Anthropometric And Biochemical Assessment Of The Nutritional Status Of Critically Ill Mechanically Ventilated Patients At The Kenyatta National Hospital Critical Care Unit.

Abstract

Background-Nutritional assessment enhances quality of nutritional care, however, its practice bemuses professionals. Malnutrition prevalence among hospitalized adults is approximately 50% and is correlated with prolonged hospital stays, increased healthcare cost, morbidity and mortality. Nutrition assessment should therefore be an integral part of the clinical evaluation and used as a basis for nutritional support. Most modalities however are cumbersome, time consuming & not routinely performed hence malnutrition goes largely unrecognized. Objective:- To determine the incidence and prevalence of malnutrition and to monitor changes in nutritional status among the critically ill mechanically ventilated patients admitted at the Kenyatta National Hospital Critical Care unit (KNH CCU). Study Design-A Prospective cross-sectional observational study. Study Site- Kenyatta National Hospital Critical Care Unit. Sampling-Consecutive sampling of adult critically ill mechanically ventilated patients Study Population-96 critically ill adult patients on mechanical ventilation in KNH CCU. Main outcome measures- Nutritional status of patients on admission and reassessment at 7 & 14 days. Methods-The study was approved by the KNH / U.O.N ethics research committee and data collected over a 4 month period (Jan-April20 1O).Demographic data was obtained by means of a structured questionnaire. Other relevant details e.g. History, diagnosis and investigation results were obtained from the medical files. Nutritional status was determined from anthropometric (MUAC/TSFT) and biochemical parameters (serum albumin). To determine changes in nutritional status during hospital stay, patients were reassessed at 7 & 14 days respectively or until death or discharge. Data was entered into the computer using Epi-info data entry programme and analysed using SPSS version 17.0.The results are presented in tables and figures where applicable. Results- 55.2% of the patients were below 40 years of age. 70.8% of patients were male while 29.2% were female.31.25% of the admissions were for severe head injury. Hypertension was the commonest comorbid illness. Prevalence of hypoalbuminaemia was 63.5%, 85.5% & 86.4% at admission, 7 days & 14 days respectively. Gender had no significant association with degree of changes in albumin levels with a p-value of 0.099.Age showed a significant association with the degree of changes in albumin (p-value-0.041). The incidence of hypoalbuminaemia was 9.4% at 7 days and 14.4% at 14 days. Gender specific incidence was 7.3% at day 7 and 11.4% at day 14 for males but was lower in the females at 2.1% at 7 days and 2.9% at 14 days. High albumin levels of above 5g/dL were noted in 4.2% and 2.4% of the patients at 7 days and 14 days respectively. MUAC values were within normal, but the mean values dropped slightly on follow up. Female patients exhibited higher mean MUAC values (29.9cm) than males (27.5cm) which was statistically significant at a p-value of 0.04. At admission, 27.1 % (26) of the patients had TSFT values within normal, 26% (25) had low values indicating depletion of fat stores and therefore some level of undernutrition. Interestingly, 46.9% (45) of the patients were noted to have above normal skin thickness values. The incidence of low TSFT .values was 1% at 7 days & 4.8% at 14 days showing a slight increase. The mean TSFT values neither showed significant increase nor decrease over the follow-up period. Female patients were noted to have higher mean TSFT values than males.