Screening nutricional en paciente crítico: Nutritional Risk Screening 2002 para detección del riesgo de malnutrición
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Publicado:
ago 2, 2021
Palabras clave:
Enfermedad crítica, nutrición
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Resumen
Resumen:
Objetivos: Describir el riesgo de malnutrición mediante el Nutritional Risk Screening 2002 en pacientes críticos con la clasificación propuesta por expertos. Analizar la asociación utilizando los puntos de corte propuesto del Nutritional Risk Screening 2002 con la mortalidad, días de estancia en la Unidad de Terapia Intensiva y estado nutricional.
Diseño: Estudio de pruebas diagnósticas, estándar de referencia, analítico, observacional y transversal con datos de carácter retrospectivo. Realizado durante noviembre y diciembre de 2019.
Ámbito: Unidad de Terapia Intensiva
Pacientes: Se incluyeron 103 pacientes > 18 años con estancia en la Terapia Intensiva >24 horas. Los criterios de exclusión fueron pacientes en cuidados paliativos y faltantes de las variables analizadas.
Intervenciones: Ninguna
Variables de interés: Datos demográficos, motivo de ingreso, ventilación mecánica, duración ventilación mecánica, días de estancia en la Terapia Intensiva, Nutrition Risk Screening 2002 (riesgo de malnutrición ≥ 3 y alto riesgo ≥ 5), Valoración Global Subjetiva y mortalidad.
Resultados: 49,5% fueron hombres con una edad [mediana (RIQ)] de 58 (47 - 67) años. La mitad (53,4%) presentó alto riesgo de malnutrición y sólo 6,8% no presentó riesgo. El alto riesgo de malnutrición tuvo una asociación estadísticamente significativa con la necesidad de Ventilación Mecánica (<0,05), estancia en la Terapia Intensiva (p 0,001), mortalidad (p 0,003) y estado nutricional según Valoración Global Subjetiva (<0,05).
Discusión: Futuros estudios controlados y aleatorizados deberían desarrollarse en pacientes con alto riesgo de malnutrición para determinar las posibles estrategias nutricionales en pos de prevenir la pérdida de masa muscular, los resultados clínicos desfavorables y la mortalidad asociada a la malnutrición.
Conclusiones: El alto riesgo de malnutrición según los puntos de corte recomendados por expertos permitió distinguir pacientes con malnutrición según Valoración Global Subjetiva, mayor estadía en Terapia Intensiva y mortalidad.
Detalles del artículo
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1.
Gómez E. Screening nutricional en paciente crítico: Nutritional Risk Screening 2002 para detección del riesgo de malnutrición. Rev Arg de Ter Int. [Internet]. 2 de agosto de 2021 [citado 26 de diciembre de 2024];38. Disponible en: https://revista.sati.org.ar/index.php/MI/article/view/750
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1 Mogensen K M, Robinson K R, Casey J, Gunasekera N S, Moromizato T, Rawn J D, et al. Nutritional Status and Mortality in the Critically Ill. Society of Critical Care Medicine 2015. Volume 43- Number 12 https://pubmed.ncbi.nlm.nih.gov/26427592/
2 Lew C, Wong G, Cheung K, Chua A, Chong M, Chua A, et al. Association between Malnutrition and Hospital Mortality and Duration of Intensive Care Unit Admission in the Critically Ill: A Prospective Cohort Study. Nutrients 2018, 10, 10 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5793238/
