Nutrition in Critical Care
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Questions and Answers

What is the recommended daily protein intake for critically ill patients with a BMI of 30-40?

  • 3.0 g/kg ideal body weight/day
  • 2.5 g/kg ideal body weight/day
  • 2.0 g/kg ideal body weight/day (correct)
  • 1.5 g/kg ideal body weight/day

    • Which of the following is a limitation of enteral nutrition in the acute disease phase?

  • Lower risk of hyperglycemia
  • Higher nutritional adequacy
  • Potential lower nutritional adequacy (correct)
  • Fewer infectious complications

    • What is the primary benefit of enteral nutrition over parenteral nutrition?

  • More physiologic and better nutritional adequacy
  • Fewer infectious complications
  • Lower risk of hyperalimentation
  • More physiologic and providing nutritional benefits without adversely affecting gut integrity (correct)

    • Which of the following is NOT a sign of malnutrition?

    <p>Muscle hypertrophy</p> Signup and view all the answers

    What is the primary challenge of parenteral nutrition?

    <p>Infectious complications and hyperalimentation</p> Signup and view all the answers

    What is the recommended daily protein intake for critically ill patients with a BMI of ≥40?

    <p>2.5 g/kg ideal body weight/day</p> Signup and view all the answers

    What is a crucial factor in determining the route of feed administration in a critically ill patient?

    <p>Hemodynamic status and gastrointestinal functioning</p> Signup and view all the answers

    What is the primary benefit of early enteral nutrition (EEN) in critically ill patients?

    <p>Reducing the risk of complications</p> Signup and view all the answers

    What is the recommended timeframe for initiating feeding in a critically ill patient who is not on vasopressor?

    <p>Within 24-48 hours</p> Signup and view all the answers

    Why is it essential to assess abdominal sounds in a critically ill patient?

    <p>To monitor the patient's bowel function</p> Signup and view all the answers

    What is a critical factor affecting patient outcomes in the ICU?

    <p>Appropriate timing of initiation, amount, and type of nutrition</p> Signup and view all the answers

    What is the primary goal of early nutrition intervention in critically ill patients?

    <p>To reduce the risk of complications</p> Signup and view all the answers

    What is the preferred method of feeding for patients who cannot eat?

    <p>Enteral feeding</p> Signup and view all the answers

    Which route is recommended as the first choice for enteral feeding?

    <p>NG route</p> Signup and view all the answers

    Why may some patients require post-pyloric feeding?

    <p>Due to delayed gastric emptying and poor intestinal motility</p> Signup and view all the answers

    What is a risk factor for the development of Clostridium difficile colitis?

    <p>Long-term enteral feeding with elemental diets</p> Signup and view all the answers

    What is a challenge when using hospital-prepared blenderized feeds?

    <p>Maintaining microbial quality within published standards of safety</p> Signup and view all the answers

    What is more likely to occur with homemade or blenderized feeds compared to scientific feeds?

    <p>Contamination and batch-to-batch inconsistency</p> Signup and view all the answers

    When should supplemental PN be considered in critically ill patients?

    <p>At the end of the 1st week after ICU admission</p> Signup and view all the answers

    What is the recommended route for enteral feeding?

    <p>NG route</p> Signup and view all the answers

    How should the NGT be measured for tube feeding?

    <p>From the tip of the nose to the tip of the ear, then to the xiphoid process</p> Signup and view all the answers

    What is the minimum caloric target that EN support should deliver?

    <p>60%</p> Signup and view all the answers

    When should total PN be considered?

    <p>In patients with septic shock, critically ill</p> Signup and view all the answers

    What is the preferred method of formula feeding?

    <p>Continuous formula feeding with pumps or gravity bags</p> Signup and view all the answers

    What is the primary goal of nutritional support in critical illness?

    <p>To prevent or reverse malnutrition and attenuate detrimental effects on nutritional state</p> Signup and view all the answers

    When should nutritional therapy be started in critical illness?

    <p>As soon as possible and certainly within the first week of critical illness</p> Signup and view all the answers

    What is the maximum volume of gastric residual volume (GRV) recommended by the ASPEN guidelines 2016 as a cutoff for EN tolerance?

    <p>500ml</p> Signup and view all the answers

    What is the primary consequence of nonuniformity of nutritional protocols in critical illness?

    <p>Increased morbidity and prolonged stay in ICU</p> Signup and view all the answers

    What is the purpose of daily monitoring of nutritional therapy in critical illness?

