Ch 23: Critical Illness and Sepsis Flashcards
How is sepsis defined?
“Life threatening organ dysfunction caused by dysregulated host response to infection”
How should EN be initiated in the initial phase of sepsis?
ASPEN/SCCM recommends trophic feeding (10-20 kcal/h or 500 kcal/d) for initial phase of sepsis, advancing as tolerated after 24-48 hours to > 80% of target energy goal over first week
What is the body’s initial response to sepsis?
The initial septic response is proinflammatory; this is immediately followed by a compensatory anti-inflammatory response
What are recommended protein needs for a septic patient?
1.5-2.0 g/kg/day and up to 2.5 g/kg/day in selected cases
What is the metabolic response to sepsis?
Similar to trauma; increased energy expenditure, protein catabolism, and oxidization of stored lipids along with alterations in body’s ability to metabolize CHO
Which tools should be used to conduct nutrition assessment for septic patient?
Clinicians should evaluate weight loss and nutrition history prior to admit, level of disease severity, and GI function and ongoing review of patients current physical and metabolic status (absence of validated tools in this population)
How should PN be used in teh acute phase of severe sepsis?
When patient is in acute phase of severe sepsis, ASPEN/SCCM recommend not using exclusive PN or supplemental PN in conjunction with EN regardless of patient’s degree of nutrition risk
What steps can be taken to maximize gut function in sepsis/inflammatory states
Visceral perfusion/adequate resuscitation, glycemic control, correction of acidosis/electrolyte abnormalities, minimizing anticholinergic meds, narcotics, and other meds that decrease intestinal motility and instituting EN even at low rates within 24-48 hours of onset of SIRS or sepsis
The acute phase response has what effect on serum iron and ferritin levels?
Decreases serum iron levels and increases serum ferritin levels
What are some metabolic causes of a RQ > 1.0?
Overfeeding, excessive CO2 production, provision of excess sodium bicarbonate
What are the complications of underfeeding a critically ill patient?
Increased length of stay, complications, infections, days on antibiotics and days on the ventilator.
OVERfeeding has the following negative effects: Hyperglycemia, liver dysfunction, fluid overload, respiratory compromise, increased CO2 production and lipogenesis.
Which of the immunomodulating nutrient may be harmful in patients with sepsis/septic shock?
Arginine
Glutamine supplementation may reduce what among critically ill patients?
Nosocomial infections .
In pulmonary insufficiency, excessive calorie administration may cause increased blood pCO2 resulting in
Respiratory acidosis
Which situations have been shown to delay weaning from mechanical ventilation in patients with chronic obstructive pulmonary disease who are receiving enteral nutrition?
Refeeding syndrome, overfeeding, and underfeeding