3 Zheng-Yii L and Heyland D. Determination of Nutrition Risk and Status in Critically Ill Patients: What are our considerations? Nutr Clin Pract. 2019; 34(1):96-111. https://pubmed.ncbi.nlm.nih.gov/30468264/
4 Chin Han Lew C, Yandell R, Fraser RJL, Chua AP, Foong Foong Chong M and Miller M. Association Between Malnutrition and Clinical Outcomes in the Intensive Care Unit: A Systematic Review. J Parenter Enteral Nutr. 2017; 41(5): 744-758. https://pubmed.ncbi.nlm.nih.gov/26838530/
5 Mueller C, Compher C and Ellen DM. A.S.P.E.N clinical guidelines: nutrition screening, assessment and intervention in adults. JPEN. J Parenter Enteral Nutr, 2011. 35(1):16-24. https://pubmed.ncbi.nlm.nih.gov/21224430/
6 Saseedharan, S. Comparison of Nutric Score, Nutritional Risk Screening (NRS) 2002 and Subjective Global Assessment (SGA) in the ICU: a Cohort Study. J. Nutrition Health Food Sci, 2019. https://www.researchgate.net/publication/343354824_Comparison_of_Nutric_Score_Nutritional_Risk_Screening_NRS_2002_and_Subjective_Global_Assessment_SGA_in_the_ICU_a_Cohort_Study
7 Reber E, Gomes F, Vasiloglou M E, Schuetz P and Stanga Z. Nutritional Risk Screening and Assessment. J. Clin. Med. 2019, 8, 1065 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6679209/
8 Dhaliwal R, Cahill N, Lemieux M and Heyland D. The Canadian Critical Care Nutrition Guidelines in 2013: An Update on Current Recommendations and Implementation Strategies. American Society for Parenteral and Enteral Nutrition 2014 Volume 29 Number 1 https://www.researchgate.net/publication/259114498_The_Canadian_Critical_Care_Nutrition_Guidelines_in_2013_An_Update_on_Current_Recommendations_and_Implementation_Strategies
9 Machado dos Reis A, Marchetti J, Forte dos Santos A, Franzosi O and Steemburgo T. NUTRIC Score: Isolated and Combined Use With the NRS-2002 to Predict Hospital Mortality in Critically Ill Patients. Journal of Parenteral and Enteral Nutrition. 2020 https://pubmed.ncbi.nlm.nih.gov/32026516/
10 Kondrup, J. Nutritional risk screening (NRS 2002): a new method based on an analysis of controlled clinical trials. Clinical Nutrition, 2003. 22(3), 321–336. https://pubmed.ncbi.nlm.nih.gov/12765673/
11 McClave SA, Taylor BE, Martindale RG, Warren MM, Johnson DR, Braunschweig C, et al. Guidelines for the Provision and Assessment of Nutrition Support Therapy in the Adult Critically Ill Patient: Society of Critical Care Medicine (SCCM) and American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.) 2016; 40(2):159-211.
https://www.researchgate.net/publication/210254821_Guidelines_for_the_Provision_and_Assessment_of_Nutrition_Support_Therapy_in_the_Adult_Critically_Ill_Patient_Society_of_Critical_Care_Medicine_SCCM_and_American_Society_for_Parenteral_and_Enteral_Nutr
12 Singer, P, Blaser AR, Berger MM , Alhazzani W, Calder PC, Casaer, MP. Et al. ESPEN guideline on clinical nutrition in the intensive care unit. Clinical Nutrition, 2019. 48-79 https://www.espen.org/files/ESPEN-Guidelines/ESPEN_guideline-on-clinical-nutrition-in-the-intensive-care-unit.pdf
13 Elke G, Hartl, WH, Kreymann, KG, Adolph, M, Felbinger, TW, Graf, T, et al. Clinical Nutrition in Critical Care Medicine – Guideline of the German Society for Nutritional Medicine (DGEM). Clinical Nutrition ESPEN. 2019. 220-275 https://clinicalnutritionespen.com/article/S2405-4577(19)30301-8/fulltext
14 Jeejeebhoy KN, Detsky AS, Baker JP. Assessment of nutritional status. J Parenteral Enteral Nutr. 1990; 14 (5 Suppl): S193-S196.
