Use of a Nutritional Risk Assessment Tool to Guide Early Enteral Nutrition among Mechanically Ventilated Trauma Patients

Julia Heizmann; Christopher Gross; Chelsea Yap; Mary Anne Walling; Moya Reid; Albert Hsu; Marie Crandall; Jin Ra

doi:10.1016/j.ajmo.2024.100080

Use of a Nutritional Risk Assessment Tool to Guide Early Enteral Nutrition among Mechanically Ventilated Trauma Patients

Am J Med Open. 2024 Nov 22:13:100080. doi: 10.1016/j.ajmo.2024.100080. eCollection 2025 Jun.

Authors

Julia Heizmann¹, Christopher Gross², Chelsea Yap¹, Mary Anne Walling¹, Moya Reid¹, Albert Hsu¹, Marie Crandall¹, Jin Ra³

Affiliations

¹ Department of Surgery, University of Florida College of Medicine - Jacksonville, Jacksonville, FL.
² University of Florida College of Medicine - Gainesville, Gainesville, FL.
³ University of North Carolina School of Medicine at Chapel Hill, Chapel Hill, NC.

Abstract

Background: The Modified Nutritional Risk in Critically Ill (mNUTRIC) score has been proposed as a tool to identify hospitalized patients at risk for malnutrition who may benefit from early enteral nutrition (EN) therapy.

Objective: Our goal was to determine if mNUTRIC scores could predict, at time of intensive care unit admission, which mechanically ventilated trauma patients were at risk for malnutrition and might benefit from early EN, as indicated by reduced mortality.

Methods: We conducted a retrospective chart review of all adult trauma patients requiring mechanical ventilation for at least 48 hours between 01/21/2012 and 12/31/2016, reviewing inpatient medical records, demographic data, disease markers, injury severity, and comorbidities. Bivariate statistics and multivariate regression analyses were used to investigate the correlation between time of EN initiation and mortality rates, as well as the relationship of mNUTRIC scores with EN commencement with early EN initiation being ≤48 hours and malnutrition risk mNUTRIC ≥5.

Results: Among 931 patients reviewed, bivariate analysis showed higher mNUTRIC scores correlated with older, sicker patients and higher mortality. However, multivariate analysis revealed no significant association between higher mNUTRIC scores and increased mortality (OR 1.2, 95% CI 0.7-2.1, p=0.52). Although most patients received EN within 48 hours, there was no association between mNUTRIC score and timing of EN initiation after adjusting for demographic variables and illness severity.

Conclusions: Our findings indicate that while the mNUTRIC score can effectively identify malnutrition risk, it does not meaningfully inform early EN initiation timing nor predict mortality in mechanically ventilated trauma patients.

Keywords: Early parenteral nutrition; Intensive care unit (ICU) patients; Malnutrition; Mechanical ventilation; Surgical intensive care unit (SICU) patients; Trauma patients; mNUTRIC.