# Nutritional Status Disorders and Selected Risk Factors of
## 2 Materials and Methods
### Methods, Techniques, and Research Tools  
The research used the method of retrospective analysis of patients' medical records, using daily observation and laboratory test results, and microbiological cultures from upper respiratory tract excretion. In order to identify pathogens, the material was acquired from the upper respiratory tract using a non-invasive method (by tracheal aspiration) before the inclusion of antibiotics, according to the accepted procedure enforced in the clinical ward of the University Hospital. The obtained material was directly transported to the laboratory in order to obtain microbiological diagnostics. To analyze the nutritional status, the results of the nutritional status assessment based on the NRS-2002 (Nutritional Risk Screening 2002) scale, developed in 2002 by a group of experts from the European Society for Clinical Nutrition and Metabolism (ESPEN), were used. The questionnaire is based on the results of randomized clinical trials, and the assessment is performed in a few stages, covering: risk of under-nutrition, the severity scale of the disease, and the initial and final screening. The risk of under-nutrition is assessed on the current nutritional status and anticipated risk of worsening of the current nutritional status due to the increased demand in the course of the disease, and the resulting increase of energy demand or caused by the surgery. A total of the obtained points > or = 3 means the risk of under-nutrition and the urge to start nutritional support (treatment) [35]. In all patients, at the time of admission, the risk of malnutrition was determined based on the NRS 2002 scale. According to the ESPEN recommendations, due to the patients' clinical conditions, and taking into consideration the results of nutritional status assessment results in the NRS 2002 scale, parenteral nutrition was introduced. Nutrition treatment is prepared according to the clinical condition of patients and their metabolic needs. In the clinical ward where the study was performed, in order to determine caloric demands, a formula was implemented, according to which the aim of nutritional treatment was to provide between 20 and 25 kcal/kg/day for the patient. Non-protein energy from carbohydrates and fats constituted 50-65% of energetic demand. The supply of protein was 1.5-2.5 g/kg/day, and the demand for water calculated per kilogram of body mass was 30-40 mL. In our own studies, to assess the nutritional status of an adult patient admitted into the ICU, the NRS 2002 scale was used, which is recommended by the Polish Ministry of Health (Minister of Health regulation of 1 January 2012 as amended). The study also used the APACHE II (Acute Physiology and Chronic Health Evaluation II) scale, which serves to assess the severity of the conditions of adult patients admitted into intensive care units, and to forecast the mortality risk. The scale allows the assessment of the condition of a patient based on their overview and physiological variables. The scale includes vital parameters, such as: rectal temperature, average blood pressure, heart function, respiratory parameters of mechanically ventilated patients, pH of arterial blood, sodium and potassium ion concentration, creatinine concentration, hemoglobin level, leukocyte count, and the result of assessment in the GCS (Glasgow Coma Score) scale [36]. A database was created using the Microsoft Office Excel calculation sheet containing the information on age, gender, injury mechanism, nutritional status of patients at the time of admission into the ward (total protein and albumin level in blood serum, the number of points in the NRS-2002 scale), the data on inflammatory indicators at the time of admission into the ward (acute phase protein, leukocytes, procalcitonin), the number of points in the APACHE II scale at the time of admission, the day of pneumonia diagnosis, and the epidemiological factor that triggered the inflammation.