15 Detsky AS, McLaughlin JR, Baker JP, Johnston N, Whittaker S, Mendelson R, Jeejeebhoy K. What is subjective global assessment of nutritional status? JPEN J Parenter Enteral Nutr. 1987; 11 (1): 8–13.
16 WHO. Physical status: the use and interpretation of anthropometry. Report of a WHO Expert Committee. WHO Technical Report Series 854. Geneva: World Health Organization, 1995.
17 Kondrup, J. Nutritional-risk scoring systems in the intensive care unit. Current Opinion in Clinical Nutrition and Metabolic Care, 2014. 17(2), 177–182. https://pubmed.ncbi.nlm.nih.gov/24492670/
18 Wischmeyer, P. Tailoring nutrition therapy to illness and recovery. Critical Care 2017, 21(Suppl 3):316 https://ccforum.biomedcentral.com/articles/10.1186/s13054-017-1906-8
19 Weijs P, Looijaard W, Dekker I, Stapel S, Girbes A, Oudemans-van Straaten H, et al. Low skeletal muscle area is a risk factor for mortality in mechanically ventilated critically ill patients. Critical Care 2014, 18:R12 https://pubmed.ncbi.nlm.nih.gov/24410863/
20 Keys A, Brozek J, Henschel A, Michelsen O and Taylor H. The biology of human starvation. Minneapolis, MN: University of Minnesota Press; 1950.
21 Küçükardali Y , Yazgan Y , Solmazgül E , Sahan B , Kaplan M , Yönem A . Malnutrition screening with the nutritional risk screening 2002 in internal medicine service and the intensive care unit. Anatol J Clin Investig 2008; 2(1):19-24. http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.665.8863&rep=rep1&type=pdf
22 Viana M V, Pantet O, Bagnoud G, Martinez A, Favre E, Charrière M, et al. Metabolic and Nutritional Characteristics of Long-Stay Critically Ill Patients. J. Clin. Med. 2019, 8, 985 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6679172/
23 Marchetti J , Machado dos Reis A, Forte dos Santo A , Stuani Franzosi O , Luft V C, Steemburgo T. High nutritional risk is associated with unfavorable outcomes in patients admitted to an intensive care unit. Rev Bras Ter Intensiva. 2019;31(3):326-332 https://www.scielo.br/scielo.php?pid=S0103-507X2019005010101&script=sci_arttext&tlng=en
24 Rattanachaiwong, S., Zribi, B., Kagan, I., Theilla, M., Heching, M., and Singer, P. Comparison of Nutritional Screening and Diagnostic Tools in Diagnosis of Severe Malnutrition in Critically Ill Patients. Clinical Nutrition. 2020. https://www.clinicalnutritionjournal.com/article/S0261-5614(20)30099-6/fulltext
25 Bin Jie Ph.D. a,b , Zhu-Ming Jiang M.D. a,*, Marie T. Nolan Ph.D. c , Shai-Nan Zhu M.P.H. d , Kang Yu M.S. e , Jens Kondrup M.D. Impact of preoperative nutritional support on clinical outcome in abdominal surgical patients at nutritional risk / Nutrition, 2012. 1022–1027 https://pubmed.ncbi.nlm.nih.gov/22673593/
26 Raslan, M., Gonzalez, M. C., Torrinhas, R. S. M. M., Ravacci, G. R., Pereira, J. C. R., & Waitzberg, D. L. Complementarity of Subjective Global Assessment (SGA) and Nutritional Risk Screening 2002 (NRS 2002) for predicting poor clinical outcomes in hospitalized patients. Clinical Nutrition, 2011. 49e53 https://pubmed.ncbi.nlm.nih.gov/20708310/
27 Bector S, Vagianos K, Suh M and Duerksen D R. Does the Subjective Global Assessment Predict Outcome in Critically Ill Medical Patients?Journal of Intensive Care Medicine 2015. 1(7):485-9. https://pubmed.ncbi.nlm.nih.gov/26188013/
