slide1 n.
Download
Skip this Video
Loading SlideShow in 5 Seconds..
Enteral Critical Care Nutrition PowerPoint Presentation
Download Presentation
Enteral Critical Care Nutrition

Loading in 2 Seconds...

play fullscreen
1 / 43

Enteral Critical Care Nutrition - PowerPoint PPT Presentation


  • 209 Views
  • Uploaded on

•. M. M. M. M. I. ARK. ORRIS. NSTITUTE. Enteral Critical Care Nutrition. Enteral Critical Care Nutrition. The need to feed The enteral route Diets/diet management. The Need To Feed. Histortic perspectives Clinical/metabolic perspectives Patient selection. Historic Perspectives.

loader
I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
capcha
Download Presentation

PowerPoint Slideshow about 'Enteral Critical Care Nutrition' - reece


An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript
slide1

M

M

M

M

I

ARK

ORRIS

NSTITUTE

Enteral Critical

Care Nutrition

slide2

Enteral Critical Care Nutrition

  • The need to feed
  • The enteral route
  • Diets/diet management
slide3

The Need To Feed

  • Histortic perspectives
  • Clinical/metabolic perspectives
  • Patient selection
slide4

Historic Perspectives

  • 1793 John Hunter
    • Eel skin nasoenteral tube
  • 1990’s $ billion industry
slide5

Clinical/Metabolic Perspectives

  • Equation for nutritional support:

Food

Deficit

Disease/Injury

Hypermetabolism

Accelerated

Starvation

+

=

slide6

Clinical/Metabolic Perspectives

Endocrine

Cytokines

Cortisol

Catecholamines

Insulin: glucagon

Thyroxine

Growth hormone

TNF

Prostaglandins

Increased

metabolic

rate

slide7

RestingMetabolism(%)

Clinical/Metabolic Perspectives

  • Metabolic Rate During Clinical Conditions

Major

burn

Maintenance

energy

requirement

160

Sepsis

Trauma,

cancer

Resting

energy

requirement

100

Total

partial

Food deprivation:

  • Days

0 10 20 30 40 50 60

slide8

Clinical/Metabolic Perspectives

  • Equation for nutritional support:

Food

deficit

Disease/injury

hypermetabolism

Accelerated

starvation

+

=

Accelerated

starvation

Compromised

host defenses

Compromised

wound healing

+

=

slide9

Clinical/Metabolic Perspectives

  • 1 liter = 170 kcal
  • Provides 1/5 patient’s energy requirement
  • No protein or micronutrients

5%

Dextrose

I.V.

slide10

Patient Selection

  • History & exam
  • Laboratory tests
  • Predictive Indicators
slide11

Patient Selection

  • Weight loss of > 10%
  • Poor food intake for > 3 days
  • Increased nutrient demands(Trauma, surgery, infection)
  • Increased nutrient losses(Vomiting, diarrhea, wounds)
  • Laboratory parameters(Albumin, creatine kinase)
slide12

Patient Selection

  • Patient selection = common sense
  • When in doubt: feed
  • Feed early
slide13

The Enteral Route

  • Advantages of enteral nutrition (EN)
  • Appetite stimulation
  • Forced feeding
  • Tube feeding
slide14

Advantages of Enteral Nutrition (EN)

  • The golden rule of critical care nutrition:

When the gut works, use it.

slide15

Advantages of Enteral Nutrition (EN)

  • EN feeds intestine as well as patient
    • Decreased bacterial translocation
    • Glutamine - enterocyte nutrient
    • Enhanced enteric immunity
slide16

Appetite Stimulation

  • Highly palatable, balanced diets
  • Assure optimal olfaction
  • Warm food to body temperature
slide17

Appetite Stimulation

  • Effect of Food Temp on Preference in Cats

80

60

40

20

80

60

40

20

  • Foodpreference(%)
  • Foodpreference(%)

10 20 30 40 50

  • Food temperature (ºC)Sohail, Nutr Abst Rev, 1983

10 20 30 40 50

  • Food temperature (ºC)Sohail, Nutr Abst Rev, 1983
slide18

Appetite Stimulation

  • Highly palatable, balanced diets
  • Assure optimal olfaction
  • Warm food to body temperature
  • Avoid K, Zn, & B vitamin def.
  • Drugs
slide19

Appetite Stimulation

  • Diazepam1 - 2 mg PO cat 0.1 - 0.2 mg/kg PO dog 0.05 - 0.1 mg/kg IV
  • Oxazepam (Serax )0.3 - 0.4 mg/kg PO dog 2.5 mg (1/4 tab) PO cat
  • Fluazepam (Dalmane )0.1 - 0.5 mg/kg PO dog 0.1 - 0.2 mg/kg PO cat

