Nutrition of the Critically Ill Obese Patient
High protein hypocaloric feeding is preferred for critically ill obese patients (supported by SCCM/ ASPEN joint Consensus statement)
Category nutrition
Gastric Residual Volume
Gastric residual volume is the amount aspirated from the stomach following administration of enteral feed. An aspirated amount of ≤ 500ml 6 hourly is safe and indicates that the GIT is functioning
Basal metabolic rate
Basal metabolic rate
Cachexia
Cachexia refers to weight loss and skeletal muscle wasting due to illness where the body does not reduce catabolism (unlike the adaptive reduction in protein metabolism that occurs in starvation). Mechanisms not clearly understood
Daily Nutritional Requirements
Daily Nutritional Requirements
Poor Nutrition in ICU
Poor Nutrition in ICU: the establishment of enteral feeding is considered an important goal
Enteral Nutrition vs Parenteral Nutrition
Enteral Nutrition vs Parenteral Nutrition: controversial issue; at present best recommendations are to optimize oral/enteral nutrition, avoid forced starvation if at all possible, and judiciously use supplemental parenteral nutrition.
Folate Deficiency
Folate Deficiency: 500-20,000 mcg stored in body; required 50-100mcg/day; required for DNA, RNA and protein synthesis (purine, thymidine and amino acid synthesis)
Glucose Control in the Critically Ill
Routine management in ICU involves avoiding complications of hyperglycaemia (infections) and hypoglycaemia (arrhythmias, neurological damage, cardiac events). Traditional goals have varied
Immunonutrition
Immunonutrition involves feeding (enteral or TPN) enriched with various nutrients (arginine, glutamine, omega-3-fatty acids, nucleotides and anti-oxidants: copper, selenium, zinc, vitamins B, C and E) to improve immune responses and modulate inflammatory responses
Indirect Calorimetry and Metabolic Cart
Indirect calorimetry is a technique that measures inspired and expired gas flows, volumes and concentrations of O2 and CO2. The equipment used is also known as a metabolic cart
Intolerance to Enteral Nutrition
OVERVIEW Intolerance to enteral nutrition is characterised by excessive aspirates (>500mL q6h),vomiting, abdominal distension, constipation or diarrhoea CAUSES Patient GORD hiatus hernia gastroparesis/ileus pseudo-obstruction retroperitoneal haematoma/oedema bowel injury bowel ischaemia shock sepsis pancreatitis bowel obstruction hyperglycemia hypoxia / ischemia trauma…