28 Sheean P M, Peterson S J, Gurka D P and Braunschweig C A. Nutrition assessment: the reproducibility of subjective global assessment in patients requiring mechanical ventilation. European Journal of Clinical Nutrition. 2010 64, 1358–1364 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4293521/
29 Maciel LRMA, Franzosi OS, Nunes DSL, Loss SH, Dos Reis AM, Rubin BA, et al. Nutritional Risk Screening 2002 Cut-Off to Identify High-Risk Is a Good Predictor of ICU Mortality in Critically ill Patients. Nutrition in Clinical Practice. 2018. (1):137-141 https://pubmed.ncbi.nlm.nih.gov/30101996/
30 Lew, C. C. H., Yandell, R., Fraser, R. J. L., Chua, A. P., Chong, M. F. F., & Miller, M. Association Between Malnutrition and Clinical Outcomes in the Intensive Care Unit: A Systematic Review. American Society for Parenteral and Enteral Nutrition 2016. 41(5):744-758 https://pubmed.ncbi.nlm.nih.gov/26838530/
31 Pardo E, Behi H, Boizeau P, Verdonk F, Alberti C and Lescot T. Reliability of ultrasound measurements of quadriceps muscle thickness in critically ill patients. BMC Anesthesiology 2018 18:205 https://www.researchgate.net/publication/329960026_Reliability_of_ultrasound_measurements_of_quadriceps_muscle_thickness_in_critically_ill_patients
32 Lopez-Ruiz, Arnaldo, Kashani and KianoushAssessment of muscle mass in critically ill patients: role of the sarcopenia index and images studies. Current Opinion in Clinical Nutrition and Metabolic Care: - Volume 23 302-311 https://www.researchgate.net/publication/329960026_Reliability_of_ultrasound_measurements_of_quadriceps_muscle_thickness_in_critically_ill_patients
33 Looijaard W, Stapel S N, Dekker I, Rusticus C, Remmelzwaal S and Girbes A. Identifying critically ill patients with low muscle mass: Agreement between bioelectrical impedance analysis and computed tomography. Clinical Nutrition 2020 https://www.researchgate.net/publication/335098790_Identifying_critically_ill_patients_with_low_muscle_mass_Agreement_between_bioelectrical_impedance_analysis_and_computed_tomography
34 Looijaard W, Dekker I, Beishuizen A, Girbes A, Oudemans-van Straaten H and Weijs P. Early high protein intake and mortality in critically ill ICU patients Q4 with low skeletal muscle area and –density. Clinical Nutrition 2020 VOLUME 39, ISSUE 7, P2192-2201 https://www.clinicalnutritionjournal.com/article/S0261-5614(19)33067-5/abstract
35 Weijs P, Mogensen K, Rawn J and Christopher K. Protein Intake, Nutritional Status and Outcomes in ICU Survivors: A Single Center Cohort Study. J. Clin. Med. 2019, 8, 43 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6352154/
36 Zanten A, De Waele E and Wischmeye P. Nutrition therapy and critical illness: practical guidance for the ICU, post-ICU, and long-term convalescence phases. Critical Care 2019 23:368 https://ccforum.biomedcentral.com/articles/10.1186/s13054-019-2657-5
37 Koekkoek K, Setten C, Olthof L E and Hans Kars J C. Timing of PROTein INtake and clinical outcomes of adult critically ill patients on prolonged mechanical VENTilation: the PROTINVENT retrospective study. Clinical Nutrition 2017. https://pubmed.ncbi.nlm.nih.gov/29486907/
2 Lew C, Wong G, Cheung K, Chua A, Chong M, Chua A, et al. Association between Malnutrition and Hospital Mortality and Duration of Intensive Care Unit Admission in the Critically Ill: A Prospective Cohort Study. Nutrients 2018, 10, 10 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5793238/
