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Nutritional assessment in the critically ill

E M Manning1, A Shenkin

  • 1Department of Clinical Chemistry, Royal Liverpool University Hospital, England.

Critical Care Clinics
|July 1, 1995
PubMed
Summary
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No single test reliably assesses nutrition in critically ill patients. While nitrogen balance is useful, advanced methods for body composition are needed for accurate nutritional status evaluation and patient care.

Area of Science:

  • Clinical Nutrition
  • Critical Care Medicine
  • Biochemical Assessment

Background:

  • Nutritional assessment in critically ill patients is challenging due to unreliable indicators.
  • Anthropometrics, skin testing, and plasma proteins lack accuracy or specificity.
  • Existing methods often fail to account for disease state and therapeutic interventions.

Purpose of the Study:

  • To review current methods for nutritional assessment in critically ill patients.
  • To evaluate the utility and limitations of various nutritional indicators.
  • To highlight the need for improved and validated assessment techniques.

Main Methods:

  • Review of anthropometric, biochemical, and body composition measurements.
  • Analysis of nitrogen balance and secretory protein concentrations.

Related Experiment Videos

  • Discussion of advanced techniques like IVNAA and isotopic measurements.

    • Main Results:

    • No single indicator is consistently valuable for initial nutritional assessment.
    • Serial measurements of plasma pre-albumin may monitor nutritional support response.
    • Nitrogen balance is a widely used and valuable indicator, with direct urine nitrogen measurement preferred.
    • Advanced body composition techniques (IVNAA, isotopic) are accurate but costly and less feasible.
    • Biochemical vitamin/mineral levels assess deficiencies but rarely guide initial support decisions.

    Conclusions:

    • Current nutritional assessment methods for critically ill patients have significant limitations.
    • Nitrogen balance remains a key indicator, but improved body composition methods are essential.
    • Further research is needed for validated, sensitive, bedside assessment tools to guide clinical outcomes.