Relationship between Mini Nutritional Assessment Score and Infection in Critical Care Patients

Moghaddam, Omid Moradi; Lahiji, Mohammad Niakan; Panah, Leyla Yazdan; Talebi-Taher, Mahshid; Rajabi, Alireza; Mirhosseini, Seyedeh Farnaz

doi:10.47176/mjiri.36.91

Cited by 3 publications

(3 citation statements)

References 33 publications

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“…Various questionnaires are looked into the prevalence of malnutrition in critically ill patients in different studies [ 20 – 22 ]. To the best of our knowledge, there has not been a study that evaluated and compared five questionnaires simultaneously to examine the incidence of malnutrition; however, different studies find varying malnutrition statuses based on their nutritional screening tools [ 23 – 26 ]. Clinical condition, nutritional screening tool, disease type/severity, and research methodology all explain these variations.…”

Section: Discussionmentioning

confidence: 99%

Relation between nutritional status on clinical outcomes of critically ill patients: emphasizing nutritional screening tools in a prospective cohort investigation

Moghaddam,

Emam,

Irandoost

et al. 2024

BMC Nutr

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Background Malnutrition is a significant concern reported in adult critically ill patients, yet there is no gold standard to assess nutritional status in this population. This study examines the association between nutritional status and clinical outcomes in intensive care unit (ICU) patients using nutritional risk assessment tools and aims to look for the best tool. Method In a single-center prospective cohort study among 165 patients, the predictive performance of high or low malnutrition risk assessed by Nutritional Risk Screening (NRS), Modified Nutrition Risk in Critically Ill (m-NUTRIC), Mini-Nutritional-Assessment Short-Form (MNA-SF), Controlling Nutritional status (CONUT), and Prognostic Nutritional Index (PNI) were evaluated and compared for mortality, organ failure, length of hospitalization, and mechanical ventilation (MV). Results Different assessment tools showed various nutritional statuses. m-NUTRIC and NRS-2002 were found to be associated more strongly relative to other tools with mortality (RR = 1.72; 95% CI, 1.42–2.08) and (RR = 1.37; 95% CI, 1.08–1.72), organ failure (RR = 1.69; 95% CI, 1.44–1.96) and (RR = 1.22; 95% CI, 0.99–1.48), MV (RR = 1.46; 95% CI, 1.27–1.65) and (RR = 1.21; 95% CI, 1.04–1.39) respectively. There was no correlation between malnutrition levels assessed by mentioned tools except for NRS-2002 and length of hospitalization. In predicting mortality or illness severity, the cut points were different for some tools like NUTRIC-score and all assessed outcomes (3.5), MNA-SF and mortality (6.5), CONUT with mortality, and MV (6.5). Conclusions A considerable proportion of patients admitted to the ICU are at high risk for malnutrition. Compared to other tools, m-NUTRIC and NRS-2002 proved superior in predicting clinical outcomes in critically ill patients. Other tools overestimated the risk of malnutrition in the ICU so couldn’t predict clinical outcomes correctly.

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Section: Discussionmentioning

confidence: 99%

Relation between nutritional status on clinical outcomes of critically ill patients: emphasizing nutritional screening tools in a prospective cohort investigation

Moghaddam,

Emam,

Irandoost

et al. 2024

BMC Nutr

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“…The placement of an Avalon Elite catheter should be guided by TEE if transfer to the cardiac catheterization lab is not possible. Enteric feedings should be initiated from the first day of ECMO (19).…”

Section: Discussionmentioning

confidence: 99%

Veno-venous Extracorporeal Membrane Oxygenation: Anesthetic Considerations in Clinical Practice

