Sedation, Nutrition, DVT, Stress Ulcer

Question 1

Role of sedation

Answer 1

Relieve anxiety
Enhance tolerance to ETT and mechanical ventilation
Pain
ARDS, brain injury

Question 2

How much feed

Answer 2

BEE (kcal/day) = 25 x body weight (kg)

Commercial feed = 1kcal/mL
Given 1.2 - 1.8mL/kg/hr -> provides 1800-2400 kcal/day

Start with 30mL/hour
Aspirate every 4 hours
Stop feeding if aspirate >200-400mL
If lesser, to return aspirate to patient and continue feeding

Question 3

When to start feeding?

Answer 3

Enteral as soon as hemodynamically stable
Trophic feeding, no need aim for early full feed
Full feeding within 48 hours

Early feeding
- Reduces infection
- Better wound healing

Parenteral can wait up to 7 days

Question 4

Signs of feed intolerance

Answer 4

High aspirates
Abdominal distention
Diarrhoea

Question 5

Causes of Diarrhoea in enteral feeding

Answer 5

C-diff
Osmolality of feed
Malabsorption

Question 6

DVT in ICU patients

Answer 6

13-31% of ICU patients

Immobility
Hypercoagulability
Vessel injury

Question 7

DVT prophylaxis

Answer 7

SC LMWH heparin 4000-6000 units once a day

SC UFH 5000 units Q8H

Sequential compression devices

Question 8

Stress ulcer phophylaxis

Answer 8

Prevent and treat shock early
Reduce acid production - PPI
Promote protective mechanism - early enteral nutrition