Nutrition - DM SEMINAR SEPTEMBER 23, 2005 NUTRITION IN ICU...

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NUTRITION IN ICU Navneet Singh Department of Pulmonary Medicine DM SEMINAR SEPTEMBER 23, 2005
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Scope of seminar • Introduction • Assessment of nutritional status • Provision of nutritional support • Enteral & Parenteral Nutrition • Obesity & ICU • Immunonutrition • Nutrition Protocols
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Introduction • Critical illnesses, stress & surgery place demands on body’s nutritional req. Æ promote a catabolic state & -ve N balance. • Prolonged bed rest & inactivity per se Æ -ve N balance in healthy individuals Bloomfield SA. Med Sci Sports Exerc. 1997; 29(2): 197-206. • Combination of hypermetabolic state like critical illness or sepsis + bed rest & inactivity Æ suitable environment for occurrence of malnutrition
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Introduction • Malnutrition - net nutrient intake < net nutrient req – 1% to 15% of ambulatory outpatients – 25% to 60% of institutionalized patients – 35% to 65% of hospitalized patients • Uncorrected it is succeeded by metabolic abnormalities, physiologic changes, reduced organ & tissue f x & loss of body mass
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OPTIMAL NUTRITIONAL STATUS & FACTORS INFLUENCING IT Nutrient Intake Nutrient Requirements SE Status, Disease, Cultural Factors, Emotional Status Physio. Stress (Preg, Growth) Psychological Stress Path. Stress (Fever, Disease)
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Disease Reduced mass Reduced Intake Losses (GI, Ur) Deficiency Loss of reserve tissue & functional capacity Change in Physiologic & Metabolic Responses Altered Requirements Inefficient Fuel Utilization Change in Body Composition Loss of Homeostasis
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Introduction • Effect on Liver: – Increased production of acute phase proteins – Decreased production of albumin – Increased catabolism of albumin – Extravasation of albumin into extravascular space • Effect on Lungs : – Decreased diaphragmatic muscle mass – Decreased max voluntary ventilation – Decreased max mouth pressures – Breathing pattern (Rapid shallow) – Increased Fluid in Interstitium – Decreased FRC & predisposition to atelectasis
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Introduction +++ + Ureagenesis + +++ Ketone production +++ + Gluconeogenesis +++ + Ur N losses +++ + Proteolysis Mixed Fat Primary fuels Cytokine levels (0.8-0.9) (0.6-0.7) Resp. Quotient BMR/REE Catabolism in Critical Illness Starvation Feature
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Introduction Demling RH, DeSanti L. Curr Opin Crit Care 1996; 2: 482–491
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Introduction • Factors adversely influencing outcome in critical illness – Depleted lean body mass – Male gender – Insulin insensitivity – Impaired anti-oxidant defences – Immunosuppression – Hyper inflammatory state – Ageing – ‘Disadvantageous genotype’ Grimble RF. Curr Opin Gastroenterol 2005; 21: 216–222
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Introduction • Malnutrition in ICU patients can be either present on admission or develop subsequently as a result of metabolic response to injury • Whatever the cause the end result is the same i.e. malnourished pts tend to have longer hospital LOS Æ costs of care & mortality Middleton MH et al. Intern Med J. 2001; 31(8): 455-461.
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This note was uploaded on 12/03/2011 for the course MEDICINE 350 taught by Professor Dr.aslam during the Winter '07 term at Medical College.

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Nutrition - DM SEMINAR SEPTEMBER 23, 2005 NUTRITION IN ICU...

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