Case Science Session

Nutrition in the Intensive

Care Unit
Bunga Julia Fentika Rahmi BP 1740312259

Preseptor:
dr. Lili Irawati Sp. An

DEPARTMENT OF ANASTHESIOLOGY AND INTENSIVE THERAPY RSUP DR.MDJAMIL

MEDICAL FACULTY OF ANDALAS UNIVERSITY
PADANG
2018
INTRODUCTION

Patient in ICU need the complication appropriate result in

special medical care caused by acute reducing
reaction or and timely
mortality rate
dysfunction of nutritional in hospitalized
one or more body support patients
systems

Acute Physiology and mortality rate in the ICUs

Chronic Health Evaluation is reported at 13.6-36%
INTRODUCTION

15-70% of patient
43% for the patients suffer from
The prevalence of
of the general ward malnutrition on the
malnutrition→ 50%
and ICU admission to the
hospitals
INTRODUCTION

- the hypermetabolic state

- anorexia
MALNUTRITION CAUSED BY - admission of the malnourished
patients
- hospital infection

• increase in the length of

hospitalization
DISADVANTAGES • delay in wound healing
• immune system dysfunction
• loss of muscle mass
• and eventually death
✓ Providing the calorie and
macronutrients requirements,
✓ supportive formulas
✓ immediate and continuos
nutritional assessments
 LIBRARY
REVIEWS

• the science that interpret the

interaction of nutrients and other
subtances in food in relation to
maintenance, growth, reproduction,
NUTRITION health and disease of organism

• It includes food intake, absorption,

assimitation, catabolism, and
excretion
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REVIEWS
Things that need to be considered in giving
nutrition are
▶ Biochemistry of nutritional composition
▶ − The process of metabolism in cells
▶ − When to start enteral and parenteral nutrition.
▶ − Duration of giving
▶ − How to calculate needs
▶ − Choose liquid composition
▶ − Create a therapeutic scheme
▶ − Monitoring
▶ − Preventing or resolving complications
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Assessing Nutrition Status
REVIEWS

All ICU care requests, should be screened to assess their need for nutritional
support. Nutrition assistance within the first 24 to 48 hours of ICU admission (or
when hemodynamically stable) is intended to7

Patients are malnourished or

hypercatabolic

Patients who are expected to stay in

ICU for 3 days or more

Patients who are not expected to

start diet within the next 5 days or
more
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Assessing Nutrition Status
REVIEWS

Before starting to provide nutrition, nutritional

assessment should consider:

❖ Lastest weight loss.

❖ Nutritional intake before admission.
❖ Severity of disease.
❖ Comorbid conditions.
❖ Digestive tract function
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Assessing Nutrition Status
REVIEWS

▶ Assessment of nutritional status in critically ill patients begins by inquiring about a

history of weight loss (exceeding 5% in one month or 10% more in 6 months) and
recording incoming weight. In addition, it should also include assessment of different
risk factors that interfere with digestion, utilization, or excretion such as gastric or
intestinal bypass surgery.
▶ Physical examination should focus on signs of malnutrition, especially deficiency of
caloric protein, signs of certain micronutrient deficiencies (such as anemia, glossitis,
or rash), hydration conditions, and edema.
▶ The most commonly measured protein is serum albumin. Low albumin levels reflect
the patient's nutritional status associated with the disease process and / or recovery
process.
▶ Hemoglobin is used as an indicator of oxygen transport capacity, while magnesium
or phosphorus is an indicator of heart, nervous, and neuromuscular disorders
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Nutritional Needs of Critical Patients
REVIEWS

There are two basic objectives of the nutrition allowance that is

▶ 1. Reduce the consequences of prolonged response to injury,

starvation and infrastructure.
▶ 2. Regulate the inflammatory response, the determination of
nutritional status in critical patients should be done repeatedly to
determine the adequacy of nutrients and to determine the
subsequent nutritional benefits
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Nutritional Needs of Critical Patients
REVIEWS

some ways to calculate the nutritional needs :

❑ Metabolic Chart- Indirect Calorimetry Resting Energy Expenditures (REE)

❑ Harris & Benedict's Formula
▪ Basal metabolic rate (BMR)
▪ Activity Energy Expenditure (AEE)

❑ Daily requirements
→ To determine the needs of calories need to know the physiological picture of
hypersacbolic state. In hypersocarbic state there is an increase in heat production,
increased energy demand (increased 25-50%), increased breathing rate, and increased
pulse rate

25 – 30 ccal/kg BW
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Nutritional Needs of Critical Patients
REVIEWS
❑ Nitrogen requirements
▶ Calculates nitrogen balance by using 24 hour urine urea and in association with
blood urea and Albumin. Each gram of nitrogen produced uses 100-150 kcal of
energy
▶ Nitrogen is needed in patients with:
→ Hypermetabolic, stress and traumatized patients.
→Patients who have urea excretion of 85% of the body protein that has solved.
 Ideally nitrogen should:
1. to a minimum as possible to the missing
2. sufficient to maintain body mass
3. nitrogen is enough for healing
4. adequate adekwat for healing
5. average nitrogen requirement 14 - 16 gm / day (90 - 100 g protein) (1 g nitrogen = 6.25 gr
protein = 30 g tissue)
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REVIEWS
Summary Table of Recommendations Macronutrient
Needs For ICU Patients
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REVIEWS