Nutrition in Critical Care

Recommended Protein Intake

• 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.

Recommended Enteral Feeding Route

• 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.

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