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 in Melbourne. He is also a Clinical Adjunct Associate Professor at Monash University. He is a co-founder of the Australia and New Zealand Clinician Educator Network (ANZCEN) and is the Lead for the ANZCEN Clinician Educator Incubator programme. He is on the Board of Directors for the Intensive Care Foundation and is a First Part Examiner for the College of Intensive Care Medicine. He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives.
After finishing his medical degree at the University of Auckland, he continued post-graduate training in New Zealand as well as Australia’s Northern Territory, Perth and Melbourne. He has completed fellowship training in both intensive care medicine and emergency medicine, as well as post-graduate training in biochemistry, clinical toxicology, clinical epidemiology, and health professional education.
He is actively involved in in using translational simulation to improve patient care and the design of processes and systems at Alfred Health. He coordinates the Alfred ICU’s education and simulation programmes and runs the unit’s education website, INTENSIVE. He created the ‘Critically Ill Airway’ course and teaches on numerous courses around the world. He is one of the founders of the FOAM movement (Free Open-Access Medical education) and is co-creator of litfl.com, the RAGE podcast, the Resuscitology course, and the SMACC conference.
His one great achievement is being the father of three amazing children.
On Twitter, he is @precordialthump.
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