Professional Documents
Culture Documents
Critical Care Nutrition
Critical Care Nutrition
• Enteral
• Parenteral nutrition
History
1913 1939 1967 1990
Dudrick et al.
Henriques and First There was
from the
Anderson successful
University of infection-
administer use of Total related risk
Pennsylvania
Parenteral
hydrolysed demonstrated which saw
Nutrition
protein in that normal a resurgent
(TPN) in
an animal study humans
growth and advocation
development
could occur of enteral
solely with nutrition in
the 1990
administration
of TPN
Targets
Critically ill patients take 1 of 3 trajectories
Immune/ Adipokine/
NeuroEndocrine
Inflammatory Gastrointestinal
Immune/ Adipokine/
NeuroEndocrine
Inflammatory Gastrointestinal
Accelerated catabolism,
Insulin resistance,
• Nasogastric (NGT)
• Jejunal (JT) or Gastric tube (GT).
Nasogastric Tube
• Reducing inflammation
• Enhancing immunity
Gut Dysmotily and Increased Gut
Bacterial Permeability
Overgrowth Bacteria Adhere to
enterocyte which
undergo apoptosis
Toxic Mediators
migrate via
Lymphatics to Activation of Inflammatory
Resultant Dysbiotic
distant organs Mediators
bacteria cause
and Cause
inflammation
injury
EN Timing
• The 2016 American Society of Parenteral and
Enteral Nutrition and Society of Critical Care
Medicine (ASPEN/SCCM) nutrition support
guidelines recommend starting early EN, defined
as within 24 to 48 hours of ICU admission
• Ileus
• Chronic
diarrhoea and vomiting or is extremely
undernourished and needs to have surgery,
chemotherapy and so on
Indications
• Bowel
anastomoses develop
anastomotic leaks in the early
postoperative period
• Hypermetabolic state
secondary to severe sepsis,
extensive full thickness
burns, major fractures ,
polytrauma, major abdominal
trauma
Contraindications
• Anthropometric
• Biochemical
• Immunological
Historical / Clinical
Parameters
• Pre-existing illness
• Weakness
• Oedema
• Uses
• Nutrional Status ( 0 - 3 )
• Severity of Disease ( 0 - 3 )
• Age > 70 - 1
males) = 66.5 + (13.7 x body weight in kg) + (5.0 x height in cm) (6.8 x age in y
emales) = 66.5 + (9.6 x body weight in kg) + (1.7 x height in cm) (4.7 x age in y
• Potassium 1 mEq/kg
• Zinc 5 mg
• copper 1 mg
• chromium 10 mcg
• manganese 0.5 mg
• iron 1-2 mg
Vitamins
• Diarrhea
• Bacterial contamination
• Tube occlusion
• Hypoglycemia
• Metabolic acidosis
• Vitamin deficiency
• Cholestatic jaundice
Complications -
Parenteral
CATHETER RELATED
• Pneumothorax
• Haemothorax
• Air embolism
• Examples
• Chronic Phase
• Recovery Phase
Nutrition in specific
50 conditions - Sepsis
37.5
25
12.5
0
Acute Chronic Recovery
Nutrition in specific
conditions - Sepsis
Acute Phase
Cytokines and
Inflammatory Mediators
Fevers, Proteolysis,
TNF, Interleukins and Lipolysis
and Trigger Anorexia