Nutritional-risk scoring systems in the intensive care unit

There is a need to develop a screening tool to assist clinical staff in deciding whether or not a patient in the ICU should be given nutrition support. The purpose of this review is to analyze the recent randomized trials in this context.

Five trials describe the effect of early supplemental parenteral nutrition. Four of these trials suggested a positive effect on clinical outcome. The results, including lengths of stay in the ICU (range on average: 3-17 days) and lengths of mechanical ventilation (range on average: 2-11 days), are discussed within the nutritional and metabolic framework of patients in intensive care. The limitations of existing screening tools, Nutritional Risk Screening 2002 (NRS 2002) and Nutrition risk in the critically ill (NUTRIC score) are described, and it also appears that the APACHE II score is not useful for predicting a possible benefit of nutrition support.

As a tentative conclusion, it is recommended to provide adequate nutrition support to severely ill patients who are likely to stay in the ICU with mechanical ventilation for a week or more.