3 Zheng-Yii L and Heyland D. Determination of Nutrition Risk and Status in Critically Ill Patients: What are our considerations? Nutr Clin Pract. 2019; 34(1):96-111. https://pubmed.ncbi.nlm.nih.gov/30468264/
4 Chin Han Lew C, Yandell R, Fraser RJL, Chua AP, Foong Foong Chong M and Miller M. Association Between Malnutrition and Clinical Outcomes in the Intensive Care Unit: A Systematic Review. J Parenter Enteral Nutr. 2017; 41(5): 744-758. https://pubmed.ncbi.nlm.nih.gov/26838530/
5 Mueller C, Compher C and Ellen DM. A.S.P.E.N clinical guidelines: nutrition screening, assessment and intervention in adults. JPEN. J Parenter Enteral Nutr, 2011. 35(1):16-24. https://pubmed.ncbi.nlm.nih.gov/21224430/
6 Saseedharan, S. Comparison of Nutric Score, Nutritional Risk Screening (NRS) 2002 and Subjective Global Assessment (SGA) in the ICU: a Cohort Study. J. Nutrition Health Food Sci, 2019. https://www.researchgate.net/publication/343354824_Comparison_of_Nutric_Score_Nutritional_Risk_Screening_NRS_2002_and_Subjective_Global_Assessment_SGA_in_the_ICU_a_Cohort_Study
7 Reber E, Gomes F, Vasiloglou M E, Schuetz P and Stanga Z. Nutritional Risk Screening and Assessment. J. Clin. Med. 2019, 8, 1065 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6679209/
8 Dhaliwal R, Cahill N, Lemieux M and Heyland D. The Canadian Critical Care Nutrition Guidelines in 2013: An Update on Current Recommendations and Implementation Strategies. American Society for Parenteral and Enteral Nutrition 2014 Volume 29 Number 1 https://www.researchgate.net/publication/259114498_The_Canadian_Critical_Care_Nutrition_Guidelines_in_2013_An_Update_on_Current_Recommendations_and_Implementation_Strategies
9 Machado dos Reis A, Marchetti J, Forte dos Santos A, Franzosi O and Steemburgo T. NUTRIC Score: Isolated and Combined Use With the NRS-2002 to Predict Hospital Mortality in Critically Ill Patients. Journal of Parenteral and Enteral Nutrition. 2020 https://pubmed.ncbi.nlm.nih.gov/32026516/
10 Kondrup, J. Nutritional risk screening (NRS 2002): a new method based on an analysis of controlled clinical trials. Clinical Nutrition, 2003. 22(3), 321–336. https://pubmed.ncbi.nlm.nih.gov/12765673/
11 McClave SA, Taylor BE, Martindale RG, Warren MM, Johnson DR, Braunschweig C, et al. Guidelines for the Provision and Assessment of Nutrition Support Therapy in the Adult Critically Ill Patient: Society of Critical Care Medicine (SCCM) and American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.) 2016; 40(2):159-211.
https://www.researchgate.net/publication/210254821_Guidelines_for_the_Provision_and_Assessment_of_Nutrition_Support_Therapy_in_the_Adult_Critically_Ill_Patient_Society_of_Critical_Care_Medicine_SCCM_and_American_Society_for_Parenteral_and_Enteral_Nutr
12 Singer, P, Blaser AR, Berger MM , Alhazzani W, Calder PC, Casaer, MP. Et al. ESPEN guideline on clinical nutrition in the intensive care unit. Clinical Nutrition, 2019. 48-79 https://www.espen.org/files/ESPEN-Guidelines/ESPEN_guideline-on-clinical-nutrition-in-the-intensive-care-unit.pdf
13 Elke G, Hartl, WH, Kreymann, KG, Adolph, M, Felbinger, TW, Graf, T, et al. Clinical Nutrition in Critical Care Medicine – Guideline of the German Society for Nutritional Medicine (DGEM). Clinical Nutrition ESPEN. 2019. 220-275 https://clinicalnutritionespen.com/article/S2405-4577(19)30301-8/fulltext
14 Jeejeebhoy KN, Detsky AS, Baker JP. Assessment of nutritional status. J Parenteral Enteral Nutr. 1990; 14 (5 Suppl): S193-S196.
