Malnutrition in the ICU: Current recommendations for the assessment of nutritional status and a review of the use of albumin as an indicator of malnutrition

Abstract

CasePatient X is a 55-year-old man, 72 inches tall, weighing 86 kg, status post motor vehicle accident with multisystem trauma. The patient is currently receiving sedation, pain control, and maintenance IV fluids; he received 3 liters of NS bolus, 2 units of FFP, and 2 units of PRBCs on admission. On admission, labs included CRP -2.1mg/dL, Alb -4.5 gm/dL and transthyretin (TTR, prealbumin) -17mg/dL. Labs on day three showed that the CRP was 37 mg/dL, Alb 1.2 gm/dL, and transthyretin 10 mg/dL. In an overall assessment of the patient, the clinician states that based on the most recent labs, enteral or parenteral nutrition needs to be started due to malnutrition as indicated by his low albumin. DisCussion Malnutrition in the iCuMalnutrition is very common in critically ill patients, and its development is a function of the patients' preexisting nutritional status and severity of illness (degree of hypermetabolism). The characteristics of ICU patients have changed during the last decade; they now tend to be older and their medical disorders more complex with frequent comorbidity. These factors may contribute to malnutrition in the ICU. The combination of stress and undernutrition is associated with negative energy balances and the loss of lean body mass 1 . Critically ill patients often have a history of decreased food intake from anorexia, gastrointestinal symptoms, depression, anxiety, and other medical and surgical factors on presentation. Their food intake may have also been restricted for diagnostic or therapeutic procedures during hospital stay, and they may have nutrient loss from diarrhea, vomiting, polyuria, wounds, drainage tubes, and renal replacement therapy 2,3 .The major physiologic change

Nutritional Status in Intensive Care Unit: A Meta-Analysis and Systematic Review

“…Most patients in ICU are unable to maintain a healthy diet due to their life-threatening and sometimes unconscious conditions [ 2 ]; therefore, paying attention to the nutritional status of patients in these units is very important and is considered as one of the main factors in these wards [ 3 ]. In ICU, the nutritional status is a key factor in the ability to overcome critical diseases and to improve clinical outcomes [ 4 , 5 ]. Nutrition and disease are closely related [ 6 ].…”

Enteral tube feeding: Safety and tolerance of nutritional supplements in hospitalized patients

“…Malnutrition is one among them and is commonly observed in 30-50% of the hospitalized patients [1]. Poor nutrition reserve is observed during presentation or it develops during hospitalization (also known as hospital malnutrition), resulting in poor clinical outcomes including morbidity and mortality [2]. The major reason behind malnutrition in ICU patients is decreased intake of food due to illness associated depression, anxiety, gastrointestinal problems, etc [2].…”

Nutritional Status in Intensive Care Unit: A Meta-Analysis and Systematic Review

“…Most patients in ICU are unable to maintain a healthy diet due to their life-threatening and sometimes unconscious conditions [2]; therefore, paying attention to the nutritional status of patients in these units is very import-ant and is considered as one of the main factors in these wards [3]. In ICU, the nutritional status is a key factor in the ability to overcome critical diseases and to improve clinical outcomes [4,5]. Nutrition and disease are closely related [6].…”