lecture 3 MNT for ICU Flashcards

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1

Nutritional assessment

is the systematic process of collecting and interpreting information in order to make decisions about the nature and cause of nutrition related health issues that affect an individual.

2

Traditional methods of assessing the nutritional status are often of limited value in critical care settings. Why??

  1. not able to provide diet history
  2. Weight may be erroneous
  3. Anthropometric measurements are not easily obtainable
  4. Nutritional biomarkes are influenced by inflammation

3

Inaccuracy of recorded weight due to

  • Presence of oedema, ascites, amputations, plaster/body casts
  • Calibration of equipment

4

10% muscle loss

  • Impaired immunity
  • increased infection
  • mortality rate 10%

5

20% muscle loss

  • Decreased healing
  • weakness
  • infection
  • mortality rate 30%

6

30 % muscle loss

  • Too weak to sit
  • pressure sores
  • pneumonia
  • no healing
  • mortality rate 50%

7

40% muscle loss

  • Death, usually from pneumonia
  • mortality rate 100%

8

Goals of nutrition support in ICU

  1. starvation
  2. nutrient deficiencies
  3. adequate calories
  4. metabolic complications
  5. gut homeostasis

9

how does IC calculate energy expenditure

  • O2 & CO2 consumption
  • metabolic chart using the Weir equation
  • identification of energy substrates

10

RQ is automatically calculated by the IC based on the following equation

RQ = VCO2 / VO2

11

> 1 RQ

Overfeeding with lipogenesis

12

0.85-0.95 RQ

Mixed substrate utilisation (adequate intake)

13

>0.82 RQ

Underfeeding

14

A number of factors may restrict the regular use of IC in ICU settings

  1. high cost of machines
  2. Lack of trained clinical staff
  3. Measurements of energy expenditure may also be limited in unstable patients, where medical care cannot be interrupted for such measurements.

15

Factors known to compromise the accuracy of energy expenditure measurements

  1. Air leak
  2. (FiO2) >60%
  3. Failure to achieve a steady state.

16

Energy requirements for BMI <15

30-40 kcal

17

Energy requirements for BMI 15-19

30-35 kcal

18

Energy requirements for BMI 20-29

20-25 kcal

19

Energy requirements for BMI ≥30

14-20 kcal

20

For all classes of obesity, the goal of the EN regimen should not exceed

65 - 70% of the target energy requirements as measured by IC

21

Calories requirements when using actual body weight for patients

  • 30-50 BMI
  • 11–14 kcal/kg

22

Calories requirements when using ideal body weight

  • 22–25 kcal/kg
  • BMI >50.

23

Protein requirements for critically ill patients Adults with a normal body weigh

1.2–2 g/kg/day

24

Obese patients protein req. based on ideal body weight (ASPEN guidelines)

2–2.5 g/kg/day

25

Obese patients protein req. based on the adjusted body (ESPEN guidelines)

1.3 g/kg/day (>1 g/kg/day)

26

ASPEN guidelines for protein requirements for critically ill children 0–2 years

2–3 g/kg/day

27

ASPEN guidelines for protein requirements for critically ill children from 2-13 years

1.5–2 g/kg/day

28

ASPEN guidelines for protein requirements for critically ill children 13–18 years

1.5 g/kg/day

29

Consequances of overfeeding critically ill patients

  1. Steatosis
  2. cholestasis
  3. Hyperglycaemia
  4. Increase in carbon dioxide production
  5. inhibition of autophagy

30

A nutrient that is not recommended to be used for critically ill patients.

Glutamine

31

Arginine beneficial effects

immune responses and nitrogen balance of critically ill and postoperative patients

32

n-3 fatty acids beneficial effects

Produce less inflammatory eicosanoids

33

what is the theoretical concern with the safety of using probiotics ?

may adhere to the intestinal mucosa and facilitate bacterial translocation and virulence

34

the supplementation of probiotics in enterally fed critically ill .............. is safe and is not associated with any clinical complications

children

35

The average intake within the first week should be how much of total estimated energy requirements as determined in the assessment.

60-70%

36

Hypoalbuminemia may indicate

  • Overhydration
  • increase catabolism
  • Decreased synthesis ( liver diseases)
  • Increased loss ( burns, large wounds, etc)

37

Serum Transferrin, TBPA, and Fibronectin half live, use, limitation

  • Transferrin- Half life 8 days
  • TBPA Half life 2 day
  • Fibronectin: Half life 12 hrs
  • markers of improved nutritional status
  • Limitation : Costly