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GUIDELINES ON NUTRITIONAL SUPPORT IN ICU Developed by: Faculty of Critical Care The College of Anaesthesiologists of Sri Lanka In collaboration with Nutrition Division of Ministry of Health of Sri Lanka Publication Date: January 2014 Date for Review: January 2016 THE COLLEGE OF ANAESTHESIOLOGISTS OF SRI LANKA WORKING GROUP Correspondance: anascol@sltnet.lk Dr Vihara Dassanayake Dr Bimal Kudavidanage Dr Chamila Jayasekera Dr Kanishka Indraratna Dr Saman Karunathillake Dr Sidarshi Kiriwattuduwa Dr Chamila Pilimathalawwe Dr Tharanga Perera Dr Buddhika Vidanagama Dr Buddhika Habaragamuwa Dr S Mathanalagan 2 Guidelines on Nutritional Support in ICU The College of Anaesthesiologists of Sri Lanka January 2014 CONTENTS Introduction 4 Assessment of Nutritional Status 4 Calculation of Energy & Nutrition Requirement 5 Establishing Enteral Feeding in ICU 5 Suggested Algorithm for Establishing Enteral Nutrition 8 Practice Recommendations for Enteral Nutrition 9 Establishing Parenteral Nutrition ICU 11 Calculation of Parenteral Nutrition for a 70kg patient 13 Practice Recommendations for Parenteral Nutrition 14 Monitoring a Patient on Parenteral Nutrition 15 Nutrition Guide in Special Circumstances 16 References 19 Appendices 1. Definitions – Malnourished, At risk of Malnourishment Re-feeding Syndrome 20 2. Calculation of Energy & Nutrient Requirement 21 3. Placement of Naso-gastric/Oro-gastric Tube 22 4. Proximate Energy & Nutrient Content of Common Food Items of Sri Lanka 23 3 Guidelines on Nutritional Support in ICU The College of Anaesthesiologists of Sri Lanka January 2014 INTRODUCTION These guidelines apply to nutritional support in adult patients in critical care units of Sri Lanka. In this document, enteral feeding refers to non-volitional delivery of nutrients via a tube into the gastrointestinal tract, and parenteral feeding refers to aseptic intravenous delivery of sufficient nutrients where adequate alimentary delivery of nutrients is not possible. Critically ill patients are in a catabolic state induced by severe disease and appropriate nutritional support should be initiated as early as possible, in all patients admitted to the critical care unit unless indicated otherwise. Starvation and underfeeding in critical care patients are associated with increased morbidity and mortality. Nutritional support can be provided by enteral or/and parenteral routes, enteral being the preferred one. It is important in patients who are malnourished and those who are at risk of malnutrition. (Appendix 1) During a critical illness, in addition to catabolic stress, there is an increased inflammatory response leading to increased nutritional requirement. Also there is an altered gut morphology and function, causing impaired digestion and absorption. Poor nutrition in critically ill patient causes decreased immunity, decreased respiratory muscle function and a reduced respiratory capacity, ventilator associated pneumonia, difficult weaning off ventilator and poor wound healing. Assessment of Nutritional Status Traditional nutritional assessment tools are not validated for use in the critical care setting. The assessment usually include Evaluation of weight loss Previous nutrient intake Level of disease severity Co morbid conditions Function of the gastrointestinal tract 4 Guidelines on Nutritional Support in ICU The College of Anaesthesiologists of Sri Lanka January 2014
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