Michael Themessl-Huber

The Patient- And Nutrition-Derived Outcome Risk Assessment Score (PANDORA): Development of a Simple Predictive Risk Score for 30-Day In-Hospital Mortality Based on Demographics, Clinical Observation, and Nutrition.

Objective To develop a simple scoring system to predict 30 day in-hospital mortality of in-patients excluding those from intensive care units based on easily obtainable demographic, disease and nutrition related patient data. Methods Score development with general estimation equation methodology and model selection by P-value thresholding based on a cross-sectional sample of 52 risk indicators with 123 item classes collected with questionnaires and stored in an multilingual online database. Setting Worldwide prospective cross-sectional cohort with 30 day in-hospital mortality from the nutritionDay 2006-2009 and an external validation sample from 2012. Results We included 43894 patients from 2480 units in 32 countries. 1631(3.72%) patients died within 30 days in hospital. The Patient- And Nutrition-Derived Outcome Risk Assessment (PANDORA) score predicts 30-day hospital mortality based on 7 indicators with 31 item classes on a scale from 0 to 75 points. The indicators are age (0 to 17 points), nutrient intake on nutritionDay (0 to 12 points), mobility (0 to 11 points), fluid status (0 to 10 points), BMI (0 to 9 points), cancer (9 points) and main patient group (0 to 7 points). An appropriate model fit has been achieved. The area under the receiver operating characteristic curve for mortality prediction was 0.82 in the development sample and 0.79 in the external validation sample. Conclusions The PANDORA score is a simple, robust scoring system for a general population of hospitalised patients to be used for risk stratification and benchmarking.

Muscle mass, strength and functional outcomes in critically ill patients after cardiothoracic surgery: does neuromuscular electrical stimulation help? The Catastim 2 randomized controlled trial.

BackgroundThe effects of neuromuscular electrical stimulation (NMES) in critically ill patients after cardiothoracic surgery are unknown. The objectives were to investigate whether NMES prevents loss of muscle layer thickness (MLT) and strength and to observe the time variation of MLT and strength from preoperative day to hospital discharge.MethodsIn this randomized controlled trial, 54 critically ill patients were randomized into four strata based on the SAPS II score. Patients were blinded to the intervention. In the intervention group, quadriceps muscles were electrically stimulated bilaterally from the first postoperative day until ICU discharge for a maximum of 14 days. In the control group, the electrodes were applied, but no electricity was delivered. The primary outcomes were MLT measured by ultrasonography and muscle strength evaluated with the Medical Research Council (MRC) scale. The secondary functional outcomes were average mobility level, FIM score, Timed Up and Go Test and SF-12 health survey. Additional variables of interest were grip strength and the relation between fluid balance and MLT. Linear mixed models were used to assess the effect of NMES on MLT, MRC score and grip strength.ResultsNMES had no significant effect on MLT. Patients in the NMES group regained muscle strength 4.5 times faster than patients in the control group. During the first three postoperative days, there was a positive correlation between change in MLT and cumulative fluid balance (r = 0.43, P = 0.01). At hospital discharge, all patients regained preoperative levels of muscle strength, but not of MLT. Patients did not regain their preoperative levels of average mobility (P = 0.04) and FIM score (P = 0.02) at hospital discharge, independent of group allocation.ConclusionsNMES had no effect on MLT, but was associated with a higher rate in regaining muscle strength during the ICU stay. Regression of intramuscular edema during the ICU stay interfered with measurement of changes in MLT. At hospital discharge patients had regained preoperative levels of muscle strength, but still showed residual functional disability and decreased MLT compared to pre-ICU levels in both groups.Trial registrationClinicaltrials.gov identifier NCT02391103. Registered on 7 March 2015.

EFFECTS OF NEUROMUSCULAR ELECTRICAL STIMULATION ON MUSCLE MASS AND STRENGTH IN CRITICALLY ILL PATIENTS AFTER CARDIOTHORACIC SURGERY (CATASTIM 2)

Intensive care unit acquired weakness (ICUAW) affects 24-77% of patients with an ICU stay longer than one week. Neuromuscular electrical stimulation (NMES) is a feasible therapy for neuromuscular activation in sedated patients. The effect of NMES on muscle mass and strength is unclear: Randomized controlled trials (RCT) either showed no effect or beneficial effects [1]. To date, no RCT assessed the effects of NMES in a homogenous cardiothoracic surgery patient population.

SUN-PP059: Which Biochemical Marker are Associated with Increased BMI in Critically Patients? A Nutritionday ICU Analysis

Rationale: In the current critical care nutrition guidelines, the energy delivery formula (25 kcal/kg) does not specify which body weight (BW), i.e. actual (ABW) versus ideal (IBW), should be used to calculate energy delivery. Methods: This is a multi-center, retrospective, observational study. All adult non obese (BMI <30 kg/m2) patients who were admitted to intensive care units (ICUs) were eligible for this study. Patients energy expenditure were estimated using the ESPEN recommendation formula (25 kcal/kg), using ABW and IBW. Results: A total of 160 ICU patients were included in the analysis. The mean BMI were 23.11±3.7 kg/m2. The mean ABW and IBW were 63.3 (±13) and 57.6 (±7) kg, respectively. Using the IBW, the energy expenditure were estimated in mean 1441 (±177) and using ABW 1582 (±318) Kcal, P-value <0.001. Differences of up to 30% below and 47% above were observed when compared the two different weights. Conclusion: Large discrepancies exist in the energy delivery when use ABW or IBW. Further research is needed to determine the influence of this discrepancies in the clinical outcome in ICU.