also the two groups were compared in terms of ICU mortality, ICU stays, Acute Physiologic Assessment and Chronic Health Evaluation (APACHE) II Scoring, and the Sequential Organ Failure Assessment (SOFA) Score.
Results: Baseline data, such as APACHE II score and mean age, except sex, were not significantly different between the two groups. In this study, results were toward shorter ICU stay, less mortality, and better SOFA score in the group receiving appropriate nutrition compared to the other group. However, due to the low number of patients, no significant differences were observed in the two groups.
Conclusion: Our data suggest that nutritional support should be considered as an essential part of the medication during critical illness.
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[8] Weijs PJ, Looijaard WG, Beishuizen A, Girbes AR, Oudemans-van Straaten HM. Early high protein intake is associated with low mortality and energy overfeeding with high mortality in non-septic mechanically ventilated critically ill patients. Critical care. 2014;18(6):701.
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[11] Guerra R, Fonseca I, Pichel F, Restivo M, Amaral T. Hand length as an alternative measurement of height. Eur J Clin Nutr. 2014;68(2):229-33.
[12] Taylor BE, McClave SA, Martindale RG, Warren MM, Johnson DR, Braunschweig C, et al. Guidelines for the provision and assessment of nutrition support therapy in the adult critically ill patient: Society of Critical Care Medicine (SCCM) and American Society for Parenteral and Enteral Nutrition (ASPEN). Critical care medicine. 2016;44(2):390-438.
[13] Blaser AR, Starkopf J, Alhazzani W, Berger MM, Casaer MP, Deane AM, et al. Early enteral nutrition in critically ill patients: ESICM clinical practice guidelines. Intensive Care Med. 2017;43(3):380-98.
[14] Mulherin DW, Cogle SV. Updates in Nutrition Support for Critically III Adult Patients. Hosp Pharm. 2017;52(1):17-26.
[15] McClave S, Taylor B, Martindale R, Warren M, Johnson D, Braunschweig C. Guidelines for the Provision and Assessment of American Society for Parenteral and Enteral Nutrition (ASPEN). Society of Critical Care Medicine. JPEN J Parenter Enteral Nutr. 2016;40(2):159-211.
[16] Heyland DK, Dhaliwal R, Jiang X, Day AG. Identifying critically ill patients who benefit the most from nutrition therapy: the development and initial validation of a novel risk assessment tool. Crit Care. 2011;15(6):R268.
[17] Heyland DK, Dhaliwal R, Wang M, Day AG. The prevalence of iatrogenic underfeeding in the nutritionally ‘at-risk’critically ill patient: Results of an international, multicenter, prospective study. Clin Nutr. 2015;34(4):659-66.
[18] Nachvak M, Hedayati S, Hejazi N, Motamedi Motlagh A, Shafizade A, Shojaee M. Nutritional assessment in ICU patients with enteral feeding in Amol hospitals. Razi J Med Sci. 2018;24(10):92-104.
[19] Ahsan B, Khaledi S. Knowledge and mortality of ICU patients in Tohid Hospital of Sanandaj in 2001. Med Sci Kordestan Univ. 2005;9:20-5.
[20] Yoosef-zadeh C, Shab-Bidar S, Dehnadi A, Ahmadi D. Nutritional support in head damage patients in ICU. Gorgan Univ Med Sci. 2008;3:53-8.
[21] Knaus WA, Draper EA, Wagner DP, Zimmerman JE. APACHE II: a severity of disease classification system. Crit care med. 1985;13(10):818-29.
[22] Dewar DC, White A, Attia J, Tarrant SM, King KL, Balogh ZJ. Comparison of postinjury multiple-organ failure scoring systems: Denver versus Sequential Organ Failure Assessment. J Trauma Acute Care Surg. 2014;77(4):624-9.
[23] Rahman A, Hasan RM, Agarwala R, Martin C, Day AG, Heyland DK. Identifying critically-ill patients who will benefit most from nutritional therapy: further validation of the “modified NUTRIC” nutritional risk assessment tool. Clin Nutr. 2016;35(1):158-62.
[24] Hejazi N, Mazloom Z, Zand F, Rezaianzadeh A, Amini A. Nutritional assessment in critically ill patients. Iran J Basic Med Sci. 2016;41(3):171.
[25] Kubrak C, Jensen L. Malnutrition in acute care patients: a narrative review. Int J Nurs Stud. 2007;44(6):1036-54.
[26] Kyle ÚG, Kossovsky MP, Karsegard VL, Pichard C. Comparison of tools for nutritional assessment and screening at hospital admission: a population study. Clin Nutr. 2006;25(3):409-17.
