Nutrition in acute care

Elia, Marinos; Stroud, Mike

doi:10.7861/clinmedicine.4-5-405

Cited by 16 publications

(7 citation statements)

References 4 publications

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“…Malnutrition is one of the major challenges confronting healthcare practitioners in the intensive care unit (ICU). Its impact is associated not merely with cellular function and body composition but also with healing acceleration, incidence of infections, difficulties in weaning from mechanical ventilation (MV) secondary to muscular weakness, length of ICU stay, and mortality rate . Because ICU admission is coupled with the hypermetabolic state, providing nutrition below the physiological requirements expedites the development of malnutrition …”

Section: Introductionmentioning

confidence: 99%

Prognostic Performance of NUTRIC Score in Quantifying Malnutrition Risk in the Critically Ill in Congruence With the Bioelectrical Impedance Analysis

2019

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Background: There is still no concrete guidance for assessing malnutrition risk in the critically ill. Nutrition Risk in the Critically Ill (NUTRIC) score is undertaken cautiously compared with other validated tools such as bioelectrical impedance analysis (BIA). This study aimed to assess the malnutrition risk in the critically ill using NUTRIC score and assess its congruency with the BIA. Methods: In this cross-section observational study, intensive care unit (ICU) patients from various etiologies were assessed using the earlier tools in addition to other prognostic markers (Acute Physiologic Assessment and Chronic Health Evaluation II [APACHE II] and Sequential Organ Failure Assessment [SOFA] scores), caloric attainment, and feeding complications. Results: Of a total 411 assessed patients, 313 (76.2%) were enterally fed, and 318 (77.4%) were mechanically ventilated. Mean age was 60.7 years, and the median of the assessment since admission was the 12th day. Of those enterally fed patients, 57.9% attained the caloric requirements. Both APACHE II and SOFA scores were compatible in ascertaining ICU mortality at a moderate level (17.88 and 7.17, respectively). The NUTRIC score and phase angle (PA) measured by BIA revealed no differences in the malnutrition risk between patients with and without enteral nutrition. However, regression indicated that the NUTRIC score has explained only 1.1% of the variance of PA after controlling other covariates (β = −0.222, P = .009, confidence interval = −0.31 to −0.05). Conclusions: NUTRIC score has a limited prediction to the urgency of aggressive nutrition therapy within the early period of ICU admission.

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Section: Introductionmentioning

confidence: 99%

Prognostic Performance of NUTRIC Score in Quantifying Malnutrition Risk in the Critically Ill in Congruence With the Bioelectrical Impedance Analysis

2019

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“…2 This recommendation mirrors earlier recommendations of the Malnutrition Universal Screening Tool Report which provided the evidence base and a practical way of identifying and treating patients with malnutrition. 9,10 Complications Enteral tube feeding and parenteral nutrition are both effective means of delivering artificial nutrition support but they are associated with a number of complications, some potentially lifethreatening (Table 1). Patients therefore require careful monitoring, ideally involving a multidisciplinary nutrition support team.…”

