6.2 Nutritional Support in ICU Flashcards
A 45-year-old man with a history of ulcerative colitis and alcohol abuse is admitted to the intensive care unit for inotropic and ventilatory support following a laparotomy to excise a toxic megacolon. His Body Mass Index is 18kg/m2.
a) Why should this patient receive early nutritional support?
1 ● Critically ill patient —
major surgery, multi-organ failure, sepsis.
2 ● Critical illness is associated with an
increased energy requirement and catabolism.
3 ● There is a high risk of malnutrition and refeeding syndrome — low BMI, alcohol abuse.
b) List any four clinical benefits of early nutrition.
1 ● Better wound healing.
2 ● Prevention of loss of muscle mass.
3 ● Decreased ventilator dependence.
4 ● Decreased ICU length of stay.
5 ● Improved immune function.
c) What are the routes of nutrition and daily energy requirements
● The enteral route of nutrition is preferred as the initial choice.
● A parenteral route can be used if the enteral route is not tolerated.
● Energy target — 25kcal/kg/day.
● Increase to target over 2-3 days.
d) What are the basic nutritional requirements in critical illness?
Carbohydrate 2g/kg/day
Protein 0.8-1.2g/kg/ day
Fat 1g/kg/day
Water 30ml/kg/ day
Sodium, chloride 1-2mmol/kg/day
Potassium 0.8-1.2mmol/kg/day
Calcium, magnesium 0.1mmol/kg/day
Phosphate 0.2-0.5mmol/kg/day
e) List two advantages of enteral nutrition.
● Cheaper and easier mode.
● Lower risk of infection.
● Preservation of integrity of the gut mucosa.
f) List three disadvantages of enteral nutrition.
● Increased association with ventilator-associated pneumonia.
● Requires intact gut function.
● Less reliable delivery of energy.
● Risk of displacement of nasogastric tubes.
● Risk of aspiration.
● Feed intolerance, diarrhoea.
