Nutrition

Question 1

Study that showed conventional glucose control had lower mortality than with intensive control

Answer 1

NICE-SUGAR (NEJM 2009)

Question 2

Trial that showed late vs early parenteral nutrition had less mortality, no difference in ICU or hospital days, less infections, and less mechanical vent days

Answer 2

EpaNIC (NEJM 2011)

Question 3

Trial that showed trophic feeding for the first 6 days in patients with ALI was no different than goal feeding.

Answer 3

EDEN (JAMA 2012)

Question 4

When to start enteral feedings in the ICU

Answer 4

< 48 hours

Question 5

Study that showed no difference in VAP rates or GI/clinical outcomes in medical ICU patients without checking gastric residuals

Answer 5

Nutrirea 1 (JAMA 2013)

Question 6

Study that showed no difference in parenteral feedings until shock resolves vs full enteral feedings BUT showed more NV and ischemic bowel and GI obstruction in the enteric feeding group

Answer 6

Nutrirea 2 (Lancet 2018)

Question 7

Should you use post-pyloric (nasojejunal) feedings in ICU patients, even those with pancreatitis?

Answer 7

No

Question 8

Is there any difference in ICU nutrition guidelines if the patient is morbidly obese?

Answer 8

Only that you should use 60-70% of the caloric target to improve insulin sensitivity

Question 9

Potassium and phosphate lab abnormalities in refeeding syndrome

Answer 9

Both low

Question 10

Refeeding syndrome timing after starting nutrition

Answer 10

several days of feedings above need

Question 11

4 clinical findings of refeeding syndrome

Answer 11

Fluid overload

Arrhythmias

Respiratory muscle weakness

Convulsions

Question 12

Lab that should be checked for the first week of patients getting enteral feedings

Answer 12

Phosphorus level

Question 13

If phosphate level drops during the first few days of enteral feeding, treatment that is required?

Answer 13

Drop the rate to 20 and replace phosphorus. Keep at that rate until phosphorus no longer needing to be repleated

Question 14

Study that showed improved long term survival with dropping the rate of tube feeding to 20 if phosphorus level drops during the first few days of enteral feeding

Answer 14

Doig GS et. al. (Lancet 2015)

Question 15

What supplementation increases mortality in ICU patients with multisystem organ failure or renal failure?

Answer 15

Glutamine

Question 16

What supplementation increases mortality in ARDS ICU patients?

Answer 16

Omega-3 fatty acids

Question 17

What supplementation improves outcomes in post surgical critically ill patients?

Answer 17

Arginine and Omega-3 fatty acid

Question 18

What supplementation has been shown to have no benefit in the ICU?

Answer 18

Selenium

Question 19

Do patients with ARDS/ALI need full feeding for the first 7 days or trophic feeds?

Answer 19

Trophic (EDEN trial)