Monday, December 5, 2016

Nutritional support

PulmCrit (EMCrit)
PulmCrit - November 7, 2016 - By Josh Farkas 
"Everyone has strong opinions about food. We all feel that we have some special, intuitive understanding of nutrition. Nonsense. Such intuitions have historically created a wide array of dogma regarding nutrition, complicating matters immensely.
Fortunately, the 2016 SCCM/ASPEN guidelines have stripped away much of the nonsense involved in nutritional support. This allows for a simple and effective approach to nutritional support in the ICU. Based on these guidelines, this post will attempt to sort out truth vs. fiction: which nutritional beliefs are valid, and which need to be discarded?
Over time, critical care nutrition is becoming progressively simpler and easier. Take-home messages from the 2016 SCCM/ASPEN guidelines include:
  • Early enteral nutrition should be provided to nearly all intubated patients.
  • The only strong contraindication to enteral nutrition is an intestinal catastrophe. The following are not contraindications: lack of bowel sounds, therapeutic paralysis, vasopressors, pancreatitis, or open abdomen.
  • Don’t check gastric residual volumes.
  • Patients with pancreatitis, septic shock, hepatic failure, or renal failure can all be fed in essentially the same way that you would feed any patient in the ICU.
  • Fancy, designer tube-feed formulations are rarely needed."