Impacting Malnutrition in Critically Ill Patients
Kris Mogensen, MS, RD, LDN, CNSC, team leader and dietitian specialist,
Department of Nutrition
Malnutrition in hospitalized patients has been recognized as a major problem since the 1970s. There are many causes of malnutrition in this population, including poor appetite as a result of illness or medical therapies, prolonged periods without oral nutrition in preparation for tests and procedures, postoperative complications that affect bowel function, and underlying disease that increase a patient’s need for calories and protein. The Department of Nutrition’s inpatient clinical dietitians conduct rigorous nutrition assessments to identify patients with malnutrition or those at risk for developing malnutrition.
There are many small-scale studies that identify malnutrition and the negative outcomes associated with it. Results show that malnourished patients have a high risk for infectious complications, poor healing after surgery, longer stays in the hospital and higher death rates than non-malnourished patients. A limitation of these studies is that malnutrition is not identified in the same way in each study and registered dietitians do not always conduct assessments of nutrition status.
Kris Mogensen, MS, RD, LDN, CNSC, of the Department of Nutrition, has collaborated with Kenneth B. Christopher, MD, of the Renal Division in the Department of Medicine, to evaluate the impact of malnutrition, as assessed by a registered dietitian, on outcomes in critically ill patients.
Approximately 7,700 critically ill patients received a comprehensive nutrition assessment from BWH dietitians from 2004 to 2011. Malnourished patients were found to have a higher likelihood of many conditions, including sepsis, bloodstream infections, acute kidney injury and death. Patients who survived an intensive care unit (ICU) stay also had higher odds of mortality after discharge from the ICU to the floor or a rehabilitation facility if they had preexisting malnutrition. Malnourished patients who are able to be discharged from the hospital after an ICU stay had higher rates of readmission compared to those patients who were not malnourished upon admission to the ICU.
These important findings emphasize the important work of registered dietitians, who carefully assess the nutritional status of their patients and develop tailored nutrition intervention plans based on presence or absence of malnutrition, underlying disease and appropriate route of feeding.