RISKS AND BENEFITS OF NUTRITIONAL SUPPORT DURING CRITICAL ILLNESS Part II课件.ppt

RISKS AND BENEFITS OF NUTRITIONAL SUPPORTDURING CRITICAL ILLNESSPart II Present: 謝廣宇 Supervisor: Dr 陳奇祥主任 Is Enteral Nutrition Without Risks? altered gastric emptying and decreased intestinal motility ? critical illness ,MV , sedatives, opiates, and catecholamines → high gastric residues → inadequate nutritional intake, reflux, emesis, and aspiration abdominal distention, diarrhea, constipation, and, rarely, mesenteric ischemia. Mechanical complications → misplacement or dislodgment of feeding tube or luminal blockage both gastric enteral feeding and feeding in supine position, as opposed to semirecumbent position, are independent risk factors for nosocomial pneumonia in MV patients -------- Drakulovic MB, 1999. Supine body position as a risk factor for nosocomial pneumonia in mechanically ventilated patients: a randomised trial. Lancet 354:1851–58 “postpyloric” feeding may result in an improved tolerance of enterally delivered nutrition and concomitant faster achievement of desired calories----- Kortbeek JB 1999.Duodenal versus gastric feeding in ventilated blunt trauma patients: a randomized controlled trial. J. Trauma 46:992–96; discussion 996–98 no trial was able to reduce incidence of nosocomial pneumonia compared with NG feeding-------- one study in medical ICU even resulted in gastric way is better feeding tube beyond gastric pylorus -----technically difficult, expensive, easy malposition and jejunal feeding is associated with risk of mesenteric ischemia strict attention to patient positioning and vigilant nursing care help to minimize rates of complications with enteral access and more important than location of enteral access metoclopramide was able to postpone nosocomial pneumonia by one day in ICU setting, its use was unable to decrease the incidence of pneumonia and mortality----Yavagal DR, 2000. Metoclopramide for preventing pneumonia in critically ill patients receiving enteral t