Important of Nutrition in ECC Patient

Question 1

Why is nutrition important in ECC patients?

Answer 1

• Massive impact on morbidity and mortality
• Malnutrition increases complication risks, hospitalisation length and cost of recovery
• Protein catabolism has severe effects
• Goal is to provide adequate calories and nutrients via GIT to prevent adverse consequences of malnutrition
• ECC patients often have decreased voluntary intake

Question 2

What does protein catabolism affect?

Answer 2

• Tissue synthesis - decreased wound healing
• Immunocompetence
• Maintenance of GI integrity - can cause sepsis
• Drug metabolism

Question 3

Nutritional Assessment

Answer 3

Think about patients individually - high, medium or low risk
* Previous diet
* Appetite
* Objective measure of amount of food consumed

Question 4

What is a high risk patient?

Answer 4

Patients that have not consumed Resting Energy Requirements for 3-5days
OR
Weight loss of 10% in adults (or 5% neonates)

Question 5

Considerations for nutritional assessment

Answer 5

Obese patients may have low lean body mass
* Critical illness can lead to dramatic loss in muscle
Don’t overlook obvious issues which preclude eating
* E.g. jaw fracture
The underlying disease will affect the various aspects of the nutritional plan
* Route of delivery
* Nutrient composition

Question 6

Considerations for Hepatic Encephalopathy

Answer 6

• Animal is basically in liver failure
  ○ Protein intolerant
  ○ Need to limit nitrogenous wastes
  ○ Need to meet calorific needs

Question 7

When are aggressive nutritional plans appropriate?

Answer 7

• Some disease are very likely to break down protein and calories rapidly
  Protein Losing Enteropathies
  Protein Losing Neuropathies
  Chylothorax
  Peritonitis
  Burns
  Draining wounds

Question 8

Considerations for aggressive nutritional plans

Answer 8

• Need much closer monitoring
  ○ Check they’re eating
  ○ Check they’re not losing weight
  ○ Identify any complications
• Need evaluation, re-evaluation and re-assessment
  ○ Change if there is a problem

Question 9

Enteral Nutrition

Answer 9

Via GIT
May be orally or by O-tube
This is ideal but may not be appropriate in some cases

Question 10

Parenteral Nutriton

Answer 10

Intravenously
Skips out GIT

Question 11

What factors affect route of nutrition?

Answer 11

○ Patient factors
GI function
Ability to protect airway
○ Non-patient factors
Cost
Predicted length of hospitalisation
Technical expertise
Level of patient monitoring

Question 12

Why must patients be haemodynamically stable for both enteral and parenteral?

Answer 12

Patients can’t absorb food from GIT or process IV food if they are hypovolaemic
Also need minimal acid-base and electrolyte derangements

Question 13

How much should you feed an ECC patient?

Answer 13

Start with RER (Resting Energy Requirements)
RER = 70xBW^0.75
Use lean body mass (not obese)
Don’t consider ‘illness factors’
Reassess nutritional needs every 12-24 hours
* Need to maintain bodyweight (ignore hydration status)
Do not overfeed - can cause GI and metabolic complications

Question 14

RER

Answer 14

Resting Energy Requirements
Amount of energy needed to maintain homeostasis in a therm-neutral environment
RER = 70xBW^0.75

Question 15

What conditions might require >RER?

Answer 15

Sepsis
Head trauma
Burns

Question 16

When would <RER be an appropriate start?

Answer 16

○ Prolonged anorexia
○ GI compromise
○ Metabolic derangements
Start at 30-50% RER goal and gradually increase over 3-5 days