Nutritional Assessment of Intensive-Care Unit Patients

Murray, Michael J.; Marsh, H. Michael; Wochos, Daniel N.; Moxness, Karen E.; Offord, Kenneth P.; Callaway, C. Wayne

doi:10.1016/s0025-6196(12)65505-0

Cited by 60 publications

(35 citation statements)

References 27 publications

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“…16,17,26 Various nutritional markers, individually or collectively, are associated with prognosis in older patients, but confounding remains uncertain. 5,17,18,20,[26][27][28][29][30][31][32] Several methods used to assess nutritional or functional status require complex scoring systems, or additional measurements such as skin fold or arm circumflex; in contrast, the nutritional index employed in the present study comprised only body mass index scores and simple biochemical parameters routinely measured in patients admitted to the ICU. This nutritional score can be easily used to predict the progress of very elderly patients admitted to the ICU.…”

Section: Discussionmentioning

confidence: 99%

Mortality and Outcomes in Very Elderly Patients 90 Years of Age or Older Admitted to the ICU

et al. 2014

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BACKGROUND:We evaluated the clinical characteristics and factors associated with mortality in very elderly patients > 90 y of age admitted to the ICU. METHODS: We evaluated age-specific rates of admission and mortality in 16,935 subjects > 18 y old and retrospectively analyzed the clinical data of 155 (0.92%) subjects > 90 y old admitted to the ICU from January 2003 to July 2012. The clinical mortality index was defined as the ICU mortality rate associated with clinical risk factors including poor nutrition, do not resuscitate (DNR) order, pneumonia, chronic renal failure, cancer, mechanical ventilation, use of a vasopressor, and admission from a ward. RESULTS: The mortality rate of ICU subjects > 90 y of age was 32.3%. A Cox's regression hazard model revealed that high glucose (P ‫؍‬ .006), poor nutrition (P ‫؍‬ .001), high Simplified Acute Physiology Scoring II scores (P < .001), DNR order (P ‫؍‬ .002), and vasopressor treatment (P ‫؍‬ .03) were independent predictive factors of mortality in subjects > 90 y of age admitted to the ICU. An increasing number of clinical risk factors was associated with progressively higher mortality rates. All subjects with more than 5 risk factors died. CONCLUSIONS: The very elderly subjects (> 90 y) admitted to the ICU had a higher mortality rate compared with subjects of other ages. High Simplified Acute Physiology Scoring II scores, poor nutritional status, high glucose, use of vasopressors, and DNR orders should be considered as important predictors of mortality in very elderly ICU patients. The level of ICU treatment should be carefully considered in very elderly patients presenting with 5 or more risk factors.

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Section: Discussionmentioning

confidence: 99%

Mortality and Outcomes in Very Elderly Patients 90 Years of Age or Older Admitted to the ICU

et al. 2014

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“…In a study by MENZIES et al [24] on patients in weaning from MV, the mean serum albumin was 2.8 g·dL -1 , but in a study by RIEVES et al [25] serum albumin levels were similar to ours. Visceral proteins are considered to reflect the severity of injury and prognosis in critically ill hospitalized patients, but they often do not accurately reflect nutritional status or adequacy of nutritional support [26,27].…”

Section: Discussionmentioning

confidence: 99%

Acute exacerbations in patients with COPD: predictors of need for mechanical ventilation

Vitacca¹,

Clini²,

Porta³

et al. 1996

European Respiratory Journal

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Predictive factors in mechanically-ventilated patients with acute exacerbations of chronic obstructive pulmonary disease (COPD) have been extensively studied but not in spontaneously breathing patients. The aim of this retrospective study was to evaluate the contribution of parameters of respiratory mechanics, clinical and nutritional status in predicting the need for mechanical ventilation (MV) in COPD patients treated with medical therapy for an acute exacerbation.Anthropometric data, Acute Physiology and Chronic Health Evaluation (APACHE) II score, bedside spirometry, breathing pattern, respiratory mechanics and blood gases were measured in 39 COPD patients upon hospital admission for exacerbation of their disease. Fourteen patients in whom MV was necessary were compared with 25 patients in whom medical therapy was enough for a good outcome.The discriminant analysis showed, with decreasing order of power, that nutritional prognostic index (NPI), APACHE II score, forced expiratory volume in one second/forced vital capacity (FEV1/FVC) ratio, vital capacity (VC) (% predicted) and FVC (% pred) provided a significant distinction between the two groups. The discriminant equation considering NPI, and FVC (% pred) could correctly predict the success in 76% of the patients. A multiparametric stepwise regression analysis showed that APACHE II score was significantly correlated with NPI, VC (% pred), pressure time index (PTI) and duty cycle, i.e. fraction of inspiration to duration of total breathing cycle (tI/ttot).In conclusion, underlying general conditions as assessed by malnutrition and APACHE II score were shown to be unfavourable indices of outcome for chronic obstructive pulmonary disease patients who experienced an exacerbation of their disease and were treated with medical therapy. Flow limitation data as assessed by the forced expiratory manoeuvre may provide additional information.

