第二代肠内营养给药方法与策略(英文教学)幻灯片课件.pptVIP

Daren K. Heyland Professor of Medicine Queen’s University, Kingston General Hospital Kingston, ON Canada;Mr CD 47 renal transplant Severe CAP Septic shock, ARDS, MODs Requires vasopressors for days Day 3- trickle feeds (20 cc/hr) Feeds on and off again for whole first week Nurses notes gastric residual volume of 60cc Ask resident what to do Resident says wait till rounds;Cahill N Crit Care Med 2010 (in press);Cahill NE CCM 2010 (in press);;;The Impact of Enteral Feeding Protocols on Enteral Nutrition Delivery:Results of a multicenter observational study;Characteristics ;The Impact of Enteral Feeding Protocols on Enteral Nutrition Delivery:Results of a multicenter observational study;Does One Size Fit All?;Resuscitation is the priority No sense in feeding someone dying of progressive circulatory failure However, if on stable or declining doses of vasopressors: ;Purcell Am J Surg 1993;165:188;9 patients day 1 Post-op following CPB requiring inotropes and vasopressors Feed enterally; metabolic response consistent with substrates being utilized;Prospectively collected multi-institutional medical intensive care unit (ICU) database. 1,174 patients were identified who required mechanical ventilation for more than two days and were placed on vasopressor agents to support blood pressure. Patients divided according to whether or not they received enteral nutrition within 48 hours of mechanical ventilation onset. 707 patients (60%) who did were labeled as the “early enteral nutrition group” and the remaining 467 patients (40%) were labeled as “late enteral nutrition group”. The primary endpoints were overall ICU and hospital mortality. Data also analyzed after controlling for confounding by matching for propensity score;Feeding the Hypotensive Patient?;“Trophic Feeds”;Initial Efficacy and Tolerability of Early Enteral Nutrition with Immediate or Gradual Introduction in Intubated Patients;Daren K. Heyland Professor of Medicine Queen’s University, Kingston Gen