lecture 3 MNT for ICU
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.
Traditional methods of assessing the nutritional status are often of limited value in critical care settings. Why??
Inaccuracy of recorded weight due to
10% muscle loss
20% muscle loss
30 % muscle loss
40% muscle loss
Goals of nutrition support in ICU
how does IC calculate energy expenditure
RQ is automatically calculated by the IC based on the following equation
RQ = VCO2 / VO2
> 1 RQ
Overfeeding with lipogenesis
0.85-0.95 RQ
Mixed substrate utilisation (adequate intake)
>0.82 RQ
Underfeeding
A number of factors may restrict the regular use of IC in ICU settings
Factors known to compromise the accuracy of energy expenditure measurements
Energy requirements for BMI <15
30-40 kcal
Energy requirements for BMI 15-19
30-35 kcal
Energy requirements for BMI 20-29
20-25 kcal
Energy requirements for BMI ≥30
14-20 kcal
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
Calories requirements when using actual body weight for patients
Calories requirements when using ideal body weight
Protein requirements for critically ill patients Adults with a normal body weigh
1.2–2 g/kg/day
Obese patients protein req. based on ideal body weight (ASPEN guidelines)
2–2.5 g/kg/day
Obese patients protein req. based on the adjusted body (ESPEN guidelines)
1.3 g/kg/day (>1 g/kg/day)
ASPEN guidelines for protein requirements for critically ill children 0–2 years
2–3 g/kg/day
ASPEN guidelines for protein requirements for critically ill children from 2-13 years
1.5–2 g/kg/day
ASPEN guidelines for protein requirements for critically ill children 13–18 years
1.5 g/kg/day
Consequances of overfeeding critically ill patients
A nutrient that is not recommended to be used for critically ill patients.
Glutamine
Arginine beneficial effects
immune responses and nitrogen balance of critically ill and postoperative patients
n-3 fatty acids beneficial effects
Produce less inflammatory eicosanoids
what is the theoretical concern with the safety of using probiotics ?
may adhere to the intestinal mucosa and facilitate bacterial translocation and virulence
the supplementation of probiotics in enterally fed critically ill .............. is safe and is not associated with any clinical complications
children
The average intake within the first week should be how much of total estimated energy requirements as determined in the assessment.
60-70%
Hypoalbuminemia may indicate
Serum Transferrin, TBPA, and Fibronectin half live, use, limitation