et al. 2023

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Context: After the COVID-19 pandemic, multiple reviews have documented the success of veno-arterial extracorporeal membrane oxygenation (VA-ECMO). Patients who experience hypoxemia but have normal contractility may be switched to veno-venous-ECMO (VV-ECMO). Purpose: In this review, we present three protocols for anesthesiologists. Firstly, transesophageal echocardiography (TEE) aids in cannulation and weaning off inotropes and fluids. Our main objective is to assist in patient selection for the Avalon Elite single catheter, which is inserted into the right internal jugular vein and terminates in the right atrium. Secondly, we propose appropriate anticoagulant doses. We outline day-to-day monitoring protocols to prevent heparin-induced thrombocytopenia (HIT) or resistance. Once the effects of neuromuscular paralysis subside, sedation should be reduced. Therefore, we describe techniques that may prevent delirium from progressing into permanent cognitive decline. Methods: We conducted a PubMed search using the keywords VV-ECMO, TEE, Avalon Elite (Maquet, Germany), and quetiapine. We combined these findings with interviews conducted with nurses and anesthesiologists from two academic ECMO centers, focusing on anticoagulation and sedation. Results: Our qualitative evidence synthesis reveals how TEE confirms cannulation while avoiding right atrial rupture or low flows. Additionally, we discovered that typically, after initial heparinization, activated partial thromboplastin time (PTT) is drawn every 1 to 2 hours or every 6 to 8 hours once stable. Daily thromboelastograms, along with platelet counts and antithrombin III levels, may detect HIT or resistance, respectively. These side effects can be prevented by discontinuing heparin on day two and initiating argatroban at a dose of 1 μg/kg/min while maintaining PTT between 61 - 80 seconds. The argatroban dose is adjusted by 10 - 20% if PTT is between 40 - 60 or 80 - 90 seconds. Perfusionists assist in establishing protocols following manufacturer guidelines. Lastly, we describe the replacement of narcotics and benzodiazepines with dexmedetomidine at a dose of 0.5 to 1 μg/kg/hour, limited by bradycardia, and the use of quetiapine starting at 25 mg per day and gradually increasing up to 200 mg twice a day, limited by prolonged QT interval. Conclusions: The limitation of this review is that it necessarily covers a broad range of ECMO decisions faced by an anesthesiologist. However, its main advantage lies in the identification of straightforward argatroban protocols through interviews, as well as the discovery, via PubMed, of the usefulness of TEE in determining cannula position and contractility estimates for transitioning from VA-ECMO to VV-ECMO. Additionally, we emphasize the benefits in terms of morbidity and mortality of a seldom-discussed sedation supplement, quetiapine, to dexmedetomidine.

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“…The nutritional needs of patients in ICUs, including energy, are higher than other patients, so malnutrition will be inevitable if proper nutritional care is not provided to them (3). Disease-related malnutrition has detrimental effects on the treatment process and causes an increase in the rate of infections, delayed recovery, prolonged hospital stays, and elevated risk of mortality (4). Various biomarkers, such as low levels of albumin and other plasma proteins, as well as anthropometric measures, such as weight, height, and BMI, are used to define nutritional risk.…”

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confidence: 99%

The Effect of the Use of Planned Entera Meal Solution on Duration of Patients Weaning from Mechanical Ventilator and Length of Stay in the ICU, a Clinical Trial

Javedan,

Asadizaker,

Molavynejad

et al. 2023

Jundishapur J Chronic Dis Care

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Background: Metabolic and nutritional status influences the condition of patients under mechanical ventilation (MV) and determines if they can be disconnected from the ventilator. Objectives: This study was conducted to determine the effect of the planned Entera Meal solution on the duration of weaning patients and the length of intensive care unit (ICU) stay. Methods: In this clinical trial with a pre-test/post-test design, 42 patients admitted to the ICUs of Golestan and Imam Khomeini hospitals of Ahvaz, Iran, who were under MV, were randomly assigned to the two groups of control and intervention. In the intervention group, the Entera Meal solution was used for energy supply. The administration of the solution was started from 50 mL every 3 hours and was scaled up to 30 mL to reach the calculated energy within 48 - 72 hours. For the control group, routine homemade hospital solutions were used. Data were collected by demographic and medical information questionnaires and a checklist for recording outcomes. The data were analyzed using SPSS software version 23. Results: The results showed that the length of ICU stay was significantly affected after the administration of the planned Entera Meal solution (P = 0.004). Although we observed that the duration of weaning patients from MV was shorter in the intervention group than in the control group, this difference was not statistically significant (5.23 ± 4.77 vs. 7.71 ± 6.14 days, P = 0.15). Conclusions: The planned Entera Meal solution reduced the length of ICU hospitalization but did not have a statistically significant effect on the duration of patients weaning from the ventilator.

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Relationship between Mini Nutritional Assessment Score and Infection in Critical Care Patients

Abstract: Energy protein malnutrition is a significant cause of immune system deficiency and increased vulnerability to infection.

Cited by 3 publications

References 33 publications

Relation between nutritional status on clinical outcomes of critically ill patients: emphasizing nutritional screening tools in a prospective cohort investigation

Relation between nutritional status on clinical outcomes of critically ill patients: emphasizing nutritional screening tools in a prospective cohort investigation

Veno-venous Extracorporeal Membrane Oxygenation: Anesthetic Considerations in Clinical Practice

The Effect of the Use of Planned Entera Meal Solution on Duration of Patients Weaning from Mechanical Ventilator and Length of Stay in the ICU, a Clinical Trial

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