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“…In a large epidemiological study, it was shown that for each 2.5 g/dL decrease in albumin concentration, mortality could be increased by up to 56%. 10 Other studies have also pointed out the association between hypoalbuminemia and mortality, [11][12][13] ventilator dependency, 14,15 poor tolerance to enteral feeding, and ICU length of stay (LOS). 15 The causal link between hypoalbuminemia and this poor prognosis is still a matter of debate.…”

Section: Hypoalbuminemia: Consequencesmentioning

confidence: 99%

“…10 Other studies have also pointed out the association between hypoalbuminemia and mortality, [11][12][13] ventilator dependency, 14,15 poor tolerance to enteral feeding, and ICU length of stay (LOS). 15 The causal link between hypoalbuminemia and this poor prognosis is still a matter of debate. In an unpublished meta-analysis of 86 cohort studies (236,009 patients) interested in hypoalbuminemia as an outcome predictor and 9 prospective studies designed to correct the condition, hypoalbuminemia was found to be a strong predictor of poor outcome (MW Wilkes, personal communication).…”

Section: Hypoalbuminemia: Consequencesmentioning

confidence: 99%

Use of Albumin in the Intensive Care Unit

Dubois

Vincent

2002

Transfus Alt Transfus Med

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( Pa ge 80 )The use of albumin in the critical care setting is a very controversial issue.Although not a new situation, we have seen a renewed interest in this question, especially after the publication of one particular meta-analysis. Much has been said about its publication, but it merits a brief review. Hypoalbuminemia, no longer considered to be "acceptable" or even inevitable in critically ill patients, has also been revisited. We will examine the issue by reviewing studies that have tried to correct the condition, the mechanisms by which it appears and its prognostic value. Finally, a great deal of work has been done to gain a better understanding of albumin and its properties beyond the most commonly accepted, namely maintenance of plasma oncotic pressure. A review of the research will help us to recognize that more randomized controlled trials are warranted. S U M M A R Y DEPARTMENT OF INTENSIVE CARE ERASME HOSPITAL FREE UNIVERSITY OF BRUSSELS BRUSSELS, BELGIUM• Albumin, • Hypoalbuminemia• Meta-analysis• Critical care• Intensive care unit ublication of the Cochrane meta-analysis on the administration of albumin solutions 1 in 1998 generated much debate. The authors concluded that overall relative risk of death in patients receiving albumin solutions was 1.67 compared with non-albumin recipients (Table 1). The study was criticized for many reasons. Not insignificant was the inclusion of studies that did not have mortality as an endpoint, not to mention the heterogeneity of the studies included (different patient populations, different goals in administering albumin, etc). Some studies had 0% mortality in the control group (despite it being highly improbable that a study in an intensive care unit [ICU] setting would result in no mortality) whereas others failed to consider important factors (age, hemodynamic data, etc.).Recently, another meta-analysis on the same issue was published by Wilkes and Navickis 2 in which the authors found no increased risk in mortality when albumin was administered (Table 1). Methodological considerations and inclusion of a larger number of studies could account for this discrepancy. However, the clinician

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Nutritional Assessment of Intensive-Care Unit Patients

Cited by 60 publications

References 27 publications

Mortality and Outcomes in Very Elderly Patients 90 Years of Age or Older Admitted to the ICU

Mortality and Outcomes in Very Elderly Patients 90 Years of Age or Older Admitted to the ICU

Acute exacerbations in patients with COPD: predictors of need for mechanical ventilation

Use of Albumin in the Intensive Care Unit

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