Nutritional assessment in critically ill patients
-
Elnaz Daneshzad
,
Leila Azadbakhat
,
Felorance Neamani
,
Saeid Abasi
,
Fatemeh Shirani
,
Peyman Adibi
Abstract
Background: Nutritional care is of special importance in the control of the rate of mortality among intensive care unit (ICU) patients. Therefore, anthropometric and biochemical assessment are important among ICU patients. We intend to report the anthropometric and biochemical indices, as well as the energy intake among ICU patients in Isfahan, Iran.
Methods: This descriptive study was carried out in Isfahan, Iran on 100 patients admitted to the ICU. Height, weight, mid arm circumference, and energy requirements were measured in this population. Some biochemical factors, such as albumin, creatinine, lymphocytes count, sodium, potassium, phosphorus, and magnesium, were measured twice within a week interval by biochemical tests. Any kind of disease, having infection or bedsore, taking oral ventilation and the kind of nutrition has been assessed in each patient.
Results: Serum albumin level was less than normal range in 67% of patients based on measurements in the first day of staying in ICU. The prevalence increased to 77% in the seventh day of hospitalization in ICU (p = 0.040). There was a significant reduction in the mean of mid arm circumference after 1 week staying in ICU (p = 0.001). There were significant differences between energy intake and the amount of energy requirements in these patients (p = 0.035).
Conclusion: ICU patients have been exposed to lower energy intake compared to their requirements and their mid arm circumference reduced significantly after 1 week staying in hospital. Therefore, they require special nutritional care.
Grigorakos L, Sotiriou E, Markou N, Stratouli S,Boutzouka E, Philntisis G, et al. Combined nutritional support in patients with chronic obstructive pulmonary disease (COPD), under mechanical ventilation (MV). Hepatogastroenterology. 2009; 56(96): 1612-4.
Ahsan B, Khaledi S. Patients prognosis and mortality in intensive care unite of Sanandaj Tohid hospital in 2000. Sci J Kurdistan Univ Med Sci. 2004; 9(2): 20-5. [In Persian].
Apostolopoulou E, Nikoloudi P, Kalafati M, Tsaras K, Katostaras T. Risk factors for ICU mortality in critically ill patients. ICUS NURS WEB J. 2002; 12: 1-7.
Jacobs S, Arnold A, Clyburn PA, Willis BA. The Riyadh intensive care program applied to a mortality analysis of a teaching hospital intensive care unit. Anaesthesia. 1992; 47(9): 775-80.
Donowitz LG. High risk of nosocomial infection in the pediatric critical care patient. Crit Care Med. 1986; 14(1): 26-8.
Abramson NS, Wald KS, Grenvik AN, Robinson D, Snyder JV. Adverse occurrences in intensive care units. JAMA. 1980; 244(14): 1582-4.
Donowitz LG, Wenzel RP, Hoyt JW. High risk of hospital-acquired infection in the ICU patient. Crit Care Med. 1982; 10(6): 355-7.
Wenzel RP, Thompson RL, Landry SM, Russell BS, Miller PJ, Ponce de LS, et al. Hospital- acquired infections in intensive care unit patients: an overview with emphasis on epidemics. Infect Control. 1983; 4(5): 371-5.
Brun-Buisson C, Legrand P, Philippon A,Montravers F, Ansquer M, Duval J. Transferable enzymatic resistance to third-generation cephalosporins during nosocomial outbreak of multiresistant Klebsiella pneumoniae. Lancet. 1987; 2(8554): 302-6.
McWhirter JP, Pennington CR. Incidence and recognition of malnutrition in hospital. BMJ.1994; 308(6934): 945-8.
Hammond K. Assessment: Dietary and clinical data.In: Mahan LK, Escott-Stump S, Editors. Krause's Food & Nutrition Therapy. 12th ed. Philadelphia, PA: Elsevier Saunders; 2008. p. 400, 406.
Demarest L M. Assessment: Laboratory data. In: Mahan LK, Escott-Stump S, Editors. Krause's food & nutrition therapy. Philadelphia, PA:Elsevier Saunders; 2008. p. 415.
Caironi P, Tognoni G, Masson S, Fumagalli R, Pesenti A, Romero M, et al. Albumin replacement in patients with severe sepsis or septic shock. N Engl J Med. 2014; 370: 1412-21.
Lee JW. Fluid and electrolyte disturbances in critically ill patients. Electrolyte Blood Press.2010; 8(2): 72-81.
Wischmeyer PE. Malnutrition in the acutely ill patient: is it more than just protein and energy? S Afr J Clin Nutr. 2011; 24(3): S1-S7.
Yousefzadeh S, Shabbidar S, Dehnadi Moghaddam A, Ahmadi Dafchahi M. Assessment of nutritional support in head trauma patients in neurosurgery intensive care unit. J Gorgan Uni Med Sci. 2007; 9(3): 53-8. [In Persian].
Hoffer LJ, Bistrian BR. Why critically ill patients are protein deprived. JPEN J Parenter Enteral
Nutr. 2013; 37(3): 300-9
Delgado AF, Okay TS, Leone C, Nichols B, del Negro GM, Vaz FA. Hospital malnutrition and inflammatory response in critically ill children and adolescents admitted to a tertiary intensive care unit. Clinics (Sao Paulo). 2008; 63(3): 357-62.
