Department of Nutrition and Dietetics, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Malaysia.
Department of Anesthesiology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
Nutr Clin Pract. 2019 Feb;34(1):96-111. doi: 10.1002/ncp.10214. Epub 2018 Nov 23.
The stress catabolism state predisposes critically ill patients to a high risk of malnutrition. This, coupled with inadequate or delayed nutrition provision, will lead to further deterioration of nutrition status. Preexisting malnutrition and iatrogenic underfeeding are associated with increased risk of adverse complications. Therefore, accurate detection of patients who are malnourished and/or with high nutrition risk is important for timely and optimal nutrition intervention. Various tools have been developed for nutrition screening and assessment for hospitalized patients, but not all are studied or validated in critically ill populations. In this review article, we consider the pathophysiology of malnutrition in critical illness and the currently available literature to develop recommendations for nutrition screening and assessment. We suggest the use of the (modified) Nutrition Risk in the Critically Ill (mNUTRIC) for nutrition risk screening and the subjective global assessment (SGA) together with other criteria relevant to the critically ill patients, such as gastrointestinal function, risk of aspiration, determination of sarcopenia and frailty, and risk of refeeding syndrome for nutrition assessment. Further research is needed to identify suitable nutrition monitoring indicators to determine the response to the provision of nutrition.
应激分解代谢状态使危重症患者面临高营养不良风险。再加上营养供给不足或延迟，将导致营养状况进一步恶化。预先存在的营养不良和医源性喂养不足与不良并发症风险增加相关。因此，准确识别营养不良和/或高营养风险的患者对于及时和最佳的营养干预非常重要。已经开发了各种用于住院患者营养筛查和评估的工具，但并非所有工具都在危重症人群中进行了研究或验证。在这篇综述文章中，我们考虑了危重病中营养不良的病理生理学，并根据现有文献为营养筛查和评估提出建议。我们建议使用（改良）危重病营养风险指数（mNUTRIC）进行营养风险筛查，以及主观整体评估（SGA），同时结合其他与危重症患者相关的标准，如胃肠道功能、误吸风险、确定肌少症和脆弱性，以及再喂养综合征风险，以进行营养评估。需要进一步研究以确定合适的营养监测指标，以确定对营养供给的反应。
