Bond University, 14 University Dr, Robina QLD 4226, Australia.
Gold Coast University Hospital, 1 Hospital Blvd, Southport QLD 4215, Australia; Griffith University, Gold Coast Campus; Parklands Dr, Southport QLD 4215, Australia.
Aust Crit Care. 2020 May;33(3):259-263. doi: 10.1016/j.aucc.2019.08.003. Epub 2019 Nov 1.
The modified NUTrition Risk In the Critically ill (mNUTRIC) score has been demonstrated to accurately quantify the risk of negative patient outcomes and discriminate which patients will benefit the most from nutrition intervention in an intensive care unit (ICU) setting. Calculation of an mNUTRIC score, however, may be time-intensive and unable to be performed within available resources. This may prevent high-risk patients from being identified and reviewed by a dietitian.
The purpose of this study was to assess the feasibility of using the mNUTRIC tool to screen for patients at increased nutrition risk and to determine the proportion of those high-risk patients who were reviewed by a dietitian.
SUBJECTS/METHODS: A retrospective observational study of 260 critically ill patients was conducted between 01/01/2017 and 30/05/2017 in a 20-bed Australian tertiary ICU. Participants included all adults admitted to the ICU for more than 72 h. Feasible implementation was defined as calculating an mNUTRIC score in <5 min per patient where all data were available for >90% of patients.
A median time of 4 min and 54 s (interquartile range: 4.3-5.6 min) was required to calculate each mNUTRIC score, with 96% of scores calculated in <10 min. Data were available to calculate mNUTRIC scores for 93% (241/260) of patients. The mNUTRIC tool identified 81 patients at high nutrition risk, 44% (36/81) of whom were not reviewed by a dietitian. There were 21 high-risk patients who were purposefully excluded from dietetic review for various clinical reasons, leaving 15 high-risk patients (19%) who were not reviewed by a dietitian.
Implementation of the mNUTRIC tool was not feasible in our ICU, given the set dietetic resources (0.6 full-time equivalent). Shared responsibility of nutrition screening or automating the calculation may be possible solutions to increase feasibility of mNUTRIC screening.
改良的营养风险在危重病患者（mNUTRIC）评分已被证明能够准确地量化患者不良结局的风险，并区分出哪些患者将从重症监护病房（ICU）的营养干预中获益最大。然而，计算 mNUTRIC 评分可能需要大量时间，并且无法在可用资源内完成。这可能会阻止高危患者被营养师识别和审查。
本研究的目的是评估使用 mNUTRIC 工具筛查营养风险增加的患者的可行性，并确定这些高危患者中有多少人接受了营养师的审查。
受试者/方法：对 2017 年 1 月 1 日至 2017 年 5 月 30 日期间在澳大利亚 20 张床位的三级 ICU 住院超过 72 小时的 260 名危重病患者进行了回顾性观察研究。参与者包括所有 ICU 住院超过 72 小时的成年人。可行的实施被定义为在每位患者中计算 mNUTRIC 评分的时间<5 分钟，其中所有数据>90%的患者都可获得。
计算每个 mNUTRIC 评分中位数时间为 4 分 54 秒（四分位距：4.3-5.6 分钟），96%的评分在 10 分钟内完成。93%（241/260）的患者有数据可计算 mNUTRIC 评分。mNUTRIC 工具确定了 81 名营养风险较高的患者，其中 44%（36/81）的患者未接受营养师的审查。由于各种临床原因，有 21 名高危患者被故意排除在饮食审查之外，留下 15 名（19%）高危患者未接受营养师的审查。
鉴于我们 ICU 的营养资源（0.6 个全职等效人员），mNUTRIC 工具的实施是不可行的。营养筛查的共同责任或自动化计算可能是提高 mNUTRIC 筛查可行性的解决方案。
