NUTRIC score usage

[megan.n...@gmail.com]

The new ASPEN/SCCM critical care guidelines recommend using a nutrition risk score for ICU patients. These scores are fairly difficult to calculate. Is anyone using the NUTRIC or NRS score for ICU patients? How are you utilizing it?

Thank you.

Megan Nordlund, MS, RD

Clinical Nutrition Manager

Harborview Medical Center

Seattle, WA

[michael wintering]

I was doing it for awhile on SICU rounds. The residents would have most of the info already available on the rounds sheets like tmax/min in the last 24 hours.  The MAP would be on the ICU flowsheet (or I would ask the nurse).  This all made the apache calculations easier. 

If I remember correctly you would want a NUTRIC score that correlates with something like a 40% or 60% mortality rate to indicate that early nutrition may benefit the patient.  And so you get a good idea if your patient is going to meet that threshold just by looking at the information at your fingertips and seeing how bad it is.  I don't remember ever having to gather every single data point.

I think the idea is if they are malnourished already, and they are probably going to die based on their APACHE II scores, feeding them ASAP may help. 

What I found was that only a small percentage of our patients (non-trauma SICU) were ill enough to meet the early feeding criteria.  It made my life a lot easier because I wasn't bugging the attending about feeding everyone right away. I also think the rest of the team appreciated an objective reasoning for wanting to feed the most ill person on the unit.

That was my experience, and by no means am I the authority here, but I hope it helps :)

Michael Wintering

RD, CNSC

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