Identifying Critically Ill Patients at Risk of Malnutrition and Underfeeding: A Prospective Study at an Academic Hospital

Osooli, Fatemeh; Abbas, Saeed A.; Farsaei, Shadi; Adibi, Payman

doi:10.15171/apb.2019.037

Cited by 28 publications

(38 citation statements)

References 28 publications

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“…Special consideration for avoidance of overfeeding in older adult ICU patients should be noted, as individuals who exemplify a malnourished catabolic state are at greater risk 71,87 . As a result, minimizing the likelihood of hyperglycemia, overfeeding, and refeeding syndrome warrants the incorporation of a hypocaloric diet with slow progression to isocaloric, when appropriate, and should be the primary goal of caloric provision in ICU patients, providing sufficient protein is given 77,80 …”

Section: Strategies To Mitigate Muscle Mass Loss In Critically Ill Olmentioning

confidence: 99%

“…Instead, the severity of undernutrition and compromised health status at the time of ICU admission has shown merit for determining optimal feeding strategy 76 . Albeit, complication arises, as undernutrition (in conjunction with the age‐related elevation and ICU‐exacerbated release of procatabolic/anti‐anabolic cytokine) and stress hormones alter metabolism, which contributes toward malnourishment and accelerated muscle loss in this population 77,78 . Nevertheless, previous meta‐analyses focused on identifying the most effective feeding strategy (i.e., enteral vs parenteral) 79 determined that enteral compared with parenteral confers no significant benefit in terms of overall mortality; however, enteral feeding has been shown to reduce rates of ICU‐induced infection and length of ICU stay 79 .…”

Section: Strategies To Mitigate Muscle Mass Loss In Critically Ill Olmentioning

confidence: 99%

“…76 Albeit, complication arises, as undernutrition (in conjunction with the age-related elevation and ICU-exacerbated release of procatabolic/anti-anabolic cytokine) and stress hormones alter metabolism, which contributes toward malnourishment and accelerated muscle loss in this population. 77,78 Nevertheless, previous meta-analyses focused on identifying the most effective feeding strategy (i.e., enteral vs parenteral) 79 determined that enteral compared with parenteral confers no significant benefit in terms of overall mortality; however, enteral feeding has been shown to reduce rates of ICU-induced infection and length of ICU stay. 79 Thus, in general, the best feeding strategy appears to be oral then early enteral then parental then delayed parenteral then delayed enteral, 80 although controversy exists surrounding order of delayed parenteral and delayed enteral.…”

Section: Parenteral Vs Enteralmentioning

confidence: 99%

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Muscle Mass Loss in the Older Critically Ill Population: Potential Therapeutic Strategies

2020

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Skeletal muscle plays a critical role in everyday life, and its age‐associated reduction has severe health consequences. The pre‐existing presence of sarcopenia, combined with anabolic resistance, protein undernutrition, and the pro‐catabolic/anti‐anabolic milieu induced by aging and exacerbated in critical care, may accelerate the rate at which skeletal muscle is lost in patients with critical illness. Advancements in intensive care unit (ICU)–care provision have drastically improved survival rates; therefore, attention can be redirected toward other significant issues affecting ICU patients (e.g., length of stay, days on ventilation, nosocomial disease development, etc.). Thus, strategies targeting muscle mass and function losses within an ICU setting are essential to improve patient‐related outcomes. Notably, loading exercise and protein provision are the most compelling. Many older ICU patients seldom meet the recommended protein intake, and loading exercise is difficult to conduct in the ICU. Nevertheless, the incorporation of physical therapy (PT), neuromuscular electrical stimulation, and early mobilization strategies may be beneficial. Furthermore, a number of nutrition practices within the ICU have been shown to improve patient‐related outcomes ((e.g., feeding strategy [i.e., oral, early enteral, or parenteral]), be hypocaloric (∼70%–80% energy requirements), and increase protein provision (∼1.2–2.5 g/kg/d)). The aim of this brief review is to discuss the dysregulation of muscle mass maintenance in an older ICU population and highlight the potential benefits of strategic nutrition practice, specifically protein, and PT within the ICU. Finally, we provide some general guidelines that may serve to counteract muscle mass loss in patients with critical illness.

