Nutrition therapy for intensive care patients
Nutrition for critically ill patients still today remains a challenge with individual diverse needs of a heterogeneous patient group based on underlying diseases. Enteral feeding has proven to be the optimum route also in this patient group, however, there are often limitations with regards to the safe use of this route as well as to reach the caloric goals. This is of particularely importance for the patients to receive adequate amounts of energy and nutrients to support recovery. The use of parenteral nutrition is prudent to optimally supplement patient needs in addition to enteral nutrition or as total parenteral nutrition in case enteral nutrition is contraindicated or impossible.
Based on the patient characteristics and assessment of needs, the adequate nutritional regime and support is decided. In addition, guidelines of the nutritional societies, as well as the availability of services of an individual hospital has to be taken into account. If parenteral nutrition is required, the addition of omega 3 fatty acids from fish oil like eicosapentaenoic acid (EPA, C20:5 [omega-3]) and docosahexaenoic acid (DHA, C22:6 [omega-3]) to lipid emulsions has demonstrable effects on cell-membranes and inflammatory processes. Omega 3 fatty acid enriched lipid emulsions probably decrease the hospital length of stay in critically ill patients.
Related Products – Prescription
Enteral Nutrition support is the provision of nutrients via the gastrointestinal tract by oral intake or through enteral feeding tubes.
Parenteral nutrition (PN) is defined as the supply of vital nutrients bypassing the digestive tract. Parenteral nutrition becomes necessary when it is not possible for the body to ingest sufficient nutrients via the oral/enteral route and to utilize these nutrients adequately. The choice between the enteral or parenteral route is decided very simply by the question "Is the gastrointestinal tract functional?"
The use of the gastrointestinal system is possible despite critical illness gastroplegia with jejunal feeding tubes which can later be changed into more proximal access types. Central venous multi-lumen catheters are often available in critically ill patients for monitoring of unstable situations as well as providing IV drugs. These can be as well used for parenteral nutrition, especially for higher osmolaric solutions.
The need for preparation largely depends on the decision of the treating physician and the availability of nutritional services in a given hospital. Oral sip and tube feeds are available as ready-to-use-products. Usually no additional preparation steps are necessary. For parenteral nutrition ready-to-mix multi-chamber bags are available which should be supplemented with vitamins and trace elements. Some patients may need individually compounded IV nutrition. These admixtures can be prepared by a pharmacy or an industrial compounding service.
The choice of route of nutrition is decisive for the application: For enteral tube feeds the use of dedicated EN Safety disposables is strongly recommended as these are non-compatible with IV-lines and thus prevent misconnections. Additionally, infusion pumps with dedicated sets for enteral and / or parenteral nutrition solutions assure the correct and safe administration. For patients with stress hyperglycemia, glucose management systems help control the blood glucose levels to prevent both hyper- and hypoglycemia, thus adding to reduced morbidity and mortality.
Related Products – Application
Infusomat® Space Line Safety Universal Adapter
Pump Administration Safety System with Universal Adapter