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SCI: Caloric and Protein Needs in Acute and Rehabilitation Phases (2007)

Citation:

Blissitt PA. Nutrition in Acute Spinal Cord Injury. Critical Care Nursing Clinics of North America. 1990;2(3):375-384.

PubMed ID: 2264960
 
Study Design:
Narrative review
Class:
R - Click here for explanation of classification scheme.
Quality Rating:
Negative NEGATIVE: See Quality Criteria Checklist below.
Research Purpose:

To review nutrition as a component of acute spinal cord management for the critical care nurse.

 

Inclusion Criteria:

None given.

Exclusion Criteria:
None given.
Description of Study Protocol:

Recruitment

Methods for study inclusion not specified

Design

Narrative review

Blinding used (if applicable)

Not applicable

Intervention (if applicable)

Not applicable

Statistical Analysis

Statistical analysis not performed

 

Data Collection Summary:

Timing of Measurements

Not applicable

Dependent Variables

Not applicable

Independent Variables

Not applicable

Control Variables

Not applicable

 

 

 

Description of Actual Data Sample:

 Initial N: 46 references cited

Attrition (final N): 46

Age: not applicable

Ethnicity: not applicable

Other relevant demographics: not applicable

Anthropometrics: not applicable

Location: worldwide studies

 

Summary of Results:

Formulas for calculating

  • energy expenditure from oxygen saturation
  • anabolic protein requirement from 24-hour urine nitrogen excretion

Factors affecting nutrition, including:

  • Glucose intolerance
  • Pressure ulcer
  • Anemia
  • Respiratory dysfunction
  • Ileus
  • GI ulcer
  • Neurogenic bowel and bladder
  • Hypercalcemia
  • Depression
  • Medication.

Nutritional Assessment-ABCD

  • Widely accepted guidelines for weight in SCI: Less than the Metropolitan Life Insurance ideal body weight for a given height and frame
    • 10 to 15 lbs. less—paraplegia
    • 15-20 lbs. less—quadriplegia.

 

 

 

 

Author Conclusion:

Prediction of energy needs

  • Harris-Benedict x1.5-1.75 for acute and x1.75-2.0 for SCI with multiple trauma
  • Also notes that the HB may overestimate actual requirement.

Protein requirement

  • 0.8 gm/kg body weight—maintenance
  • 1.0 to 1.5 gm/kg with injury, illness or stress
  • Calorie-to-nitrogen ratio 150:1 for minimum depletion, and 100:1 for multiple trauma.
Funding Source:
University/Hospital: Baptist Memorial of Memphis
Reviewer Comments:

Traditional” review article with no description of search strategy, article selection, or critique of sources cited.

Alternative views and emerging changes based on new studies are noted.

Quality Criteria Checklist: Review Articles
Relevance Questions
  1. Will the answer if true, have a direct bearing on the health of patients? ???
  2. Is the outcome or topic something that patients/clients/population groups would care about? Yes
  3. Is the problem addressed in the review one that is relevant to dietetics practice? Yes
  4. Will the information, if true, require a change in practice? ???
 
Validity Questions
  1. Was the question for the review clearly focused and appropriate? Yes
  2. Was the search strategy used to locate relevant studies comprehensive? Were the databases searched and the search termsused described? ???
  3. Were explicit methods used to select studies to include in the review? Were inclusion/exclusion criteria specified andappropriate? Wereselectionmethods unbiased? No
  4. Was there an appraisal of the quality and validity of studies included in the review? Were appraisal methodsspecified,appropriate, andreproducible? No
  5. Were specific treatments/interventions/exposures described? Were treatments similar enough to be combined? No
  6. Was the outcome of interest clearly indicated? Were other potential harms and benefits considered? ???
  7. Were processes for data abstraction, synthesis, and analysis described? Were they applied consistently acrossstudies and groups? Was thereappropriate use of qualitative and/or quantitative synthesis? Was variation in findings among studies analyzed? Were heterogeneity issued considered? If data from studies were aggregated for meta-analysis, was the procedure described? No
  8. Are the results clearly presented in narrative and/or quantitative terms? If summary statistics are used, are levels ofsignificance and/or confidence intervals included? No
  9. Are conclusions supported by results with biases and limitations taken into consideration? Are limitations ofthe review identified anddiscussed? No
  10. Was bias due to the review's funding or sponsorship unlikely? Yes