Nutritional status as a predictor of duration of mechanical ventilation in critically ill children

Grippa, Rafaela Bouvie; Silva, Paola S.; Barbosa, Eliana; Bresolin, Nilzete Liberato; Mehta, Nilesh M.; Moreno, Yara Maria Franco

doi:10.1016/j.nut.2016.05.002

Cited by 76 publications

(55 citation statements)

References 25 publications

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“…We have identified no studies in the literature describing this association in critically ill children. Grippa et al 30 observed that upper arm muscle area-for-age besides weight/age and height/age was able to predict the duration of mechanical ventilation in 72 children and adolescents in the PICU, but association with mortality and LOS was not studied. In adults, MUAC was a better mortality predictor compared with BMI in patients with chronic obstructive pulmonary disease, as shown by Soler-Cataluña et al 26 Ravasco et al 5 also observed a higher mortality rate in critically ill adults whose MUAC values were <5th percentile.…”

Section: Discussionmentioning

confidence: 99%

Bioelectrical Impedance Phase Angle and Morbidity and Mortality in Critically Ill Children

et al. 2018

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Background Nutrition markers may be useful for diagnosis and monitoring and, also, as additional indicators of estimating death risk. We tested the association of body composition indicators (mid–upper arm circumference and phase angle) with pediatric intensive care unit (PICU) length of stay and mortality in critically ill pediatric patients. Methods Data from children aged 2 months–18 years were collected, and bioelectrical impedance was performed to obtain phase angle. Severity was evaluated by scoring the Pediatric Index of Mortality. Descriptive statistics were reported for nominal variables. Receiver operating characteristic curve was used to analyze the association of phase angle with 30‐day mortality and to find the best cutoff. Survival probabilities and PICU length of stay were estimated using the Kaplan‐Meier method. Results We evaluated 247 children with a median age of 4.8 years whose main cause of admission was sepsis. Survival curves showed higher survival in patients with phase angle >2.8° compared with patients with phase angle ≤2.8° (P < .0001). Kaplan‐Meier time‐to‐event analysis showed that children with lower phase angle values were more likely to remain in the PICU (hazard ratio, 1.84; P = .003). Lower survival was also observed in patients who presented mid–upper arm circumference values ≤5th percentile (P < .03). Conclusions Mid–upper arm circumference and phase angle were associated with mortality and morbidity in critically ill children, suggesting that these parameters may be useful not only for nutrition diagnosis and monitoring, but also as an additional indicator in estimating prognosis.

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Section: Discussionmentioning

confidence: 99%

Bioelectrical Impedance Phase Angle and Morbidity and Mortality in Critically Ill Children

et al. 2018

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“…Comparisons of these and other studies to each other and to the present study are difficult; however, because of the wide variation in their definitions of malnutrition and the outcomes they measured . One advantage of our study is the use of standardized ASPEN definitions of malnutrition severity, which are derived from expert consensus, conform to World Health Organization (WHO) standard growth curves, and have been used in several patient populations, including critically ill children . Moreover, use of standardized malnutrition definitions allows for appropriate comparisons within groups over time and with other studies utilizing the same methodology .…”

Section: Discussionmentioning

confidence: 99%

“…5,10,11,13,17,25 One advantage of our study is the use of standardized ASPEN definitions of malnutrition severity, which are derived from expert consensus, conform to World Health Organization (WHO) standard growth curves, and have been used in several patient populations, including critically ill children. [26][27][28] Moreover, use of standardized malnutrition definitions allows for appropriate comparisons within groups over time and with other studies utilizing the same methodology. 21 One controversial aspect of the ASPEN criteria that deserves mention, however, is the qualification for malnutrition based on height-for-age z-score alone.…”

Section: Discussionmentioning

confidence: 99%

Impact of ventricular assist device implantation on the nutritional status of children awaiting heart transplantation

