16 Questions
What is nutritional support in critically ill patients?
Enteral or parenteral provision of calories, protein, electrolytes, vitamins, minerals, trace elements, and fluids
Why do critically ill patients have increased nutritional requirements?
Due to hyper metabolism and acute phase responses
What is the purpose of nutrition risk screening in critically ill patients?
To identify patients who would benefit from early full enteral nutrition therapy
What is the gold standard for estimating energy requirements in critically ill patients?
IC (indirect calorimetry)
What is the score range for the original NUTRIC score?
1-10
What is the recommended nutrition screening tool for critically ill patients?
NUTRIC score
What is the purpose of nutrition assessment in critically ill patients?
To evaluate comorbid conditions and GI tract function
What is the consequence of malnutrition in critically ill patients?
Altered immunity, increased susceptibility to nosocomial infections, decreased wound healing, and organ failure
What is the recommended range of protein requirement in critically ill patients per day?
1.2-2.0 g/kg
What is the gold standard for measuring energy expenditure in clinical settings?
Indirect calorimetry
What is the recommended route of nutrition therapy in critically ill patients with an intact and functional GI tract?
Enteral nutrition (EN)
What is the recommended time frame for initiation of enteral nutrition in haemodynamically stable patients?
Within 24-48 hours
What is one of the benefits of enteral nutrition in critically ill patients?
Reducing the risk of pneumonia
Why is protein important in critically ill patients?
To regulate the inflammatory response
What is the purpose of nitrogen balance studies in critically ill patients?
To monitor protein provision
What is the benefit of enteral nutrition in maintaining gut structural and functional integrity?
Maintaining gut structural and functional integrity
Study Notes
Nutritional Support in Critically Ill Patients
- Nutritional support is a crucial part of care for critically ill patients, providing essential nutrients, electrolytes, and fluids to meet their increased metabolic needs.
- Critically ill patients are at high risk of malnutrition due to acute phase responses, which can lead to catabolism, altered nutritional responses, and increased susceptibility to infections.
Nutrition Screening and Assessment
- The NUTRIC score is a validated nutrition screening tool specifically designed for critically ill patients, with a score range of 1-10 (original) or 1-9 (modified).
- A score of ≥6 (original) or ≥5 (modified) indicates high nutrition risk, and patients with high nutrition risk may benefit from early full enteral nutrition therapy.
- Nutrition assessment should include evaluation of comorbid conditions, GI tract function, and risk of aspiration.
Energy Requirements
- Indirect calorimetry (IC) is the gold standard for estimating energy requirements in critically ill patients.
- In the absence of IC, predictive equations or simplistic weight-based equations (25-30 kcal/kg/d) can be used, but their accuracy is uncertain.
Protein Requirements
- Protein requirements in critically ill patients should range from 1.2-2.0 g/kg actual body weight per day, with ongoing evaluation of adequacy.
- Protein is essential for optimizing immune function, regulating inflammatory response, and improving body protein economy.
Route of Nutrition Therapy
- Enteral nutrition (EN) is recommended over parenteral nutrition (PN) in critically ill patients with an intact and functional GI tract.
- EN can reduce infectious complications, maintain gut structural and functional integrity, modulate metabolic response, and support the humoral immune system.
Initiation of EN
- Early initiation of EN within 24-48 hours of ICU admission in hemodynamically stable patients can reduce mortality, lower the incidence of pneumonia, and reduce infectious complications.
This quiz covers the importance of nutritional support in critically ill patients, including enteral and parenteral provision of essential nutrients and fluids. It also discusses the effects of acute phase responses on malnutrition in these patients.
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