[27] Tsai J-R, Chang W-T, Sheu C-C, Wu Y-J, Sheu Y-H, Liu P-L, et al. Inadequate energy delivery during early critical illness correlates with increased risk of mortality in patients who survive at least seven days: a retrospective study. Clin Nutr. 2011;30(2):209-14.
[28] Leiva Badosam E, Badia Tahull M, Virgili Casas N, Elguezabal Sangrador G, Faz Méndez C, Herrero Meseguer I, et al. Cribado de la desnutrición hospitalaria en la admisión: la desnutrición aumenta la mortalidad y la duración de la estancia hospitalaria. Nutr Hosp. 2017;34(4):907-13.
[29] Martindale R, McClave S, Vanek V, McCarthy M, Roberts P, Taylor B. Guidelines for the provision and assessment of nutrition in nutrition support therapy in the adult critically ill patient: Society of Critical Care Medicine (SCCM) and American Society for Parenteral and Enteral Nutrition (ASPEN). JPEN J Parenter Enteral Nutr. 2009;33(3):277-316.
[30] Rice TW, Mogan S, Hays MA, Bernard GR, Jensen GL, Wheeler AP. A randomized trial of initial trophic versus full-energy enteral nutrition in mechanically ventilated patients with acute respiratory failure. Crit Care Med. 2011;39(5):967.
[31] Villet S. chiolero rL, Bollmann Md. Negative impact of hypocaloric feeding and energy balance on clinical outcome in Icu patients. clin Nutr. 2005; 24:502-9.
[2] Hooper MH, Marik PE. Controversies and misconceptions in intensive care unit nutrition. Clin Chest Med. 2015; 36(3):409-18.
[3] Preiser J-C, Taccone FS. Nutrition in critically ill patients: where do we stand? Minerva Anestesiol. 2016; 82(8):908-13.
[4] Amiri Farahani L, Heidari T, Narenji F, Asghari Jafarabadi M, Shirazi V. Relationship between pre menstrual syndrome with body mass index among university students. J hayat. 2012; 17(4):85-95.
[5] Jensen GL, Compher C, Sullivan DH, Mullin GE. Recognizing malnutrition in adults: definitions and characteristics, screening, assessment, and team approach. J Parenter Enteral Nutr. 2013; 37(6):802-7.
[6] Preiser J-C, van Zanten AR, Berger MM, Biolo G, Casaer MP, Doig GS, et al. Metabolic and nutritional support of critically ill patients: consensus and controversies. Critical care. 2015;19(1):35.
[7] Tian F, Gao X, Wu C, Zhang L, Xia X, Wang X. Initial energy supplementation in critically ill patients receiving enteral nutrition: a systematic review and meta-analysis of randomized controlled trials. Asia Pac J Clin Nutr. 2017;26(1):11.
[8] Weijs PJ, Looijaard WG, Beishuizen A, Girbes AR, Oudemans-van Straaten HM. Early high protein intake is associated with low mortality and energy overfeeding with high mortality in non-septic mechanically ventilated critically ill patients. Critical care. 2014;18(6):701.
[9] Mondal MK, Jana TK, Giri S, Roy H. Height prediction from ulnar length in females: a study in Burdwan district of West Bengal (regression analysis). J Clin Diagn Res: JCDR. 2012;6(8):1401.
[10] Harvey SE, Parrott F, Harrison DA, Bear DE, Segaran E, Beale R, et al. Trial of the route of early nutritional support in critically ill adults. N Engl J Med. 2014;371(18):1673-84.
[11] Guerra R, Fonseca I, Pichel F, Restivo M, Amaral T. Hand length as an alternative measurement of height. Eur J Clin Nutr. 2014;68(2):229-33.
[12] Taylor BE, McClave SA, Martindale RG, Warren MM, Johnson DR, Braunschweig C, et al. Guidelines for the provision and assessment of nutrition support therapy in the adult critically ill patient: Society of Critical Care Medicine (SCCM) and American Society for Parenteral and Enteral Nutrition (ASPEN). Critical care medicine. 2016;44(2):390-438.
[13] Blaser AR, Starkopf J, Alhazzani W, Berger MM, Casaer MP, Deane AM, et al. Early enteral nutrition in critically ill patients: ESICM clinical practice guidelines. Intensive Care Med. 2017;43(3):380-98.
[14] Mulherin DW, Cogle SV. Updates in Nutrition Support for Critically III Adult Patients. Hosp Pharm. 2017;52(1):17-26.
[15] McClave S, Taylor B, Martindale R, Warren M, Johnson D, Braunschweig C. Guidelines for the Provision and Assessment of American Society for Parenteral and Enteral Nutrition (ASPEN). Society of Critical Care Medicine. JPEN J Parenter Enteral Nutr. 2016;40(2):159-211.