®

®

slide20

Tube Feeding

  • Orogastric
  • Nasoesophageal
  • Pharyngostomy
  • Esophagostomy
  • Gastrostomy
  • Enterostomy

Indwelling

slide21

Diets/Diet Management

  • Nutrient requirements
  • Diet selection
  • Feeding protocols
  • Cost analysis
slide22

Nutrient Requirements

  • Water
  • Energy
  • Protein
  • Minerals & vitamins
slide23

Nutrient Requirements

  • Resting energy requirement (RER)
    • 1000 kcal/m2
    • 70 (Wt kg0.75)
    • 30 (Wt kg) + 70*

Dogs

&

Cats

* > 2 kg and < 45 kg

slide24

Nutrient Requirements

  • Maintenance energy requirement (MER)
    • MER dogs = 1.6 RER
    • MER cats = 1.2 RER
slide25

RestingMetabolism(%)

Clinical/Metabolic Perspectives

  • Metabolic Rate During Clinical Conditions

Major

burn

Maintenance

energy

requirement

160

Sepsis

Trauma,

cancer

Resting

energy

requirement

100

Total

partial

Food deprivation:

  • Days

0 10 20 30 40 50 60

slide26

Energy Requirements

Infection

Illness (cancer)

Injury (surgery, trauma)

Energy

requirement

(IER)

  • IER = 1.0 - 1.25
slide27

Nutrient Requirements

  • Protein quantity
    • At least maintenance amounts

4g protein/100 kcal16% of energy as protein

Dogs

6g protein/100 kcal24% of energy as protein

Cats

slide28

Nutrient Requirements

  • Protein quality
    • Digestibility/availability
    • Amino acid profile

EAA’s (extra arginine, branched chains)

Glutamine (conditionally essential)

Taurine (cat)

slide29

Nutrient Requirements

  • Minerals and vitamins
    • Maintenance/growth levels
    • Micronutrient def. common
slide30

Nutrient Requirements

  • Concept:

When a diet is properly formulated, the nutrients are balanced to the energy density of the diet

slide31

Nutrient Requirements

Thus, when such a diet is fed to meet a patient’s energy requirements, the requirements for the non-energy nutrients are automatically met

slide32

Clinical/Metabolic Perspectives

Patient’s Diet Daily

Daily energy Energy Diet

Requirement Density Dosage

=

÷

slide33

Nutrient Requirements

  • Example 10 kg dog with septic bile peritonitis

RER = 30 Wt kg+ 70 = 30(10) + 70 = 370 kcal

IER = 1.25 RER = 1.25(370) = 463 kcal/day

slide34

Nutrient Requirements

  • Canned pet food = 675 kcal/can

Patient’s Diet Daily

Daily energy Energy Diet

Requirement Density Dosage

(463 kcal/day) (675 kcal/can) (2/3 can/day)

=

÷

slide35

Nutrient Requirements

  • Liquid diet = 1 kcal/ml

Patient’s Diet Daily

Daily energy Energy Diet

Requirement Density Dosage

(463 kcal) (1 kcal/ml) (463 ml/day)

=

÷

slide36

Diet Selection

  • Defined formula diets
    • Meal replacement(polymeric, intact protein)
    • Elemental (monomeric)
slide37

Diet Selection

  • Blenderized diets - follow recipe
    • 15 oz. Can (recuperative type) cat food
    • 1½ cup water
    • Blend - high speed 1 minute
    • Strain through kitchen strainer
    • > 8 Fr
slide38

Diet Selection

  • Diameter of tube
  • Location of tube
  • Functional status of GI tract
slide39

Feeding Protocols

  • Bolus - maximal amount/feeding30-45 ml/kg
  • Bolus - minimal feeding frequency3-5/day
  • Gradual transition1/3 day 1, 2/3 day 2, full feeding day 3
slide40

Cost Analysis

Daily cost ($)

Diet10 kg septic dog

Canine/Feline a/d 2.77

Clinicare Canine 10.62

Levity 5.12

Peptamen 13.82

slide41

Due to

Due to

Due to

Feeding Protocols

  • Diet- & feeding-related complications:

Vomiting, Overly-aggressive administration,

cramping, excessive diet osmolality,

diarrhea improper diet composition,

GI alterations

Airway Regurgitation,

aspiration not checking for proper

tube placement

Plugged Inadequate tube maintenance

tube

slide42

Summary

  • Critically ill animals are in a hypermetabolic state
  • When it comes to nutritional support, the sooner the better
  • When the gut works, use it
  • Use RER rather than MER for calculation of energy needs in the critically ill patient
slide43

Summary

  • Veterinary products are more suitable than human preparations for use in critically ill patients