| dc.description.abstract | Introduction Nutritional therapy in critically ill patients requires recurring assessments to accommodate the increased nutritional demands alongside the decreased tolerance for receiving nutrition in the stress-induced hypermetabolic state. This project aimed to investigate the nutritional status of patients admitted to the intensive care unit at Haukeland University Hospital (HUH) and how this changed during stay. Secondary aims were to estimate nutritional requirements, map the nutritional therapy and to evaluate the compliance to the local nutritional protocol (LNP). Method Data collection for this observational study was done between August 2022 and October 2022 on the intensive care unit at HUH. Information on nutritional status was retrieved from patient journals and charts including body weight, height, and body mass index (BMI). Measurements of mid-upper arm circumference (MUAC) and a bioimpedance analysis (BIA) of body composition were performed by the master student. BIA-parameters of interest were phase angle (PhA) and body cell mass (BCM). These were measured at baseline and compared to new measurements done at discharge. Also, the master student assessed patients for nutritional risk using the Nutrition Risk in the Critically Ill (NUTRIC)-score. Nutritional requirements were estimated by the master student based on the weight and height measurements registered at admission in patients records. The nutritional calculator that has been implemented in the unit was used to estimate nutritional requirements. Requirements were based on 20-30 kcal/kg and 1.3 grams protein/kg body weight per 24 hours, respectively. Information on nutritional therapy was retrieved from patient charts and records. This included registered daily energy and protein intake, non-nutritional energy sources and nutritional delivery methods. The performed nutritional practice was then compared to the LNP. Results Out of 103 eligible patients, 46 (45%) patients were included in the study and 15 (33%) patients had follow-up measurements at discharge in addition to baseline measurements. Most patients were acutely hospitalized, n=35 (76%), and multi-trauma was the most common diagnosis group n=12 (26%). The study population had a majority of males n= 28 (61%), a mean (SD) age of 55 (18) years and mean length of stay (LOS) of 6 (5) days. At admission, 27 (68%) of the population were at high nutritional risk based on PhA and 3 (7%) based on NUTRIC-score. Malnutrition was identified in 4 (9%) patients based on BMI <18.5 kg/m2, 5 (11%) patients based on MUAC <24.5 cm and 17 (37%) patients with a PhA below 4.1. A positive correlation was found between PhA and BCM (r=0.853, p=<0.001) and age had an inverse correlation with PhA (r=-0.425, p=0.003) and BCM (r=-0.262, p=0.049). Finally, LOS had a negative correlation with change in PhA (rs=-0.493, p=0.037) at follow-up. Nutritional adequacy was investigated for 40 patients, whereas 21 patients had a LOS >3 days. According to the LNP, the mean nutritional adequacy after 3 days was 67% for energy and 59% for protein, respectively. Conclusion In this observational study we found that nutritional therapy was inadequate in accommodating the estimated requirements. Nutritional practice followed LNP to some degree, however, nutritional therapy was inconsistent for the majority of the study population. We found a high prevalence of nutritional risk in the population and a decline in nutritional status during stay. Though prevalence of malnutrition both on admission and at follow-up varied with anthropometric measurements, several nutritional parameters such as PhA, BCM and MUAC, were decreased at follow-up. We also found that muscle mass represented by PhA decreased with prolonged LOS. We suggest a dietitian to take part in the interdisciplinary treatment of patients in the intensive care unit to contribute to identifying those at nutritional risk and in securing consistent and adequate nutritional therapy. | |
