Critical Care Flashcards
Goal reach 80% TF goal x
48 hrs
pSBO what enteral tube to use
feed distally, and decompress proximally
Ileus
takes a mix of fluid/nutrients and air to make BS
TF factors for pts with aspiration risk include:
HOB 30-40 degrees, slow continuous rate, prokinetics, post pyloric
Diarrhea
investigate cause (drug/infectious), antidiarrheals/fiber
Best outcomes with TF providing this amt
33-65%
Acute pancreatitis with EN
proximal feeds do not exacerbate, reduces mortality
Distal Jtube used for
obstruction UGI, pancreatic rest, suppression of pancreatitis
Mild-Moderate Trauma –resume po 3-5 days
No Nutrition support
Severe Trauma (burns 20% BSA or MOSF), anticipate no po 5-10 days
YES Nutrition support
Cascade
SIR-neuroendocrine and cytokine response to maintain O2 delivery
SIR catabolic state
store substrates,increase insulin, inc HR, minute vent
Increase GI blood flow with
presence luminal nutrients
Nutrients effect lumin
Dextrose: inc bld flow, improve gut dysfx, AA: amplify injury, Glutamine: enhance neutrophil fx and prevent damage, IVF: ?
Primary Nutrition Support plan for trauma, surgery and burn with intact GI
EN
Early Feeding
within 2 hrs of injury to 5 days
G tubes predisposed to (may cause)
aspiration/PNA
Aspiration seen with these tubes
G/J despite low residuals
Advocate for J tubes
Dec GE regurg, dec rate vent assoc PNA, Inc nutrient delivery, short time to get to TF goal
Fewer post-op infections with this type of feeds
EN, preserved GI immunity, mucosal barrier function, dec pulmonary infections in trauma pts
Uncomplicated Malnutrition markers
normal visceral proteins
Hyperglycemia with PN may cause
negative outcomes
Gastric and Colorectal Cancer significant dec post-op intra abdomenal abscesses with
Pre-operative EN
Post-op PN highest M/M over how long
over 14 days
J tube oncology pts no advantages over
IVF
GI not functioning over 2 weeks post-op
PN regardless of M/M
Pre-op EN in malnourished pt
elective surgery maybe beneficial to outcome
Post-op Nutrition support 7-10 days
regardless of all info
1 liter of fluid=
1 kg body wt
Prealbumin
synthesized in liver, limited by fluid/liver dysfx, inflammation (CRP)
Penn State Equation
valid in ICU/vented pts
PRO in Burn
3-4g/kg/day in Large SA Burn
PRO in CVVHD
2-2.5g/kg/d
CHO metabolic stress
4-7mg/kg/min=MAX
LIPIDs in Critically Ill
Lipid metabolism is altered d/t hormonal/mediator alterations, mobilize adipose tissue TG stores
Lipid free PN in Critically Ill
fewer complications
Fat facilitates
protein sparing, dec risk CHO overload, limits tv and provides EFAs
IV Fat negatively causes
Dec immune fx, inc TG, hypoxemia
Minimal complications with IV Fat
18-24 hr infusions, .1g/kg/hr, Omega 3
REactive Oxygen Sepcies (ROS) generated during Critical Illness
tissue injury–SIRS–Dec Vit C & E
Early Vit C &E decreases
organ failure and ICU stay (DRI amt)
Burns decrease which vitamin
Vit D
