Korean J Nutr.  2011 Oct;44(5):384-393. 10.4163/kjn.2011.44.5.384.

Degree of Nutritional Support and Nutritional Status in MICU Patients

• Chi SN
• Ko JY
• Lee SH
• Lim EH
• Kown KH
• Yoon MS
• Kim ES

• KMID: 2268562
• DOI: http://doi.org/10.4163/kjn.2011.44.5.384

Abstract

The objective of this study was to determine the nutritional support in patients treated in medical intensive care units (MICUs) by evaluating the extent of current nutritional support using the patient care plan and considering the association between nutritional status and the amount of nutrition supplied. From April to December 2010, 114 patients (age > or = 18 years) admitted to the MICU and who underwent nutritional support for > 5 days were included. Descriptive statistics showed that the 114 patients received nutritional support within 1.2 +/- 0.7 days and for 16.2 +/- 11.7 days in the MICUs. The total delivered/required caloric ratio was 81.08 +/- 27.31%, and the protein ratio was 80.32 +/- 28.93%. Patients who received > 80% of required calories and protein showed improved nutritional status (p < 0.05). The results showed that adequate nutritional support is crucial to critically ill patients. We suggest early nutritional screening using simple tools such as periodic monitoring and management to recalculate nutritional status and nutritional requirements and nutritional support using a multidisciplinary method. Systematic nutritional support teams are needed to provide adequate nutritional support for patients in the MICU.

Keyword

nutrition support; nutritional status; calories; protein; intensive care unit

MeSH Terms

Critical Illness
Humans
Intensive Care Units
Mass Screening
Nutritional Requirements
Nutritional Status
Nutritional Support
Patient Care

Reference

1. Heyland DK, Schroter-Noppe D, Drover JW, Jain M, Keefe L, Dhaliwal R, Day A. Nutrition support in the critical care setting: current practice in Canadian ICUs-opportunities for improvement? JPEN J Parenter Enteral Nutr. 2003. 27(1):74–83.

2. McWhirter JP, Pennington CR. Incidence and recognition of malnutrition in hospital. BMJ. 1994. 308(6934):945–948.

3. Giner M, Laviano A, Meguid MM, Gleason JR. In 1995 a correlation between malnutrition and poor outcome in critically ill patients still exists. Nutrition. 1996. 12(1):23–29.

4. Norman K, Pichard C, Lochs H, Pirlich M. Prognostic impact of disease-related malnutrition. Clin Nutr. 2008. 27(1):5–15.

5. Allison SP. Malnutrition, disease, and outcome. Nutrition. 2000. 16(7-8):590–593.

6. Windsor JA, Hill GL. Risk factors for postoperative pneumonia. The importance of protein depletion. Ann Surg. 1988. 208(2):209–214.

7. Heyland DK, MacDonald S, Keefe L, Drover JW. Total parenteral nutrition in the critically ill patient: a meta-analysis. JAMA. 1998. 280(23):2013–2019.

8. Hill GL. Jonathan E. Rhoads Lecture. Body composition research: implications for the practice of clinical nutrition. JPEN J Parenter Enteral Nutr. 1992. 16(3):197–218.

9. Pirlich M, Lochs H. Nutrition in the elderly. Best Pract Res Clin Gastroenterol. 2001. 15(6):869–884.

10. Lee JS, Byeon SH, Park KH, Kown MH, LEE MK, Kim SN, Shin CS, editors. Nutrition status and nutritional support needs in intensive care. Proceedings of the 3th KSPEN conference. 2003 Sep 30; Seoul, Korea.

11. Ra MY, Kim EM, Cho YY, Choi HM, Seo JM, editors. Impact of nutritional support on clinical outcomes in patients. Proceedings of the 3th KSPEN conference. 2003 Sep 30; Seoul, Korea.

12. Hong SK, editor. Nutritional therapy of intensive care. Proceedings of the 8th KSPEN conference. 2009 Aug 21; Seoul, Korea.

13. Dissanaike S, Shelton M, Warner K, O'Keefe GE. The risk for bloodstream infections is associated with increased parenteral caloric intake in patients receiving parenteral nutrition. Crit Care. 2007. 11(5):R114.

14. Krishnan JA, Parce PB, Martinez A, Diette GB, Brower RG. Caloric intake in medical ICU patients: consistency of care with guidelines and relationship to clinical outcomes. Chest. 2003. 124(1):297–305.

15. Pirlich M, Schütz T, Norman K, Gastell S, Lübke HJ, Bischoff SC, Bolder U, Frieling T, Güldensoph H, Hahn K, Jauch KW, Schindler K, Stein J, Volkert D, Weimann A, Werner H, Wolf C, Zürcher G, Bauer P, Lochs H. The German hospital malnutrition study. Clin Nutr. 2006. 25(4):563–572.

16. Heidegger CP, Romand JA, Treggiari MM, Pichard C. Is it now time to promote mixed enteral and parenteral nutrition for the critically ill patient? Intensive Care Med. 2007. 33(6):963–969.

17. Chung HK, Lee SM, Lee JH, Shin CS. Energy deficiency aggravates clinical outcomes of critically ill patients. Korean J Crit Care Med. 2005. 20(1):49–53.

18. An GJ, Baek MY, Kim KO, Kim JE, Woo MH, Lee JH, Gang GR, Jung YM, editors. Degree of enteral tube feeding and nutritional status in the ICU patients. Proceedings of the 5th KSPEN conference. 2006 Sep 22; Seoul, Korea.

