Martina M. Cartwright, Ph.D., R.D.
Keynote Speaker     Consultant     Author

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malnutrition research 

 critical care nutrition                    malnutrition                    icu-acquired weakness                 hospital complications


Martina M. Cartwright, PhD, RD is a nationally recognized critical care nutrition expert specializing in identification and prevention of hospital-related malnutrition.  She is the only doctoral-trained dietitian specializing in the recognition and treatment of ICU Acquired Weakness (ICU-AW). 

"Patients deserve a commitment to overall care, including nutrition."

Dr. Cartwright has over 20 years experience as a clinician, researcher and scientist in hospital, academia and pharmaceutical industry settings. She has several published articles in peer reviewed medical journals and is a keynote speaker at critical care medical meetings.  Dr. Cartwright is a member of the American Society of Parenteral and Enteral Nutrition (ASPEN) and adjunct professor of nutritional sciences at the University of Arizona. 

Dr. Cartwright's expert malnutrition research services include:

  • Summary and interpretation of medical records
  • Chronological timelines with attention to malnutrition, ICU-AW and related complications including surgical infections, wounds and frailty
  • Evaluation of healthcare practitioner documentation of nutrition related issues and treatment
  • Thorough evidence-based medicine literature searches
  • Assistance in preparation for courtroom evidence

Contact Dr. Cartwright:  martina@martinacartwright.com  or (480) 399-0270

 The latest from Dr. Martina Cartwright on Critical Care Nutrition, Malnutrition and Sepsis:

Malnutrition:
Sepsis press release

FACTS ABOUT HOSPITAL MALNUTRITION

50% of hospitalized patients are malnourished upon admission and 20% receive a nutrition consult1

Elderly patients are at highest risk of pre-admission malnutrition

  • 30-80% of the institutionalized elderly are malnourished1
  • 25% of the free living2-5
  • 76% of Medicare patients are nutritionally compromised with only 34% receiving nutritional consultation1

Nutritional screening is poor and many patients are discharged from the hospital malnourished or even more malnourished 

Malnutrition contributes to6-10:

  • Cost
  • Length of stay
  • Infections
  • Morbidity and mortality

Poor documentation practices by dietitians, nurses and other healthcare practitioners and failure to follow clinical nutrition practice guidelines contribute to malnutrition and its complications

Most critically ill patients require Nutrition Support (tube feeding)11-12

  • Enteral nutrition, or tube feeding into the GI tract, is preferred over Total Parenteral Nutrition (TPN)
  • TPN is more expensive and associated infection and other serious complications
  • TPN is often used inappropriately
  • Enteral nutrition is less expensive, more physiological and preferred if the GI tract is working

66% of enteral feeds are shut off for inappropriate reasons13

Most adult and pediatric patients receive less than 50% of their prescribed nutrition13-14


ICU ACQUIRED WEAKNESS--ICU-AW

ICU-Acquired Weakness is a condition of profound  weakness and fatigue that develops after an ICU stay19

  • 50-60% of ICU patients develop ICU-AW


ICU-AW is characterized by:

  • Profound muscle weakness19
  • Depression20
  • High rates of functional dependencies19-20

50-94% are unable to return to work 1-year post-ICU hospitalization21-22

ICU-AW is rarely recognized or treated leading to increased complications and hospitalizations and an inability to return to work







HOSPITAL MALNUTRITION CONTRIBUTES TO:

  • Pressure ulcers15
  • Frailty and falls16
  • 10 days of bed rest is equal to 15 years of age17
  • Infections16
  • Re-admissions1,18


 


Selected References:

  1. Somanchi M. et al. JPEN 2011;35:209-16
  2. Pitkala K.  Nutritional disorders in the elderly. IN: Evidence Based Medicine Guidelines ed: Kunnamo I. 2005; Wiley & Sons UK. pp695
  3. Thomas D. Clin Geriatr Med. 2002;18(4):XIII
  4. Correia MITD, Waitzberg DL.  Am J Clin Nutr. 2003;22(3):235–23
  5. Lyder C, et al.  Arch Int Med. 2001;161:1549-1554
  6. Norman, K et al. Clin Nutr. 2008;27(1):5-15
  7. Fry, DE et al. Arch Surg. 2010;145:148-151
  8. Stratton RJ et al. Br J Nutr.2006;95:325-330
  9. Braunschweig C. et al. J Am Diet Assoc. 2000;100:1316-1322
  10. Loser, C. Dtsch Artebl Int. 2010;107:911-917
  11. Cartwright MM. Crit Care Nurs Clin North Am. 16(4)467-87, 2004.
  12. McClave S. et al.  JPEN 2009:32:277-316
  13. McClave SA, Sexton LK, Spain DA, et al Crit Care Med. 1999;27:1252-1256
  14. Chwals WJ. Clinical Nutrition Week. 2013. Post graduate course: Nutrition for the practicing pediatric clinician: Metabolic support in critically ill children. Feb 9, 2013. Phoenix AZ.  ASPEN
  15. Demling RH, Stasik L, Zagoren AJ. Protein-energy malnutrition and wounds: nutritional intervention. Treatment of Chronic Wounds Number 10. Hauppauge, NY: Curative Health Services; 2000
  16. Bauer JD et al. J Hum Nutr Diet. 2007;20:558-564.
  17. Evans WJ. Revisiting malnutrition in older adults. Clinical Nutrition Week. Monday February 11, 2013. Dudrick Research Symposium.
  18. Jencks SF, Williams MV, Coleman EA. NEJM 2009; 360:1418-1428
  19. Schweickert WD and Hall J CHEST 2007;121(5):1541-49
  20. Stevens RD et al.  Int Care Med 2007: 33: 1876-91
  21. Herridge MS, et al. N Engl J Med 2003;348(8):683- 693
  22. Unroe M et al. Ann Intern Med. 2010; 53:167-175.

 

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