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An Introduction To Nutrition In Critical Care PowerPoint Presentation

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Description : Check out this medical PowerPoint presentation titled "An introduction to Nutrition in Critical Care" by Bernadette Tavner Allsopp.

This medical PowerPoint presentation discusses how nutrition plays a critical role in the care of patients in critical care settings. Critical illness can lead to a state of malnutrition, which can impair immune function, prolong hospital stays, and increase mortality rates. Therefore, providing adequate and appropriate nutrition is essential in the management of critically ill patients.

There are various nutritional support strategies that can be utilized in critical care, including enteral nutrition, parenteral nutrition, and oral nutrition. Enteral nutrition involves providing nutrition through a feeding tube placed into the gastrointestinal tract, while parenteral nutrition involves providing nutrition intravenously. Oral nutrition involves providing nutrition orally, either through the consumption of regular food or through the use of supplements.

The type and amount of nutrition provided will depend on the patients medical condition, nutritional status, and ability to tolerate feeding. Nutritional assessments should be performed regularly to monitor the patients nutritional status and adjust the nutrition plan accordingly.

Nutrition therapy in critical care settings also involves the management of complications related to nutrition, such as refeeding syndrome, hyperglycemia, and electrolyte imbalances. Healthcare providers should work together to ensure that the patients nutritional needs are met while minimizing the risk of complications.

In summary, nutrition is an integral part of the care of critically ill patients. Appropriate nutrition therapy can improve patient outcomes, reduce complications, and shorten hospital stays.

Tags : Nutrition in Critical Care, Critical illness, malnutrition, enteral nutrition, parenteral nutrition, oral nutrition, critical care medicine, critical care medicine PowerPoint presentation

