Nutrition Therapy Intensive Care

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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.

Prescription

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.

Patient Access

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.

Preparation

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.

Application

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.

Discharge Management

Upon recovery the patient is discharged from the intensive care unit to a peripheral ward and later to his home. Discharge Management ensures optimal continous support and hand over to nursing services. It bridges the interface between hospital treatment and home care.