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    Icu Guidelines: Evidence-Based ICU Feeding Algorithm

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    eryxsp
    This document provides guidelines for evidence-based feeding of patients in the intensive care unit (ICU). It outlines an algorithm for determining if and how a patient should be enterally fed based on their condition at admission and ability to tolerate enteral nutrition. The guidelines describe how to initiate enteral feeding through gastric or post-pyloric tubes, monitor tolerance, and supplement with parenteral nutrition if enteral feeding goals are not met. It also provides guidance on addressing tube feeding-associated diarrhea.

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    Icu Guidelines: Evidence-Based ICU Feeding Algorithm

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    eryxsp
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    This document provides guidelines for evidence-based feeding of patients in the intensive care unit (ICU). It outlines an algorithm for determining if and how a patient should be enterally fed based on their condition at admission and ability to tolerate enteral nutrition. The guidelines describe how to initiate enteral feeding through gastric or post-pyloric tubes, monitor tolerance, and supplement with parenteral nutrition if enteral feeding goals are not met. It also provides guidance on addressing tube feeding-associated diarrhea.

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    This document provides guidelines for evidence-based feeding of patients in the intensive care unit (ICU). It outlines an algorithm for determining if and how a patient should be enterally fed based on their condition at admission and ability to tolerate enteral nutrition. The guidelines describe how to initiate enteral feeding through gastric or post-pyloric tubes, monitor tolerance, and supplement with parenteral nutrition if enteral feeding goals are not met. It also provides guidance on addressing tube feeding-associated diarrhea.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Flag for inappropriate content
    Download as pdf or txt
    15 views2 pages

    Icu Guidelines: Evidence-Based ICU Feeding Algorithm

    Uploaded by

    eryxsp
    This document provides guidelines for evidence-based feeding of patients in the intensive care unit (ICU). It outlines an algorithm for determining if and how a patient should be enterally fed based on their condition at admission and ability to tolerate enteral nutrition. The guidelines describe how to initiate enteral feeding through gastric or post-pyloric tubes, monitor tolerance, and supplement with parenteral nutrition if enteral feeding goals are not met. It also provides guidance on addressing tube feeding-associated diarrhea.

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    of 2

    I C U G U I D EL I N E S

    Evidence-based ICU feeding algorithm


    At ICU admission: Should this patient be fed?

    NO

    YES
    Can EN be started within 24 hours?

    Acceptable conditions: tolerating adequate oral intake < 24 hours to oral intake palliative care

    NO

    YES
    GASTRIC CHALLENGE use full strength concentration Consider prokinetic with challenge GOAL: at least 80% of requirements at 72h assess q12h

    Acceptable conditions: acute pancreatitis* enteric anastomosis* ischemic bowel enteric fistula imminent bowel resection imminent endoscopy bowel obstruction high nasogastric losses on admission severe exacerbation of IBD *may still opt for elemental feeds

    YES NO

    Will at least 80% of requirements be met by 72h?

    NO YES Is Goal met? YES


    Increase rate to 100% Use prokinetic and/or Use post-pyloric tube

    Begin TPN: consider TPN with glutamine Reassess q12h for EN eligibility

    YES

    Is Goal met?

    NO

    Continue EN to Max. tolerated Supplement with PN Continue EN challenges q12h

    Evidence updated by the ANZICS CTG Feeding Investigators Group Oct 28th, 2003. Chief Investigator: Dr. Gordon S. Doig, University of Sydney. Contact: gdoig@med.usyd.edu.au

    ICU GUIDELINES
    Intolerant patients have:
    Clinically significant stools liquid stools > 300ml per day or > 4 loose stools per day or risk of contamination of wounds or catheters readily apparent abdominal distension OR increased abdominal girth OR clinically detected aspiration OR gastric residuals > 200ml for nasogastric feeds
    Is diarrhoea present?

    YES
    Is stool clinically significant?

    Addressing tube feeding associated diarrhoea


    NO
    Continue same enteral feeding

    YES
    Are medications the possible cause?**

    YES
    Change medications, feed to tolerance

    NO
    Is the patient receiving antibiotics?

    YES

    NO
    Consider elemental formulation

    Check stool for C. difficile toxins, feed to tolerance

    ** Medications that commonly cause diarrhoea: metoclopramide aminophyline magnesium erythromycin xylitol phosphorus quinidine sorbital

    Is the diarrhoea resolved?

    YES

    Continue same enteral feeds Advance to goal rate as tolerance improves

    NO
    Decrease rate until tolerance achieved

    Evidence updated by the ANZICS CTG Feeding Investigators Group Oct 28th, 2003. Chief Investigator: Dr. Gordon S. Doig, University of Sydney. Contact: gdoig@med.usyd.edu.au
    19073

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