15 Detsky AS, McLaughlin JR, Baker JP, Johnston N, Whittaker S, Mendelson R, Jeejeebhoy K. What is subjective global assessment of nutritional status? JPEN J Parenter Enteral Nutr. 1987; 11 (1): 8–13.
16 WHO. Physical status: the use and interpretation of anthropometry. Report of a WHO Expert Committee. WHO Technical Report Series 854. Geneva: World Health Organization, 1995.
17 Kondrup, J. Nutritional-risk scoring systems in the intensive care unit. Current Opinion in Clinical Nutrition and Metabolic Care, 2014. 17(2), 177–182. https://pubmed.ncbi.nlm.nih.gov/24492670/
18 Wischmeyer, P. Tailoring nutrition therapy to illness and recovery. Critical Care 2017, 21(Suppl 3):316 https://ccforum.biomedcentral.com/articles/10.1186/s13054-017-1906-8
19 Weijs P, Looijaard W, Dekker I, Stapel S, Girbes A, Oudemans-van Straaten H, et al. Low skeletal muscle area is a risk factor for mortality in mechanically ventilated critically ill patients. Critical Care 2014, 18:R12 https://pubmed.ncbi.nlm.nih.gov/24410863/
20 Keys A, Brozek J, Henschel A, Michelsen O and Taylor H. The biology of human starvation. Minneapolis, MN: University of Minnesota Press; 1950.
21 Küçükardali Y , Yazgan Y , Solmazgül E , Sahan B , Kaplan M , Yönem A . Malnutrition screening with the nutritional risk screening 2002 in internal medicine service and the intensive care unit. Anatol J Clin Investig 2008; 2(1):19-24. http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.665.8863&rep=rep1&type=pdf
22 Viana M V, Pantet O, Bagnoud G, Martinez A, Favre E, Charrière M, et al. Metabolic and Nutritional Characteristics of Long-Stay Critically Ill Patients. J. Clin. Med. 2019, 8, 985 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6679172/
23 Marchetti J , Machado dos Reis A, Forte dos Santo A , Stuani Franzosi O , Luft V C, Steemburgo T. High nutritional risk is associated with unfavorable outcomes in patients admitted to an intensive care unit. Rev Bras Ter Intensiva. 2019;31(3):326-332 https://www.scielo.br/scielo.php?pid=S0103-507X2019005010101&script=sci_arttext&tlng=en
24 Rattanachaiwong, S., Zribi, B., Kagan, I., Theilla, M., Heching, M., and Singer, P. Comparison of Nutritional Screening and Diagnostic Tools in Diagnosis of Severe Malnutrition in Critically Ill Patients. Clinical Nutrition. 2020. https://www.clinicalnutritionjournal.com/article/S0261-5614(20)30099-6/fulltext
25 Bin Jie Ph.D. a,b , Zhu-Ming Jiang M.D. a,*, Marie T. Nolan Ph.D. c , Shai-Nan Zhu M.P.H. d , Kang Yu M.S. e , Jens Kondrup M.D. Impact of preoperative nutritional support on clinical outcome in abdominal surgical patients at nutritional risk / Nutrition, 2012. 1022–1027 https://pubmed.ncbi.nlm.nih.gov/22673593/
26 Raslan, M., Gonzalez, M. C., Torrinhas, R. S. M. M., Ravacci, G. R., Pereira, J. C. R., & Waitzberg, D. L. Complementarity of Subjective Global Assessment (SGA) and Nutritional Risk Screening 2002 (NRS 2002) for predicting poor clinical outcomes in hospitalized patients. Clinical Nutrition, 2011. 49e53 https://pubmed.ncbi.nlm.nih.gov/20708310/
27 Bector S, Vagianos K, Suh M and Duerksen D R. Does the Subjective Global Assessment Predict Outcome in Critically Ill Medical Patients?Journal of Intensive Care Medicine 2015. 1(7):485-9. https://pubmed.ncbi.nlm.nih.gov/26188013/