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Section: Strategies To Mitigate Muscle Mass Loss In Critically Ill Olmentioning

confidence: 99%

Section: Strategies To Mitigate Muscle Mass Loss In Critically Ill Olmentioning

confidence: 99%

Section: Parenteral Vs Enteralmentioning

confidence: 99%

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Muscle Mass Loss in the Older Critically Ill Population: Potential Therapeutic Strategies

2020

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“…The absence of gut nutrients consequently results in mucosal atrophy, loss of body tissue, skeletal muscle atrophy, general weakness, immunosuppression, and delayed wound healing 4‐6 . Patients with critical illness are at an exceptionally high risk of malnutrition 7‐9 . These patients are more likely to be in a hypermetabolic state because of their acute illness and require nutritional intervention to meet the metabolic demands and replenish energy stores 7 .…”

Section: Introductionmentioning

confidence: 99%

Enteral Nutrition Administration Record Prescribing Process Using Computerized Order Entry: A New Paradigm and Opportunities to Improve Outcomes in Critically Ill Patients

Kamel

Rosenthal

Citty

et al. 2020

J Parenter Enteral Nutr

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Background Prevalence of malnutrition has been reported in 60% of hospitalized and up to 78% of patients admitted to intensive care units. Malnutrition has been associated with complications, such as infection, increased hospital length of stay, morbidity, and mortality. Nutritional support has been shown to reduce avoidable readmissions, pressure ulcers, malpractice claims, and hospital costs. Creating a new electronic nutrition administration record (ENAR) with a linked nutrition tab within the electronic health record (EHR) would promote enhanced patient outcomes by improving adherence to established institutional enteral nutrition (EN) protocols and achieving early energy goals. Additionally, it would enable a clear and standardized method for documentation and administration of EN therapy. Methods The multidisciplinary nutrition support team was established and met on a weekly basis to discuss strategies and barriers, identify stakeholders, evaluate the current state, and establish a process and workflow from the point of order entry, delivery, administration, and electronic documentation of orders of EN supplements. The aim of this article is to describe a systematic approach and process of creating a new ENAR with a linked nutrition tab in the EHR, and to illustrate the order panel built and lessons learned from the process. Results A separate nutrition tab was created in the EHR with minimal disruption in patient care and end‐users’ positive feedback for the new order panel. Conclusion ENAR allows for easier data collection and promotes nutrition‐related research that may result in enhanced patient care. Utilizing technology to build a full ENAR would result in optimized patient care and safety.

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“…Malnutrition is a frequent clinical condition in intensive care units (1), which increases morbidity and mortality (2,3). Appropriate caloric intake in intensive care patients is an important part of treatment (4).…”

Section: Introductionmentioning

confidence: 99%

Retrospective Evaluation of Unstable Patients Fed Parenterally in Intensive Care Unit: Single Center Experience.

Elay¹,

Yardimci²,

Gündoğan³

2020

Eastern J Med

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The aim of this study was to determine the demographic and clinical characteristics of patients fed with total parenteral nutrition who were hemodynamically unstable in the ICU. This study was performed retrospectively in the medical intensive care unit of a university hospital. Information was obtained from the patients' files, the hospital electronic registry system and nutrition unit registration forms. This study included 51 patients. The mean age of the patients was 57 ± 19 years, of the patients 47% were male and 53% were female. When the reasons for total parenteral nutrition were evaluated, it was found that the most common causes of total parenteral nutrition were because of septic shock (47%) and gastrointestinal bleeding (23%). The daily caloric intake of the patients was 1,389 ± 286 kcal, and the target caloric value was 1,824 ± 256. The number of days with mechanical ventilation was 5 (median 0-42), the number of days stayed in the intensive care unit was 9 (median 1-125) and the number of days stayed in the hospital was 13 (median 1-155). The mortality rate of the patients was 71%. Serum albumin levels were found to be lower in patients who died than in those who lived, and these low albumin levels were statistically significant (p=0.015). In this study, it was seen that total parenteral nutrition was most commonly applied to the patients in a state of septic shock who had vasopressor support and to the patients who had gastrointestinal bleeding. In addition, it was determined that the target energy value could not be reached.

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Identifying Critically Ill Patients at Risk of Malnutrition and Underfeeding: A Prospective Study at an Academic Hospital

Cited by 28 publications

References 28 publications

Muscle Mass Loss in the Older Critically Ill Population: Potential Therapeutic Strategies

Muscle Mass Loss in the Older Critically Ill Population: Potential Therapeutic Strategies

Enteral Nutrition Administration Record Prescribing Process Using Computerized Order Entry: A New Paradigm and Opportunities to Improve Outcomes in Critically Ill Patients

Retrospective Evaluation of Unstable Patients Fed Parenterally in Intensive Care Unit: Single Center Experience.

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