    <p>To identify factors that might affect the desired volume and total energy of the prescribed diet</p> Signup and view all the answers

    What medication can be used to manage nutrition intolerance in critical illness?

    <p>Metoclopramide or erythromycin</p> Signup and view all the answers

    Study Notes

    • Recommended daily protein intake for critically ill patients with a BMI of 30-40 is 1.2 to 2.0 g/kg of adjusted body weight.
    • For critically ill patients with a BMI of ≥40, the suggested intake is also 1.2 to 2.0 g/kg of adjusted body weight.

    Enteral Nutrition Limitations

    • Limitations of enteral nutrition during the acute disease phase include gastrointestinal dysfunction or intolerance.

    Benefits of Enteral vs. Parenteral Nutrition

    • Primary benefit of enteral nutrition is preservation of gut integrity and function compared to parenteral nutrition, which bypasses the gastrointestinal tract.

    Signs of Malnutrition

    • Signs not considered indicative of malnutrition include normal weight and absence of physical symptoms such as muscle wasting.

    Challenges of Parenteral Nutrition

    • Primary challenge of parenteral nutrition is the risk of infections related to catheter use.

    Factors in Feeding Route Administration

    • A crucial factor in determining route of feed administration is the patient’s gastrointestinal function and tolerance.

    Early Enteral Nutrition (EEN) Benefits

    • Primary benefit of EEN in critically ill patients includes reduced incidence of infectious complications and improved clinical outcomes.

    Feeding Start Timetable

    • Recommended to initiate feeding in critically ill patients not on vasopressors within 24-48 hours of admission.

    Importance of Abdominal Sounds

    • Essential to assess abdominal sounds in critically ill patients to monitor gastrointestinal motility and function.

    ICU Patient Outcome Factors

    • A critical factor affecting patient outcomes in the ICU is the timing and method of nutritional intervention.

    Goals of Early Nutrition Intervention

    • Primary goal of early nutrition intervention in critically ill patients is to minimize muscle catabolism and improve recovery.

    Preferred Feeding Method

    • Preferred method of feeding for patients unable to eat is enteral nutrition via a nasogastric tube or feeding tube.
    • First choice for enteral feeding is usually a nasogastric tube, when feasible.

    Post-pyloric Feeding Necessity

    • Some patients may require post-pyloric feeding to reduce aspiration risk or accommodate delayed gastric emptying.

    Risk Factors for Clostridium Difficile Colitis

    • Risk factors for developing Clostridium difficile colitis include antibiotic use and prolonged hospitalization.

    Challenges with Blenderized Feeds

    • Challenges with hospital-prepared blenderized feeds include risk of nutritional inadequacy and variability in composition.

    Homemade vs. Scientific Feeds

    • Homemade or blenderized feeds are more likely to lead to nutrient imbalances compared to standardized scientific feeds.

    Supplemental PN Consideration

    • Supplemental parenteral nutrition should be considered when enteral nutrition is insufficient to meet caloric requirements.

    Caloric Targets for EN Support

    • Minimum caloric target for enteral nutrition support should deliver at least 25-30 kcal/kg/day.

    Total PN Timing

    • Total parenteral nutrition should be considered when enteral nutrition is contraindicated or unable to meet nutritional needs.

    Nutritional Support Goal in Critical Illness

    • Primary goal of nutritional support in critical illness is to promote anabolism and support healing.

    Start of Nutritional Therapy

    • Nutritional therapy should ideally begin within 24 hours after admission for critically ill patients.

    Gastric Residual Volume (GRV) Guidelines

    • Maximum volume of gastric residual volume recommended by ASPEN guidelines as a cutoff for enteral nutrition tolerance is 500 mL.

    Consequence of Nutritional Protocol Nonuniformity

    • Primary consequence of nonuniformity in nutritional protocols during critical illness is variability in patient outcomes and complication rates.

    Daily Monitoring Purpose

    • Purpose of daily monitoring of nutritional therapy in critical illness is to adjust interventions based on patient tolerance and nutritional needs.

    Managing Nutrition Intolerance

    • Medication that can be used to manage nutrition intolerance in critical illness includes prokinetic agents like metoclopramide.

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    Description

    This quiz covers the importance of choosing the right route of administration for nutrition in critically ill patients, considering hemodynamic status and gastrointestinal functioning.

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