CURRENT Essentials of Critical Care.pdf

14 Current Essentials of Critical Care■■Nutrition, EnteralEssential Concepts• Enteral feeding preferred over parenteral; better outcome, fewerinfections, maintenance of GI function• Enteral formulas supply calories and protein, vitamins, trace elements• Most contain protein hydrolysates, simple and complex carbohydrates,medium chain triglycerides; others elemental (aminoacids, sugars)• Enteral nutrition formulary includes standard formula (1cal/mL); formulas for fluid restriction, higher or lower protein,hepatic encephalopathy (high branch chain amino acids)• Use nasogastric tubes designed for enteral feeding or gastrostomyor jejunostomy tubesEssentials of Management• Start enteral feeding support in all patients who have no contraindication;no indication for parenteral feeding• Determine nutritional status and requirements• Select enteral feeding formula based on underlying diseases, patient’svolume status, protein and calorie requirements• Choose starting and goal target rate (generally 60–90 mL/h forcontinuous feeding); use enteral feeding pump• Place and check position of nasogastric or gastrostomy tube; elevatehead of bed 30–45 degrees during feeding to avoid aspirationpneumonia• In cases of malnutrition, hypoalbuminemia, diarrhea or prolongeddisuse of GI tract, begin feeding at low rate and advanceover 24 hours to goal.• Consider metoclopramide or erythromycin (promotility agents)if high gastric residual volume• Complications: high gastric residual volume (check every 2–4hours), diarrhea, abdominal distension, aspiration pneumonia■ PearlIf diarrhea persists after slowing feeding rate and diluting formulawith sterile water, consider antibiotic-induced diarrhea or C difficileinfection.ReferenceASPEN Board of Directors and the Clinical Guidelines Task Force. Guidelinesfor the use of parenteral and enteral nutrition in adult and pediatric patients.JPEN J Parenter Enteral Nutr 2002;26(1 Suppl):1SA. [PMID: 11841046]