Enternal Nutrition In Icu

Enteral and Parenteral Nutrition in the Critical Care Setting

Management of patient nutrition has long been a topic of controversy. Questing of timing, route of administration and composition of feeding solution constituents are several variables that share a lack of consensus.

There is a 50% rate of malnutrition cited in hospitalized patients.

Many states associated with critical care admissions have altered metabolic rates. Some examples of increased catabolism are multiple injury trauma, sepsis, organ failure (CHF, ARF, RF), and ventilator dependent status. It is important to assess for a history of such hyper- or altered metabolic states like Diabetes Melitus, Alcoholism, Renal Failure, and COPD.

Over feeding is associated with: immunosuppression, hyperglycemia, liver dysfunction and refeeding syndrome.

Enteral No associated immune suppression, no associated infection complications, easier to maintain electrolyte balance.

Parenteral Immune suppression (the converse is also true- malnutrition also causes immune suppression), fatty liver, potential for pneumothorax, line infections, loss of gut barrier, hyperosmolality, refeeding syndrome

Feeding tubes - great option, if the gut works, use it.

Prealbumin (2-3 day t1/2)

Transferrin (8-10 day t1/2)

Albumin (14-20 day t1/2)

Nitrogen balance studies can aid in the clinical picture of nutrition status although there is not any clinical evidence of their effect on morbidity and mortality

BMI = (weight in kg) / (чheight in meters)

MEE (measured energy expenditure) 104.67 - 146.54 kj/kg can be used to estimate the avg. daily caloric requirement

Mifflin-St Jeor formula REE = 9.99 x weight + 6.25 x height - 4.92 x age + 166 x sex (males, 1; females, 0) - 161. Simplification of this formula REE (males) = 10 x weight (kg) + 6.25 x height (cm) - 5 x age (y) + 5; REE (females) = 10 x weight (kg) + 6.25 x height (cm) - 5 x age (y) - 161.

Harris-Benedict equation -

Males BEE (kcal) = 66.5 + [13.8 x weight (kg)] + [5 x height (cm)] - [6.8 x age (yrs)]

Females Males BEE (kcal) = 655.1 + [9.6 x weight (kg)] + [1.8 x height (cm)] - [4.7 x age (yrs)]

Indirect calorimetry (metabolic cart) - measures the CO2 produced and the O2 consumed. Also gives the RQ (respiratory quotient)