Abstract
The Guidelines for the Provision and Assessment of Nutrition Support Therapy in the Adult Critically Ill Patient published in May 2009 (joint guidelines between the Society of Critical Care Medicine (SCCM) and the American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.) have advanced our clinical practice for the nutritional management of critically ill patients. In the current article, we will review how to implement these guidelines using a case study model. Two mechanically ventilated and tube fed patients are discussed, one with pneumonia and the second with severe acute pancreatitis. We address the questions of the feeding timing, method of administration, and management of its complications for these two patients.
Highlights
Critical illness is often associated with catabolic stress and the systemic inflammatory response, which can lead to complications of increased infectious morbidity, multiorgan dysfunction, prolonged hospitalization, and increased mortality [1]
The Guidelines for the Provision and Assessment of Nutrition Support Therapy in the Adult Critically Ill Patient published in May 2009 (joint guidelines between the Society of Critical Care Medicine (SCCM) and the American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.) have advanced our clinical practice for the nutritional management of critically ill patients
Critical illness is associated with loss of lean body mass, which negatively impacts survival in the intensive care unit (ICU) and post discharge
Summary
Critical illness is often associated with catabolic stress and the systemic inflammatory response, which can lead to complications of increased infectious morbidity, multiorgan dysfunction, prolonged hospitalization, and increased mortality [1]. The stress response to critical illness can be modulated nutritionally with the use of early enteral nutrition, appropriate macro- and micronutrient delivery, and adequate glycemic control. A proactive therapeutic strategy of delivering early nutrition support therapy can help lessen disease severity, reduce complications, mitigate inflammation-related catabolism of lean body mass, decrease length of stay in the ICU, favorably modulate the. In the following review we will discuss these guidelines and apply them in clinical practice using a case study model. Through discussing two case studies, the current article presents common clinical issues that arise during enteral feeding of the critically ill patients. We will review the evidence-supported practice guidelines of how to address these issues in order to prevent unnecessary interruption of enteral feeding. The experience and learning from these two cases could serve as a clinical tool to be generally used when enterally feeding the critically ill patients
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