[16] Heyland DK, Dhaliwal R, Jiang X, Day AG. Identifying critically ill patients who benefit the most from nutrition therapy: the development and initial validation of a novel risk assessment tool. Crit Care. 2011;15(6):R268.
[17] Heyland DK, Dhaliwal R, Wang M, Day AG. The prevalence of iatrogenic underfeeding in the nutritionally ‘at-risk’critically ill patient: Results of an international, multicenter, prospective study. Clin Nutr. 2015;34(4):659-66.
[18] Nachvak M, Hedayati S, Hejazi N, Motamedi Motlagh A, Shafizade A, Shojaee M. Nutritional assessment in ICU patients with enteral feeding in Amol hospitals. Razi J Med Sci. 2018;24(10):92-104.
[19] Ahsan B, Khaledi S. Knowledge and mortality of ICU patients in Tohid Hospital of Sanandaj in 2001. Med Sci Kordestan Univ. 2005;9:20-5.
[20] Yoosef-zadeh C, Shab-Bidar S, Dehnadi A, Ahmadi D. Nutritional support in head damage patients in ICU. Gorgan Univ Med Sci. 2008;3:53-8.
[21] Knaus WA, Draper EA, Wagner DP, Zimmerman JE. APACHE II: a severity of disease classification system. Crit care med. 1985;13(10):818-29.
[22] Dewar DC, White A, Attia J, Tarrant SM, King KL, Balogh ZJ. Comparison of postinjury multiple-organ failure scoring systems: Denver versus Sequential Organ Failure Assessment. J Trauma Acute Care Surg. 2014;77(4):624-9.
[23] Rahman A, Hasan RM, Agarwala R, Martin C, Day AG, Heyland DK. Identifying critically-ill patients who will benefit most from nutritional therapy: further validation of the “modified NUTRIC” nutritional risk assessment tool. Clin Nutr. 2016;35(1):158-62.
[24] Hejazi N, Mazloom Z, Zand F, Rezaianzadeh A, Amini A. Nutritional assessment in critically ill patients. Iran J Basic Med Sci. 2016;41(3):171.
[25] Kubrak C, Jensen L. Malnutrition in acute care patients: a narrative review. Int J Nurs Stud. 2007;44(6):1036-54.
[26] Kyle ÚG, Kossovsky MP, Karsegard VL, Pichard C. Comparison of tools for nutritional assessment and screening at hospital admission: a population study. Clin Nutr. 2006;25(3):409-17.
[27] Tsai J-R, Chang W-T, Sheu C-C, Wu Y-J, Sheu Y-H, Liu P-L, et al. Inadequate energy delivery during early critical illness correlates with increased risk of mortality in patients who survive at least seven days: a retrospective study. Clin Nutr. 2011;30(2):209-14.
[28] Leiva Badosam E, Badia Tahull M, Virgili Casas N, Elguezabal Sangrador G, Faz Méndez C, Herrero Meseguer I, et al. Cribado de la desnutrición hospitalaria en la admisión: la desnutrición aumenta la mortalidad y la duración de la estancia hospitalaria. Nutr Hosp. 2017;34(4):907-13.
[29] Martindale R, McClave S, Vanek V, McCarthy M, Roberts P, Taylor B. Guidelines for the provision and assessment of nutrition in nutrition support therapy in the adult critically ill patient: Society of Critical Care Medicine (SCCM) and American Society for Parenteral and Enteral Nutrition (ASPEN). JPEN J Parenter Enteral Nutr. 2009;33(3):277-316.
[30] Rice TW, Mogan S, Hays MA, Bernard GR, Jensen GL, Wheeler AP. A randomized trial of initial trophic versus full-energy enteral nutrition in mechanically ventilated patients with acute respiratory failure. Crit Care Med. 2011;39(5):967.
[31] Villet S. chiolero rL, Bollmann Md. Negative impact of hypocaloric feeding and energy balance on clinical outcome in Icu patients. clin Nutr. 2005; 24:502-9.
| Files | ||
| Issue | Vol 6 No 3 (2020): Summer |
|
| Section | Research Article(s) | |
| DOI | https://doi.org/10.18502/aacc.v6i3.3997 | |
| Keywords | ||
| Intensive care unit Malnutrition Nutritional support Modified-nutrition risk in critically ill (m-nutric) score | ||
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How to Cite
1.
Bagheri E, Hematian F, Izadpanah M, Rashidi M. Nutritional Assessment in the Critically Ill Patients. Arch Anesth & Crit Care. 2020;6(3):133-138.
