Nutrition in critical care课件.ppt

Nutrition in critical care Pratthana Srisangthong,MD Scope Metabolic response in critical illness Assessment of nutritional status Enteral nutrition Parenteral nutrition Immunonutrition and antioxidant Background Adequate nutrition is essential to the critically ill patient. It helps support anabolism uncontrolled catabolism maintain a competent immune system improve patient outcome. Severe trauma, burns, sepsis, and head injury are associated with marked hypermetabolism and hypercatabolism, ? metabolic alterations. Metabolic response in critical illness 2 principal metabolic response 1 response to starvation 2 response to stress Metabolic response to starvation Typical setting ? patient with chronic disease During the first 12 – 24 hr of acute starvation mobilization of hepatic glycogen stores 24 – 72 hr stimulation of gluconeogenesis After 72 hr - increase in hepatic ketone bodies production - reduction of gluconeogenesis - decreased protein breakdown Subsequently, as starvation progresses decrease lean body mass and BMR Metabolic response to starvation Several features distinguish the metabolic response of starved, critically ill patients. As starvation progresses increased loss of lean body mass energy expenditure is not decrease. Continuation of starvation beyond 3 d not accompanied by a stimulation of both ketogenesis and ketone body oxidation (with their normally concomitant suppression of gluconeogenesis and protein breakdown) Metabolic response to starvation Starvation in critically ill patients leads to accelerated protein-calorie malnutrition. These alterations caused by inflammatory mediators. Metabolic response to stress 1 energy metabolism - increased REE Metabolic response to stress Factor influenced energy expenditure 1 effect of illness - stage and length of illness - fever each 1 c ? increase 10 – 15% of EE - pain , physical