Abstract
Patients requiring advanced organ support are often malnourished. A rapid, simple and reasonably accurate method of identifying malnutrition is through the use of a screening tool. Indeed, a nutritional screen is required to complete a full holistic clinical assessment. Organizations such as ESPEN (the European Society for Parenteral and Enteral Nutrition) recommend standardization of nutritional screening (i.e. use of a single tool across a region).
Many tools for nutritional screening have been developed. None have been fully validated for use in the intensive therapy unit (ITU). Moreover, most of these tools consider all critically ill patients to be malnourished or at high risk of malnutrition. However, not all patients in the ITU will benefit from nutritional interventions. For this reason, the Nutrition Risk in Critically ill (NUTRIC) score was developed specifically for patients in ITU. However a recent analysis of the PermiT trial failed to demonstrate any benefit on outcomes associated with the use of the NUTRIC Score. Recommendations on use of a tool for nutritional screening can, therefore, only be based on expert opinion. Those ITUs awaiting a validated tool should adopt a pragmatic approach to identify patients at risk of malnutrition.
For those ITUs that are using a tool for screening it is best if this is used at first contact with the patient by a healthcare professional (e.g. a nurse or a doctor) who is not a specialist in nutrition. Subsequently, recurrent, sequential screening can plot the trajectory of a patient's nutritional status along the timeline of their admission to hospital. This can be continued after step down from ITU to the ward and discharge home. This simple sequential assessment can inform past, present and/or future risk of malnutrition.
The subsequent prevention and treatment of malnutrition depend on the management after screening. Thus a support structure for nutritional interventions (e.g. measurement tools, documentation, follow-up plans) is as important as the tools themselves.