Nutritional risk screening in noninvasively mechanically ventilated critically ill adult patients: A feasibility trial.

BACKGROUND: Malnutrition rates for critically ill patients being admitted to the intensive care unit (ICU) are reported to range from 38% to 78%. Malnutrition in the ICU is associated with increased mortality, morbidity, length of hospital admission, and ICU readmission rates. The high volume of ICU admissions means that efficient screening processes to identify patients at nutritional or malnutrition risk are imperative to appropriately prioritise nutrition intervention. As the proportion of noninvasively mechanically ventilated patients in the ICU increases, the feasibility of using nutrition risk screening tools in this population needs to be established. OBJECTIVES: The aim of this study was to compare the feasibility of using the Malnutrition Universal Screening Tool (MUST) with the modified NUtriTion Risk In the Critically ill (mNUTRIC) score for identifying patients at nutritional or malnutrition risk in this population. METHODS: A single-centre, prospective, descriptive, feasibility study was conducted. The MUST and mNUTRIC tool were completed within 24 h of ICU admission in a convenience sample of noninvasively mechanically ventilated adult patients (≥18 years) by a trained allied health assistant. The number (n) of eligible patients screened, time to complete screening (minutes), and barriers to completion were documented. Data are presented as mean (standard deviation), and the independent samples t-test was used for comparisons between tools. RESULTS: Twenty patients were included (60% men; aged 65.3 [13.9] years). Screening using the MUST took a significantly shorter time to complete than screening using the mNUTRIC tool (8.1 [2.8] vs 22.1 [5.6] minutes; p = 0.001). Barriers to completion included obtaining accurate weight history for the MUST and time taken for collection of information and overall training requirements to perform mNUTRIC. CONCLUSIONS: The MUST took less time and had fewer barriers to completion than mNUTRIC. The MUST may be the more feasible nutrition risk screening tool for use in noninvasively mechanically ventilated critically ill adults.

Severe mucositis: how can nutrition help?

PURPOSE OF REVIEW: To review the recent evidence on the effect of nutrition on the incidence and severity of mucositis following anticancer treatment. RECENT FINDINGS: There have been many recent publications on mucositis and on nutrition in cancer, but very few on nutrition and mucositis in cancer. It is difficult to establish a definite link between nutritional status, nutritional interventions and mucositis. Malnutrition is probably a risk factor for mucositis, however, and some of the interventions that improve nutrition in cancer patients and reduce the risk of cancer in the general population work via mechanisms that might positively affect the development and course of mucositis. Whilst it can be tempting to extrapolate these findings to suggest that nutritional support can reduce the incidence and severity of mucositis, this would be premature. SUMMARY: There may well be a link between nutritional status, nutritional supplementation, anticancer treatment and mucositis, but it is not yet proven; and mechanism-based, prospective, randomized studies are required to answer the question. This is likely to be an area of increased study in the future.