Hollander

Schultz

Dennis

et al. 2019

Pediatric Transplantation

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Background Malnutrition is common in pediatric heart failure and is associated with mortality. The effect of VAD support on malnutrition in children is unknown. We sought to compare the prevalence and severity of malnutrition at HT in children on VAD support vs OMT to inform decisions regarding support strategies. Methods Retrospective chart review involving all patients <18 years who underwent HT at Stanford between 1/1/2011 and 3/1/2018. Malnutrition diagnosis and severity were defined by ASPEN guidelines using the lowest age‐adjusted z‐score for weight (WAZ), height (HAZ), and BMI (BMIZ) when the patient was euvolemic. Changes in z‐scores from baseline to HT and across groups were analyzed. Results A total of 104 patients (52 in each group) were included. Among all patients, WAZ (−0.9 vs 0.3, P < 0.001) and BMIZ (0 vs 0.6, P < 0.001) improved while HAZ (−0.9 vs −0.9, P = 0.4) did not. Compared to children on OMT, children on VAD experienced greater increases in WAZ (0.8 vs 0.3, P < 0.001) and BMIZ (0.7 vs 0.2, P < 0.003) at HT. The prevalence of moderate‐to‐severe malnutrition decreased in VAD patients (40% to 19%, P < 0.001) and increased in OMT patients (37% to 46%, P < 0.001), leading to a lower prevalence of moderate‐to‐severe malnutrition at HT (19% vs 46%, P = 0.003). Conclusions Malnutrition is common in pediatric HT candidates. Compared to children on OMT, children on VAD support had greater improvement in nutritional status while awaiting HT, and a lower prevalence of malnutrition at HT.

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“…The 30-day mortality rate was 5.7%, which was related to the lower birth weight, weight, height and WLZ. Several studies have demonstrated that malnourished CHD patients have a longer hospital stay length (25,31). Ross et al (11) in 2017 found that lower WAZ and LAZ have a significant association with postoperative mortality, cardiac arrest, infection, longer mechanical ventilation and ICU stay.…”

Section: Discussionmentioning

confidence: 99%

Nutritional Status in Non-Syndromic Cyanotic Congenital Heart Diseases Patients: A Single Tertiary Center Study in Iran

et al. 2020

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Background:Patients with congenital heart disease (CHD) are susceptible to mild malnutrition up to failure to thrive. The prevalence of malnutrition among patients with CHD is higher in developing countries. Many factors are considered to affect the nutritional status such as cyanosis.Objectives: This study aims to assess the prevalence and severity of malnutrition in patients with CHD prior to the surgical corrective or palliative repair. Methods: This study was performed by reviewing inpatient medical records and cardiac surgery databases of children with cyanotic CHD who underwent palliative or corrective surgery between March 2011 and March 2017. Patients' age and height at the time of surgery, birth weight, duration of intensive care unit (ICU) stay and 30-day mortality were extracted and weight for age z score (WAZ), weight for length z score (WLZ) and length for age z score (LAZ) were calculated. Z scores above -1 were considered as normal, between -1 and -2 as mild, between -2 and -3 as moderate and below -3 as severe malnutrition. Results:In a total number of 639, the average age, weight and height were 16.688 ± 24.859 months, 7.509 ± 5.629 kilograms and 73.759 ± 95.869 centimeters, respectively. The average length of ICU stay was 8.36 ± 6.254 days and the 30-day mortality was 36 (5.7%). The average WAZ, LAZ, WLZ and BMI Z was -1.5 ± 1.69, -0.9 ± 2.38, -1.2 ± 3.97 and -1.4 ± 2.11, respectively. Regarding WAZ, LAZ, WLZ and BMI Z, 62.2%, 46.1%, 72.3% and 70.9% of patients had mild to severe forms of malnutrition, since the rate of malnutrition based on WAZ (P = 0.001), LAZ (P < 0.0001), WLZ (P < 0.0001) and BMI Z (P = 0.007), was significantly higher than normal subjects. Conclusions: The prevalence of mild to severe forms of malnutrition, based on different growth indices, for both cyanotics and acyanotics are higher than those reported in the other previous studies. These findings reflect the fact that cultural, genetic and racial differences of Iranians compared to others, cause malnutrition to be more frequent in Iranian CHD children. This calls for higher requirement of nutritional support for these patients.

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Nutritional status as a predictor of duration of mechanical ventilation in critically ill children

Cited by 76 publications

References 25 publications

Bioelectrical Impedance Phase Angle and Morbidity and Mortality in Critically Ill Children

Bioelectrical Impedance Phase Angle and Morbidity and Mortality in Critically Ill Children

Impact of ventricular assist device implantation on the nutritional status of children awaiting heart transplantation

Nutritional Status in Non-Syndromic Cyanotic Congenital Heart Diseases Patients: A Single Tertiary Center Study in Iran

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