Nutritional status: assessing and understanding its value in the critical care setting

Rodriguez, Les

doi:10.1016/j.ccell.2004.06.009

Cited by 11 publications

(9 citation statements)

References 12 publications

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“…It might be argued that NRSs are unhelpful in ICU as all critically ill patients are at risk of malnutrition and hypercatabolism. However, use of a NRS allows nurses to identify current status, estimate nutritional objectives and plan interventions to prevent the development of malnutrition and associated sequelae (Harrington 2004, Rodriguez 2004). Green and Watson (2005) suggest that, despite the wide number of NRSs, few have been comprehensively validated across a range of patient groups and it is unclear whether such instruments formally assess or screen nutritional status.…”

Section: Discussionmentioning

confidence: 99%

“…In the majority of units the responsibility for assessment of nutritional status rested with physicians (73·6%, n = 262). This means that ICU nurses, who are constantly at the bedside, may fail to develop expertise in recognizing characteristic signs of malnourishment in their patients (Rodriguez 2004). Arguably if nurses participate in reviewing nutritional status of patients daily they can implement appropriate interventions to prevent deterioration.…”

Section: Discussionmentioning

confidence: 99%

“…Arguably if nurses participate in reviewing nutritional status of patients daily they can implement appropriate interventions to prevent deterioration. Educating nurses to assess risk and nutritional status improves patient care and may increase the number of critically ill persons eligible for NS (Rodriguez 2004).…”

Section: Discussionmentioning

confidence: 99%

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A European survey of enteral nutrition practices and procedures in adult intensive care units

Fulbrook¹,

Bongers²,

Albarran³

2007

Journal of Clinical Nursing

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This study is relevant to all nurses working in critical care areas. The findings suggest that when an intensive care unit is supported by a nutritional support team it is more likely that a nutritional score will be used and nutritional assessments will be made daily. Many intensive care practices do not conform to international guidelines for enteral feeding. Nutritional assessment and the use of nutritional risk scores are areas that would benefit from further application in intensive care. This study may provide an impetus for intensive care units to review their nutrition assessment practices and to advance evidence-based guidelines, developed by multi-professional teams, which ensure the safe and effective management of patients receiving enteral nutrition.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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A European survey of enteral nutrition practices and procedures in adult intensive care units

Fulbrook¹,

Bongers²,

Albarran³

2007

Journal of Clinical Nursing

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“…The algorithm was designed to enable senior nursing staff to not only initiate enteral feeding but also set safe and adequate calorific target rates (25–30 kcal/kg) of enteral feed, based upon the patients estimated or recorded body weight. Involving ICU nurses in decisions relating to nutrition support has been shown to positively influence patient outcome through shortened recovery times and reduced length of stay (Rodriguez, 2004).…”

Section: Introductionmentioning

confidence: 99%

Review of ICU nutrition support practices: implementing the nurse‐led enteral feeding algorithm

Dobson

Scott

2007

Nursing in Critical Care

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Many intensive care units (ICUs) have standard feeding protocols which promote safe early initiation of enteral feeding. The use of these protocols has been shown to increase the incidence of enteral feeding and achieve greater adequacy of nutrition support. A multidisciplinary working party developed and implemented a nurse-led enteral feeding algorithm which enabled senior nursing staff to set safe and nutritionally adequate target feed volumes based upon patient body weight. The algorithm incorporated best practice-based referral criteria so that patients at nutritional risk were referred for tailored dietetic assessment. The aims were to determine compliance with the ICU nurse-led enteral feeding algorithm and to ascertain its safety and efficacy. A 3-month prospective audit was conducted by specialist ICU dietitians. Data were obtained from electronic patient records and through observing feeding practices. Data collected included prescribed feed type and infusion rate versus volume received, frequency of gastric aspiration and prokinetic usage. In all, 90% (n = 43) of referrals received by the dietitian met the referral criteria. Absolute compliance with patients receiving correct type and volumes of feed, with a correct feed prescription and an accurate documented weight was just 2% (n = 1). Despite this finding, 60% of patients were actually receiving the correct feed regimen. If the nurse-led enteral feeding algorithm is wholly adhered to, the ICU dietitian need not formally assess every ICU patient. Nursing staff require further support in assessing patient body weight alongside an ongoing intensive educational programme for the multidisciplinary team and regular reaudit.

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“…serum albumin, transferrin, and nitrogen balance studies; (iii) subjective global assessment (SGA) based on medical history and physical examination; patient-generated SGA (PG-SGA) adapted from the SGA specifically for cancer patients; (iv) the malnutrition screening tool (MST), considered the quickest and most simple tool for nutritional screening by the American Society for Parenteral and Enteral Nutrition (ASPEN); (v) Nutritional Risk Screening 2002 (NRS-2002), designed to detect malnutrition and the risk of developing malnutrition in the hospital setting as recommended by the European Society for Clinical Nutrition and Metabolism (ESPEN) [10], and (vi) the Malnutrition Universal Screening Tool (MUST), developed by the British Association for Parenteral and Enteral Nutrition, devised for application in all adult patients across all health care settings [1]. Many other nutritional parameters, including the Prognostic Nutritional Index, the Nutritional Risk Index, the Nutritional Screening Tool, the Maastricht Index, the Instant Nutrition Assessment, and the Mini Nutritional Assessment, have also been used to attempt to risk stratify patients [3,11,12]. The utility of these nutritional screening tools has been evaluated by their ability to predict relevant clinical outcomes, such as complications, treatment response, survival, hospital length of stay (LOS), and higher costs of health care [4,9,13].…”

Section: Introductionmentioning

confidence: 99%

Role of Nutritional Status in Predicting the Length of Stay in Cancer: A Systematic Review of the Epidemiological Literature

et al. 2011

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Background: Length of stay (LOS) has been used as a surrogate marker for patients’ well-being during hospital treatment. We systematically reviewed all pertinent literature on the role of nutritional status in predicting LOS in cancer. Methods: A systematic search of human studies published in English was conducted using the MEDLINE data base (all articles published as of December 2010). We searched using the terms ‘nutritional status’ and ‘nutritional assessment’ and ‘nutritional screening’ and ‘malnutrition’ in combination with the following terms: length of stay, length of hospital stay, duration of stay, and duration of hospitalization together with ‘cancer’ or ‘oncology’. Results: The MEDLINE search identified a total of 149 articles, of which only 21 met the selection criteria. Of the 21 studies, 10 studies investigated gastrointestinal cancer patients, 4 gynecological cancer, and 7 heterogeneous cancer. Eight studies used subjective global assessment (SGA) or patient-generated SGA (PG-SGA), 9 used serum albumin and/or BMI, and 4 used other methods of nutritional assessment. Conclusions: Validated nutritional tools such as SGA/PG-SGA are better predictors of LOS in gastrointestinal cancers requiring surgery than in nonsurgical gastrointestinal cancer patients. Correcting malnutrition may decrease the LOS and perhaps even lower the rate of hospital readmissions in this population.

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Nutritional status: assessing and understanding its value in the critical care setting

Cited by 11 publications

References 12 publications

A European survey of enteral nutrition practices and procedures in adult intensive care units

A European survey of enteral nutrition practices and procedures in adult intensive care units

Review of ICU nutrition support practices: implementing the nurse‐led enteral feeding algorithm

Role of Nutritional Status in Predicting the Length of Stay in Cancer: A Systematic Review of the Epidemiological Literature

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