19. Knaus WA, Draper EA, Wagner DP, Zimmerman JE. APACHE II: a severity of disease classification system. Crit Care Med. 1985. 13(10):818–829.

20. Del Bufalo C, Morelli A, Bassein L, Fasano L, Quarta CC, Pacilli AM, Gunella G. Severity scores in respiratory intensive care: APACHE II predicted mortality better than SAPS II. Respir Care. 1995. 40(10):1042–1047.

21. Han JS, Lee SM, Chung HK, Ahn HS, Lee SM. Development and evaluation of a Nutritional Risk Screening Tool (NRST) for hospitalized patients. Korean J Nutr. 2009. 42(2):119–127.

22. Kondrup J, Rasmussen HH, Hamberg O, Stanga Z. Ad Hoc ESPEN Working Group. Nutritional risk screening (NRS 2002): a new method based on an analysis of controlled clinical trials. Clin Nutr. 2003. 22(3):321–336.

23. Kondrup J, Allison SP, Elia M, Vellas B, Plauth M. Educational and Clinical Practice Committee, European Society of Parenteral and Enteral Nutrition (ESPEN). ESPEN guidelines for nutrition screening 2002. Clin Nutr. 2003. 22(4):415–421.

24. Brugler L, Stankovic AK, Schlefer M, Bernstein L. A simplified nutrition screen for hospitalized patients using readily available laboratory and patient information. Nutrition. 2005. 21(6):650–658.

25. Bauer J, Capra S, Ferguson M. Use of the scored Patient-Generated Subjective Global Assessment (PG-SGA) as a nutrition assessment tool in patients with cancer. Eur J Clin Nutr. 2002. 56(8):779–785.

26. The Korean Society of Parenteral and Enteral Nutrition. Nutrition support guideline. 2007. Seoul: 9–10.

27. McClave SA, Martindale RG, Vanek VW, McCarthy M, Roberts P, Taylor B, Ochoa JB, Napolitano L, Cresci G. A.S.P.E.N. Board of Directors. American College of Critical Care Medicine. Society of Critical Care Medicine. Guidelines for the provision and assessment of nutrition support therapy in the adult critically ill patient: Society of Critical Care Medicine (SCCM) and American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.). JPEN J Parenter Enteral Nutr. 2009. 33(3):277–316.

28. Gottschlich MM, DeLegge MH, Mattox T, Mueller C, Worthington P, Guenter P. The A.S.P.E.N nutrition support core curriculum. 2007. Maryland: American Society for Parenteral and Enteral Nutrition;493.

29. Gottschlich MM, Matarese LE, Shronts EP. Nutrition support dietetics. 1993. American Society for Parenteral and Enteral Nutrition: Maryland;236–237.

30. Funk KL, Ayton CM. Improving malnutrition documentation enhances reimbursement. J Am Diet Assoc. 1995. 95(4):468–475.

31. Park EK, Lee JH, Lim HS. Degree of enteral tube feeding in the intensive care unit and change in nutritional status. J Korean Diet Assoc. 2001. 7(3):217–226.

32. McClave SA, Martindale RG, Vanek VW, McCarthy M, Roberts P, Taylor B, Ochoa JB, Napolitano L, Cresci G. A.S.P.E.N. Board of Directors. American College of Critical Care Medicine. Society of Critical Care Medicine. Guidelines for the provision and assessment of nutrition support therapy in the adult critically ill patient: Society of Critical Care Medicine (SCCM) and American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.). JPEN J Parenter Enteral Nutr. 2009. 33(3):277–316.

33. Singer P, Berger MM, Van den Berghe G, Biolo G, Calder P, Forbes A, Griffiths R, Kreyman G, Leverve X, Pichard C. ESPEN. ESPEN guidelines on parenteral nutrition: intensive care. Clin Nutr. 2009. 28(4):387–400.

34. De Jonghe B, Appere-De-Vechi C, Fournier M, Tran B, Merrer J, Melchior JC, Outin H. A prospective survey of nutritional support practices in intensive care unit patients: What is prescribed? What is delivered? Crit Care Med. 2001. 29(1):8–12.

35. Rubinson L, Diette GB, Song X, Brower RG, Krishnan JA. Low caloric intake is associated with nosocomial bloodstream infections in patients in the medical intensive care unit. Crit Care Med. 2004. 32(2):350–357.

36. Moon SS, Lim H, Choi JW, Kim DK, Lee JW, Ko S, Kim DC. Analysis of nutritional support status in the intensive care unit. Korean J Crit Care Med. 2009. 24(3):129–133.

37. Choi MS, Kim JN. A study on nutritional status and support in critically ill patients. J Korean Diet Assoc. 1995. 1(1):21–30.

38. Mackenzie SL, Zygun DA, Whitmore BL, Doig CJ, Hameed SM. Implementation of a nutrition support protocol increases the proportion of mechanically ventilated patients reaching enteral nutrition targets in the adult intensive care unit. JPEN J Parenter Enteral Nutr. 2005. 29(2):74–80.

39. Umali MN, Llido LO, Francisco EM, Sioson MS, Gutierrez EC, Navarrette EG, Encarnacion MJ. Recommended and actual calorie intake of intensive care unit patients in a private tertiary care hospital in the Philippines. Nutrition. 2006. 22(4):345–349.