Monitoring for Efficacy Outcome Evaluation

The most useful physical measurement of efficacy of EN in the long-term patient is typically body weight. Depending on the clinical situation, the goal may be weight gain, weight maintenance, or weight loss. Whereas day-to-day fluctuations in weight generally reflect fluid changes, week-to-week variations are more useful in determining if caloric provision is appropriate.

The amount of EN actually administered is often less than the amount ordered owing to interruptions in therapy caused by carrying out of procedures and other daily activities, especially in hospitalized patients. It is imperative to monitor volume of feedings actually received and to make adjustments in rates or amounts of EN as necessary.

Biochemical markers may help the SNS practitioner interpret adequacy of the EN therapy. Albumin frequently is measured as part of standard metabolic lab panels. Its long half-life renders this visceral protein less useful for making decisions regarding adequacy of the nutritional prescription over the short term. Prealbumin, with a much shorter half-life that is expected to increase more rapidly in the setting of sufficient calorie and protein provision, has become the major biochemical monitoring parameter used to determine efficacy of SNS. However, in the acute phase of illness characterized by a proinflammatory state, proteins known as acute-phase reactants are preferentially synthesized. One of these acute-phase reactants measured clinically is C-reactive protein (CRP). In some patients with significant illness, prealbumin may not rise, even though the patients are receiving the appropriate EN regimen, until CRP begins to fall. Collection of urine to measure nitrogen balance can help analyze adequacy of caloric and protein provision but must be performed with care to obtain reliable information.

In patients with wounds (e.g., decubitus ulcers), a goal of nutritional therapy is to help facilitate wound healing. Therefore, monitoring the status of the wound becomes part of the ongoing nutritional assessment. In debilitated patients, particularly those on long-term EN, measures of functional status such as grip strength and ability to perform activities of daily living become important parts of the assessment of nutritional adequacy.

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