Critical Care Flashcards
What are the main triggers for the Metabolic Response to Stress?
Sepsis, physical trauma, severe burns, major surgery
Sepsis refers to a widespread infection that enters the bloodstream.
What are the main characteristic of the metabolic response to stress?
Catabolism of lean body mass, negative nitrogen balance, muscle wasting
What occurs during the Ebb phase of the metabolic response?
Hypovolemia, shock, tissue hypoxia, drop in oxygen consumption, drop in cardiac output, drop in body temperature
What happens during the Flow phase of the metabolic response?
Increase in oxygen and fluids, increase in cardiac output, increase in body temperature, release of pro-inflammatory cytokines
What is hypometabolism and when does it occur?
A state of low metabolism due to starvation, leading to low blood sugar
What are the key metabolic processes during starvation?
Muscle breakdown, ketosis, low insulin, high glucagon, glycogen depletion, gluconeogenesis, low energy expenditure
What defines Systemic Inflammatory Response Syndrome (SIRS)?
High or low body temperature, increased heart rate and respiratory rate, high or low WBC count, MODS, edema, low BP and impaired blood flow
What is the significance of early enteral feeding in critically ill patients?
Restores gut function, reduces bacterial translocation, supports tight junctions
Why is enteral nutrition preferred over parenteral nutrition?
Decreased risk of infection and stress response
What are the risks associated with parenteral nutrition lipids?
Pro-inflammatory effects
What factors affect weight assessment in ICU patients?
Fluid resuscitation, plasma protein levels due to injury, illness, inflammation, fluid overload
What is the recommended blood glucose level for critically ill patients?
140-180 mg/dl
What should be avoided when providing nutrition to a malnourished patient?
Overfeeding
What is refeeding syndrome?
Electrolyte imbalance resulting from aggressive nutrition administration to a malnourished patient
What are the signs of fluid overload in a patient receiving nutrition?
Rapid weight gain, hyperglycemia, difficulty weaning from the vent
What is the recommended caloric intake for non-ventilated patients?
25-30 kcals/kg/d
What is the recommended protein intake for critically ill patients?
1.2-2 g/kg/d
What is the role of glutamine in nutrition for critically ill patients?
Fuel source for GI issues and supports the immune system
What are the benefits of omega-3 fatty acids in nutrition?
Anti-inflammatory properties
What are the goals of enteral nutrition in critically ill patients?
Minimize starvation, correct nutrient deficiencies, provide adequate energy, fluid and electrolyte management, reduce oxidative stress, modulate immune response
What is the gold standard for monitoring hemodynamic stability?
Mean arterial pressure (MAP)
When should enteral nutrition be initiated in ICU patients?
Within 24-48 hours of ICU admission
What should be monitored for tolerance during enteral feeding?
Pain/distension, gastric residual volume, aspiration, passage of flatus/stool
What can be done to improve enteral feeding tolerance?
Post-pyloric tube placement, elevate the head of the bed, lower tube feeding rate, pro-motility medication, soluble fiber or probiotics