Published on : Mar 28, 2023 | Views : 2539 | Downloads : 5

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Slide 1-

An introduction to Nutrition in Critical Care:Birmingham City University Bernadette Tavner Allsopp Advanced Dietitian March 2020
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Overview Critical Care at BHT and me The Critical Care patient The importance of nutritional intervention in this setting The dietetic role in Critical Care The dietetic assessment Nutritional requirements A case study Key messages
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My role within BHT
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The SMH Critical Care Dietetic Team
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The Critical Care patient (DOH, 2000)
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The why? Phases of the physiological response to injury (Cerra, 1987)
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What’s the evidence to support nutritional intervention? Supports functional and structural integrity of the gut and modulates the systemic immune response and attenuates disease severity (McClave et al, 2016) A feeding protocol can ↑ the goal energy delivery (Intensive Care Society, 2015) Commence enteral feeding within 24-48 hours (Dhaliwal et al, 2013) Appropriate nutrition is associated with: improved ↑patient outcomes, ↓ length of hospital stay, ↓dependence on ventilation, ↓infection (Villet et al, 2005)
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The Acute Phase Response (1) Any insult (injury, infection or surgical intervention) changes metabolism and leads to a net loss of lean body mass. The goal of nutritional intervention is, therefore to try, to meet those losses Task 1: understanding the mediators of APR: Use your knowledge of physiology to consider how the brain, muscle, liver, GI tract and inflammatory system are affected by an insult. Use the crib sheet to help you
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The Acute Phase Response (2)
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The dietitian role in Critical Care Part of an extensive , highly specialized team Opportunity to join daily Ward Rounds Participate in weekly MDTs and influence decision making Opportunity to contribute to the survival of a patient Gather information from a variety of sources Use evidence based practice and up to date research Monitor and adjust care plans Training and development
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Dietetic assessment in CC Determine likely: energy expenditure net protein loss Optimise blood glucose control bowel function fluid management Advise on alternative feeding routes Naso-jejunal Gastrostomy Parenteral Nutrition Identify risk re-feeding deficiencies
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Feeding Barriers (PENG, 2018) Fasting for procedures (surgery/ tracheostomy) Fasting for diagnostic tests (CT-computed tomography/endoscopy) Delay in feeding tube placement/ displacement ‘High’ gastric residual volumes Gastrointestinal intolerance (vomiting/ nausea/ileus/diarrhoea) Non-feed energy sources (dialysate/ citrate/ propofol/ glucose) Unit starter feeding protocol
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Sources of information to complete assessment As a dietitian you will use a variety of sources of information to gather data about your patient; Patient – pallor, skin, oedema, distension, losses Family members – missing information Nursing staff- gains, issues, concerns Clinical chart and notes – A,B, C, D, E,F Anaesthetic and Consultant Team – aim: short to longer term Pharmacist – drug nutrient interactions Physio & OT – physical progress and limitations Task 2: Use the example clinical daily chart to locate your ABCDs
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Your Dietetic Assessment 1 (BDA)
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Your Dietetic Assessment 2 Looking further at C-current clinical state: Temperature Fluid balance- UO, Haemofiltration, BO, GRVs, other Respiratory function and type of support Medication and fluids /crystalloid (Slide 16) Anaesthetic / MDT goal Medications: (PENG, 2018) handout
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Example Starter Feeding Protocol
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Your Dietetic Assessment 3 Identify your PASS statement / Dietetic Diagnosis Identify the OUTCOME Establish achievable, measurable GOALS Describe your INTERVENTION Determine when to REVIEW
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Focus on Nutritional requirements - Protein
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Recommendations for protein targets for critically ill patients
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Energy Targets in the Critically Ill (PENG, 2018) ESPEN Guidelines recommend Indirect Calorimetry as gold standard to measure energy expenditure Commonly used ‘Predictive Equations’ : Mifflin St Jeor (MSJ) Women: 10(wt) +6.25(ht) -5(age) – 161 Men: 10(wt) + +6.25(ht) -5(age) + 5 Penn State University (PSU) 09, validated equation MSJ(0.96) + Tmax (167) +VE (31) -6262 ESPEN Catabolic phase TEE= 20-25kcal/kg/d Anabolic / Recovery phase TEE = 25-30kcal/kg/d
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Other requirements: Fluid Electrolyes Micronutrients Pabrinex Vitamin D Trace Elements
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Which feed (1)?
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Which feed (2)?
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Case Study 1 Initial assessment for NG feeding in CC. Mr P. Born 1959. Chest infection with Abx 1/52 pre-admission Admitted 48 hrs ago. D3 of admission A – 105kg, 1.82m, BMI ? B – Na 134, K 5.0 , PO4 1.30 , Ur 11.1, Cr , Mg 1.13 , CRP 122, eGFR 53 , Alb 25 C - Diagnosis- CAP, IECOPD, T1RF. PMHx: COPD, T2DM. Bilevel 35% Fi02. Ve: (mean) 9.2. Propofol 11mls/hr. GRV <275mls. T< 38.1. Peripheral oedema D – NG: 60mls/hr Osmolite x24hrs E – Lives with mother. F – N/A - sedated
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Case Study 2 Work in groups of 3 What are the estimated energy requirements? Compare PSU and ESPEN What are the advantages and disadvantages of each method? (Segaran, 2014) How much protein is required for this patient? What fluid (mls/kg) would you advise.? Is the patient at risk from re-feeding syndrome? Is there likely to be nutritional deficit? Task 3: Calculating Nutritional Requirements Task 4: Which enteral feed could meet his needs?
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Case Study 2 Initial assessment Requirements Estimated energy requirements? Estimated protein requirements? Dietetic Diagnosis (PASS) Inadequate nutritional intake (problem) related to unit starter feeding protocol and inability to eat and drink (aetiology) evidenced by intubation and sedation (signs and symptoms) Outcome Minimise losses Goals Meet > 85% estimated energy and protein requirements by enteral feeding Intervention Change enteral feed to ……. Run feed at Xmls/hr x Yhrs to provide….. Review ?
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Case Study 3 Day 5 of admission A – no new weight B – Na 145 , K 5.5 , Ur 27.4, Cr 419, Mg 1.49, CRP 35, eGFR 13, PO4 2.00. Blood glucose 11mmol/L (Insulin 3mls/hr) C – CVVHDF started today. Propofol 12mls/hr . D- ? Task 5: How might the NG feed change with or without haemofiltration ? Task 6: Consider how you might write the PASS statement, goal(s) and intervention?
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Feedback How did the intervention change on review?
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Working in CC Use clinical judgement Use the information available Talk to the MDT Work within your competency Review regularly Ask questions Reflect
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References British Dietetic Association (2016) Model and Process for Nutrition and Dietetic Practice (online) Cerra, FB.(1987) Hypermetabolism, organ failure, and metabolic support Surgery. Jan;101(1):1-14 Dhaliwal et al (2013) The Canadian Critical Care Nutrition Guidelines in 2013 Nutrition in Clinical Practice 29(1), 29-43 Frankenfield, DC and Ashcroft, CM (2011) Estimating Energy Needs in Nutrition Support Patients Journal of Parenteral and Enteral Nutrition 35(5) ,563-570 Heyland et al (2019) The Effect of Higher Protein Dosing in Critically Ill Patients. A multicentre Registry-Based Randomised Trial: The EFFORT Trial Journal of Parenteral and Enteral Nutrition 43(3) 326-334 McClave S A et al (2005) Poor validity of residual volumes as a marker for risk of aspiration in critically ill patients. Critical Care Medicine 33(2) 324-330 McClave S A et al (2016) Guidelines for the provision and assessment of Nutrition Support Therapy in the adult critically ill patient Journal of Parenteral and Enteral Nutrition 40(2)159-211 Mifflin M D et al (1990) A new predictive equation for resting energy expenditure in healthy individuals. American Journal of Clinical Nutrition 51, 241-247 PENG (2019). Nutrition in critical care, Chapter 16 A Pocket Guide to Clinical Nutrition (5th ed.) Segaran, E (2014) Trauma and critical care, Chapter 7.12 Manual of Dietetic Practice (5th ed) Singer P, et al (2009) ESPEN guidelines on parenteral nutrition: Intensive Care Clinical Nutrition 28 387-400 Taylor, B. et al (2005) The role of the dietitian in the intensive care unit Current Opinion in Clinical Nutrition and Metabolic Care 8(2) 211-216 Villet, SP et al (2005) Negative impact of hypocaloric feeding and energy balance in clinical outcome in ICU patients . Clinical Nutrition 24(4) 502-509