Poor Nutrition in ICU
OVERVIEW
- the establishment of enteral feeding is considered an important goal
ASSESSMENT
- calculation of daily energy requirement (Harris-Benedict Equation)
- assessment of nutritional state
- how much is being absorbed?
- quantify aspirate volumes
- bowel motions or flatus being passed
- how many days has patient being not been fed adequately?
- why is patient not absorbing?
-> N/G in correct position
-> intra-abdominal pathology
-> opioids
-> interruptions of feed for procedures/OT
-> gastric paresis
-> ileus
-> peristalsis present
-> sepsis
-> electrolyte abnormalities
MANAGEMENT
- treat cause of intolerance
- feeding protocol
- educate staff
- reduce times when not feeding
- improve motility (reduce narcotics and anti-cholinergics, add prokinetics)
- consider post-pyloric feeding
- consider TPN
- re-assess Q12 hrly
Critical Care
Compendium
Chris is an Intensivist and ECMO specialist at The Alfred ICU, where he is Deputy Director (Education). He is a Clinical Adjunct Associate Professor at Monash University, the Lead for the Clinician Educator Incubator programme, and a CICM First Part Examiner.
He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives. He was one of the founders of the FOAM movement (Free Open-Access Medical education) has been recognised for his contributions to education with awards from ANZICS, ANZAHPE, and ACEM.
His one great achievement is being the father of three amazing children.
On Bluesky, he is @precordialthump.bsky.social and on the site that Elon has screwed up, he is @precordialthump.
| INTENSIVE | RAGE | Resuscitology | SMACC