28 Sheean P M, Peterson S J, Gurka D P and Braunschweig C A. Nutrition assessment: the reproducibility of subjective global assessment in patients requiring mechanical ventilation. European Journal of Clinical Nutrition. 2010 64, 1358–1364 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4293521/
29 Maciel LRMA, Franzosi OS, Nunes DSL, Loss SH, Dos Reis AM, Rubin BA, et al. Nutritional Risk Screening 2002 Cut-Off to Identify High-Risk Is a Good Predictor of ICU Mortality in Critically ill Patients. Nutrition in Clinical Practice. 2018. (1):137-141 https://pubmed.ncbi.nlm.nih.gov/30101996/
30 Lew, C. C. H., Yandell, R., Fraser, R. J. L., Chua, A. P., Chong, M. F. F., & Miller, M. Association Between Malnutrition and Clinical Outcomes in the Intensive Care Unit: A Systematic Review. American Society for Parenteral and Enteral Nutrition 2016. 41(5):744-758 https://pubmed.ncbi.nlm.nih.gov/26838530/
31 Pardo E, Behi H, Boizeau P, Verdonk F, Alberti C and Lescot T. Reliability of ultrasound measurements of quadriceps muscle thickness in critically ill patients. BMC Anesthesiology 2018 18:205 https://www.researchgate.net/publication/329960026_Reliability_of_ultrasound_measurements_of_quadriceps_muscle_thickness_in_critically_ill_patients
32 Lopez-Ruiz, Arnaldo, Kashani and KianoushAssessment of muscle mass in critically ill patients: role of the sarcopenia index and images studies. Current Opinion in Clinical Nutrition and Metabolic Care: - Volume 23 302-311 https://www.researchgate.net/publication/329960026_Reliability_of_ultrasound_measurements_of_quadriceps_muscle_thickness_in_critically_ill_patients
33 Looijaard W, Stapel S N, Dekker I, Rusticus C, Remmelzwaal S and Girbes A. Identifying critically ill patients with low muscle mass: Agreement between bioelectrical impedance analysis and computed tomography. Clinical Nutrition 2020 https://www.researchgate.net/publication/335098790_Identifying_critically_ill_patients_with_low_muscle_mass_Agreement_between_bioelectrical_impedance_analysis_and_computed_tomography
34 Looijaard W, Dekker I, Beishuizen A, Girbes A, Oudemans-van Straaten H and Weijs P. Early high protein intake and mortality in critically ill ICU patients Q4 with low skeletal muscle area and –density. Clinical Nutrition 2020 VOLUME 39, ISSUE 7, P2192-2201 https://www.clinicalnutritionjournal.com/article/S0261-5614(19)33067-5/abstract
35 Weijs P, Mogensen K, Rawn J and Christopher K. Protein Intake, Nutritional Status and Outcomes in ICU Survivors: A Single Center Cohort Study. J. Clin. Med. 2019, 8, 43 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6352154/
36 Zanten A, De Waele E and Wischmeye P. Nutrition therapy and critical illness: practical guidance for the ICU, post-ICU, and long-term convalescence phases. Critical Care 2019 23:368 https://ccforum.biomedcentral.com/articles/10.1186/s13054-019-2657-5
37 Koekkoek K, Setten C, Olthof L E and Hans Kars J C. Timing of PROTein INtake and clinical outcomes of adult critically ill patients on prolonged mechanical VENTilation: the PROTINVENT retrospective study. Clinical Nutrition 2017. https://pubmed.ncbi.nlm.nih.gov/29486907/