ICU Nutrition and criticial care area.pptx

Nutrition in critical care

1. ICU Nutrition Brig Zahid Farooq Baig FCPS (Med), FCPS (Neph), FCPS (CCM) FRCP Edinburgh SCE Neph UK, OJT Neph London

2. Introduction Nutrition support refers to entral or parentral provision of calories, proteins, electrolytes, minerals, vitamins etc Every critically ill patient should be considered at risk for malnutrition after 48 hours in the ICU

3. Risks of Malnutrition Weakness, fatigue Infection Impaired wound healing Diminished organ function Death

4. Approach When – should nutritional support started Which – route should be used What – special precautions should be used How – to terminate parentral nutrition

5. When Medical nutrition therapy shall be considered for all patients staying in the ICU, mainly for more than 48 hours Which route Entral nutrition is the mainstay of treatment Parentral nutrition has role in selected patients

6. What precautions Diabetes mellitus Chronic kidney disease Chronic liver disease Cardiac disease How to terminate PN PN should be replaced by EN whenever possible

7. Assessment Nutritional assessment can be done by ABCD A – Anthopometric Measurements Body weight Mid-arm circumference Skin-fold thickness B – Biochemical tools Hemoglobin Almumin / Prealbumin Transferrin Lymphocyte count

8. C – Clinical assessment Nutritional history Physical examination Loss of subcutaneous fat Ascites/edema D – Dietary assessment Food frequencies Food daily technique

9. Nutrition requirements Nutrition intake recommended is 20 to 30 kcal per kg body weight per day Weight gaining diet Weight maintaining diet Weight reducing diet

10. Entral Feeding

11. Methods Nasogastric tube Naso -duodenal tube Naso-jejunal tube Percutaneous gastrostomy Jejunostomy tube

12. Entral feeding Bolus or intermittent feeding Administration of 200 to 400ml feed every 30 to 60 minutes Continuous feeding Continuous administration over 16 to 24 hours

13. NG tube Advantages Stomach initiates digestion Gastric acid secretion sterilizes gastric content Stomach protects gut from osmotic load Disadvantages Development of gartric atony Risk of aspiration of gastric contents Monitoring of gastric residual volume every 2 to 4 hours is mandatory

14. Complications Gastric retention Vomiting and aspiration Feeding tube obstruction Malposition Dislodgement

15. Parentral Feeding

16. Indications Inadequate oral or entral nutrition Pre-existing severe malnutrition Impaired absorption of nutrient - entero-cutaneous fistula, small bowel obstruction Bowel rest – severe pancreatitis Motility disorders – prolonged ileus

17. Complications Catheter related – pneumothorax Metabolic – azotemia, liver dysfunction, cholestasis , acid base and electrolyte imbalances, hyper/ hypoglycemia Refeeding syndrome Overfeeding

18. Disease specific Liver disease – low sodium and altered amino acid content Renal disease – low phosphate and potassium, low fluid 2 Kcal/ml Respiratory disease – low fat and carbohydrate content reduce CO2

19. Thank You Any Questions???