Section: Peri-operative Parenteral Nutritionmentioning

confidence: 99%

Artificial nutrition support in hospital: indications and complications

Smith

Elia

2006

Clinical Medicine

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Artificial nutrition support in hospital: indications and complications Malnutrition is a common clinical problem in hospitalised patients and is both a cause and consequence of diseaseArtificial nutrition support with enteral or parenteral nutrition is indicated in patients who are malnourished or at risk of malnutrition where food fortification and/or oral nutritional supplements are inadequate Enteral tube feeding should be used in preference to parenteral nutrition where the gastrointestinal tract is functioning adequately; if there is doubt, enteral and parenteral feeding can temporarily be used in combination Enteral tube insertionProblems arising shortly after insertion of enteral tubes should arouse suspicion of an insertion complication. Such complications can be minimised by ensuring that correct placement procedures are followed by trained healthcare professionals. Nasogastric tube positioning should be confirmed with a tube aspirate pH<5. If there is any doubt about tube positioning, the patient is on acid suppression or a naso-jejunal tube has been inserted, an X-ray is needed to exclude bronchial placement. Injection of air through the tube and auscultation with a stethoscope is unreliable and should not be used. 11 To minimise the risks of pulmonary aspiration, patients should be fed propped up by 30°or more and kept propped up for 30 minutes after feeding. 11 Venous catheterisationProblems arising shortly after insertion of a venous catheter (frequently a central venous catheter) for parenteral nutrition should also arouse suspicion of an insertion complication (eg shortness of breath due to pneumothorax, blockage of line due to kinking of catheter). Meticulous care in inserting catheters under aseptic conditions by trained operators can do much to minimise the risk of these complications. Catheter-related sepsisCatheter-related sepsis is a major complication, the causes of which frequently relate to inappropriate procedures and techniques, for example multiple blood sampling and inadequate aseptic technique when inserting and accessing lines. If line sepsis is suspected, parenteral feeding should be stopped and blood cultured both from peripheral and central line sites prior to initiating antibiotics. Temporary lines should usually be removed, although in minor catheterrelated sepsis due to Staphylococcus Metabolic disturbancesMetabolic disturbances occur with both enteral and parenteral nutrition support, although they are more common with the latter as many of the body's homeostatic mechanisms are overridden. Hyperglycaemia is common, particularly in the critically ill who have coexisting insulin resistance which predisposes to septic complications. A raised blood glucose of a few mmol/l may have major deleterious effects on clinical outcome in critical illness in both medical and surgical patients. 8,12,13 These patients should be monitored closely, with careful consideration of feeding levels and a low threshold for introducing insulin therapy. Refeeding syndromeMalnourished patients who ...

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“…Upper arm circumference measurement is a parameter that shows total body muscle ratio and physical function (19). Alert et al (20) found a significant relationship between UAC and MNA.…”

Section: Discussionmentioning

confidence: 99%

Comparison of Tests Used in Malnutrition in Hospitalized Geriatric Patients, Relationship with Anthropometric Measurements and Hand Grip Strength

Yavuzer¹,

Emiroğlu²,

Demir³

et al. 2020

ejgg

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Objective:There is no single test and recommended method ideal for nutritional risk assessment in hospitalized elderly patients. In this study, we intended to screen hospitalized elderly patients for malnutrition by using two tests and compare the results with anthropometric measurements and hand grip strength test and describe the relationship between them. Materials and Methods:In this study, we evaluated 200 hospitalized patients aged 60 years and over in the internal medicine, cardiology and Infectious diseases departments. We applied nutritional risk screening (NRS 2002) with the hand grip test and the mini nutritional assessment (MNA). Body Mass index and upper arm and calf circumference measurements were recorded. Chi-square and ANOVA test were used for statistical analyses. Results:Of the 200 patients, 98 were female and 102 were male. The mean age was 71.3±8.1 years. According to the NRS-2002, the prevalence of malnutrition risk was 34%; according to the MNA, the prevalence of malnutrition was 23.5%, and the prevalence of malnutrition risk was 27.5%. According to the NRS-2002, 38% of the patients at risk for malnutrition were female and 62% were male (p=0.029). The relationship between hand grip test and Mini Nutritional Assesment (MNA) was statistically significant (p<0.0001). Conclusion:We suppose that the MNA test which was used for screening of malnutrition in outpatient setting can be used for hospitalized patients as NRS 2002, and we suggest that anthropometric measurements and hand grip test would be reliable tools for sarcopenia as malnutrition screening and assessment.

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Nutrition in acute care

Cited by 16 publications

References 4 publications

Prognostic Performance of NUTRIC Score in Quantifying Malnutrition Risk in the Critically Ill in Congruence With the Bioelectrical Impedance Analysis

Prognostic Performance of NUTRIC Score in Quantifying Malnutrition Risk in the Critically Ill in Congruence With the Bioelectrical Impedance Analysis

Artificial nutrition support in hospital: indications and complications

Comparison of Tests Used in Malnutrition in Hospitalized Geriatric Patients, Relationship with Anthropometric Measurements and Hand Grip Strength

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