Critical Care and Nutrition Flashcards
What does Level 3 classification of care mean?
Requiring advanced respiratory support or basic respiratory resort with the support of at least 2 other organ systems
The stress response following trauma priorities which two bodily processes?
Defence and repair
Who first described the terms ‘ebb’ and ‘flow’ to describe metabolic response following injury?
Cuthbertson (2001)
How long does the Ebb phase last
24-48 hours
What are the markers of the Ebb phase (MOTE)
- reduced metabolic activity
- reduced O2 consumption
- reduced body temperature
- Energy reserves (glycogen–> glucose; FFA) are mobilised but their use is impaired
What characterises the Flow phase?
Hypermetabolism
Increased O2 consumption
What does the length of the flow phase depend on?
The severity of the injury and recovery/resolution
Following uncomplicated major surgery, how long would it take to enter the anabolic phase?
2-3 weeks
How long can catabolic states last after sepsis or major burns?
continues for as long as the pathological stimulus is present
What mediates the flow phase
catecholamines, glucagon and cortisol, cytokines
What do the mediators of the flow phase do?
Glucagon - stimulates gluconeogenesis
Cortisol - increases net protein catabolism
Catecholamines - glucose intolerance (insulin resistance)
Cytokines - act on hepatic and peripheral tissue to increase protein breakdown and loss
Why is gluconeogenesis important
for CNS, wounds and immunity. More metabolically active in stress. Glycogen stores are quickly depleted so needs met through muscle breakdown.
Why is protein catabolism important
Synthesis of acute phase proteins e.g. CRP from liberated amino acids
What did Frankenfield et al. 1997 demonstrate
Achievement of energy balance will fail to alleviate catabolism.
Risk factors for ICU Aquired Weakness (PISS Inc.)
Prolonged artificial ventilation Inflammation (SIRS) Sepsis/septic shock Severity Immobilisation Neuromuscular blockage/paralysing agents Corticosteroid medication