Salehifar E, Ala S, Hosseini H. The study of hospital bavage solution and calorie and protein in take. For patients needs from the special care unit at Imam Khomeini hospital, Sari, Iran during 2005-2006. J Mazandaran Univ Med Sci. 2008;18(64): 81-5. [In Persian].
Nancy F. Butte and Benjamin Caballero. In: Shils ME, Shike M, Editors. Modern nutrition in health and disease. Philadelphia, PA: Lippincott Williams & Wilkins; 2014. p. 93.
Holcombe BJ. Adult parenteral nutrition. In:Koda-Kimble MA, Young LY, Editors. Applied therapeutics: the clinical use of drugs. 7th ed. Philadelphia, PA: Lippincott Williams & Wilkins;2001. p. 35.
Haensch C. Cerebrospinal fluid magnesium level in different neurological disorders. Neuroscience & Medicine. 2010; 1(2): 60-3.
Duly EB, Grimason S, Grimason P, Barnes G, Trinick TR. Measurement of serum albumin by capillary zone electrophoresis, bromocresol green,bromocresol purple, and immunoassay methods. J Clin Pathol. 2003; 56(10): 780-1.
Hough TA, Nolan PM, Tsipouri V, Toye AA, Gray IC, Goldsworthy M, et al. Novel phenotypes identified by plasma biochemical screening in the mouse. Mamm Genome. 2002; 13(10): 595-602.
Ramsay JA, Brown RHJ, Falloon, Falloon SWH.Simultaneous determination of sodium and potassium in small volumes of fluid by flame photometry. J Exp Biol. 1953; 30(1): 19.
Huynh D, Chapman MJ, Nguyen NQ. Nutrition support in the critically ill. Curr Opin Gastroenterol. 2013; 29(2): 208-15.
Weijs PJ, Wischmeyer PE. Optimizing energy and protein balance in the ICU. Curr Opin Clin Nutr Metab Care. 2013; 16(2): 194-201.
Griffiths R, Bongers T. Nutrition support for patients in the intensive care unit. Postgrad Med J.2005; 81(960): 629-36.
Walker RN, Heuberger RA. Predictive equations for energy needs for the critically ill. Respir Care.2009; 54(4): 509-21.
Singer P, Berger MM, van den Berghe G, Biolo G, Calder P, Forbes A, et al. ESPEN guidelines on parenteral nutrition: intensive care. Clin Nutr. 2009; 28(4): 387-400.
Heidegger CP, Berger MM, Graf S, Zingg W, Darmon P, Costanza MC, et al. Optimisation of energy provision with supplemental parenteral nutrition in critically ill patients: a randomised controlled clinical trial. Lancet. 2013; 381(9864):385-93.
Simmer K, Rakshasbhuvankar A, Deshpande G.Standardised parenteral nutrition. Nutrients. 2013;5(4): 1058-70.
Tereran NP, Viski Zanei S, Whitaker IY. Quality of life before admission to the intensive care unit. Rev Bras Ter Intensiva. 2012; 24(4): 341-6.
Honarmand A, Safavi MR. Association between admission hypomagnesemia mortality or mortality of critically ill patients in intensive care unit. Hormozgan Med J. 2008; 12(3): 151-60. [In Persian].
Tong GM, Rude RK. Magnesium deficiency in critical illness. J Intensive Care Med. 2005; 20(1):3-17.
Sungurtekin H, Sungurtekin U, Oner O, Okke D.Nutrition assessment in critically ill patients. Nutr Clin Pract. 2008; 23(6): 635-41.
Thuo N, Ohuma E, Karisa J, Talbert A, Berkley JA, Maitland K. The prognostic value of dipstick urinalysis in children admitted to hospital with severe malnutrition. Arch Dis Child. 2010; 95(6):422-6.
Shahin ES, Dassen T, Halfens RJ. Incidence, prevention and treatment of pressure ulcers in intensive care patients: a longitudinal study. Int J Nurs Stud. 2009; 46(4): 413-21.
Cox J. Predictors of pressure ulcers in adult critical care patients. Am J Crit Care. 2011; 20(5):364-75.
Fraser RJ, Bryant L. Current and future therapeutic prokinetic therapy to improve enteral feed intolerance in the ICU patient. Nutr Clin Pract. 2010; 25(1): 26-31.
Gerasimidis K, Keane O, Macleod I, Flynn DM, Wright CM. A four-stage evaluation of the Paediatric Yorkhill Malnutrition Score in a tertiary paediatric hospital and a district general hospital. Br J Nutr. 2010; 104(5): 751-6.
Mahan L, Escott-Stump S, Raymond JL. Krause's food & the nutrition care process. Oxford, UK: Elsevier Health Sciences, 2012. p. 1085.
Ebrahimi Fakhar H, Salemi Z. Malnutrition of patients in intensive care units of Arak hospitals, in 2009. J Urmia Nurs Midwifery Fac. 2012;10(4): 475-84. [In Persian].
Banks M, Ash S, Bauer J, Gaskill D. Prevalence of malnutrition in adults in Queensland public hospitals and residential aged care facilities. Nutrition & Dietetics. 2007; 64(3): 172-8.
Lee JW. Fluid and electrolyte disturbances in critically ill patients. Electrolyte Blood Press.2010; 8(2): 72-81.
| Files | ||
| Issue | Vol 1, No 3 (Summer 2015) | |
| Section | Original Article(s) | |
| Keywords | ||
| Malnutrition Nutritional assessment Anthropometric indices Intensive care unit patients | ||
| Rights and permissions | |
|
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
