Nutrition Support

 Nutrition Therapy
o The provision of either enteral nutrition (EN) and/ or parenteral nutrition (PN).

 Enteral Nutrition
o By enteral access device

 Parenteral Nutrition
o By central venous access

 Standard Therapy (STD)

o The provision of intravenous (IV) fluids, no EN or PN, and advancement to oral
diet as tolerated.

 Delivering early nutrition support therapy, primarily by the enteral route, is seen as a
proactive therapeutic strategy that may reduce disease severity, diminish complications,
decreases LOS in the ICU, and favorably impact patient outcomes.
 All hospitalized patients are required to undergo an initial nutrition screen within 48
hours of admission.
 Patients at higher nutrition risk in an ICU setting require a full nutrition assessment.
o Mini Nutritional Assessment
o Malnutrition Universal Screening Tool
o Short Nutritional Assessment Questionnaire
o Malnutrition Screening Tool
o Subjective Global Assessment
 Patients at high nutrition risk are more likely to benefit from early EN with improved
outcome (reduced nosocomial infection, total complications, and mortality) than
patients at low nutrition risk.

Serum protein markers

(albumin, prealbumin, transferrin,
Retinol-binding protein)
Do not accurately represent
Anthropometrics nutrition status in ICU

Levels of calcitonin, CRP, interleukin 1,

TND, interleukin 6, and citrulline
Ultrasound
Computed Tomography (CT) Scan
Both are valuable future tools
to incorporate into nutrition
assessment; however,
validation and reliability
studies in ICU patients are still
pending.
  Enteral Tube Nutrition
o For patients who have a functioning GI tract but cannot ingest enough nutrients
orally because they are unable or unwilling to take oral feedings.
o Compared with parenteral nutrition, enteral nutrition has the following
advantages
 Better preservation of the structure and function of the GI tract
 Lower cost
 Probably fewer complications, particularly infections
o May cause
 Prolonged anorexia
 Severe protein-energy undernutrition
 Coma/ depressed sensorium
 Liver failure
 Inability to take oral feedings due to head/ neck trauma
 Critical illnesses (eg, burns) causing metabolic stress

 Total Parenteral Nutrition (TPN) = IV

o Supplies all daily nutritional requirements.
o Can be used in the hospital or at home
o TPN solutions are concentrated and can cause thrombosis of peripheral veins
o A central venous catheter is usually required
o Parenteral nutrition for patients who do not have a functioning GI tract/ who
have disorders requiring complete bowel rest
o Parenteral nutrition should not be used routinely in patient with an intact GI
tract. Compared with enteral nutrition, it has the following disadvantages
 It causes more complications
 It does not preserve GI tract structure and function as well
 It is more expensive
o

1) Which percentage of patients receiving TPN develops glucose abnormalities (hypo- or

hyperglycemia) or liver dysfunction?
Ans: 90%

2) Weight, CBC, serum electrolyte concentrations and serum BUN concentration should be
monitored daily in hospitalized patients receiving TPN. Which of the following should be
monitored continuously on TPN patients?
Ans: Fluids

3) Lipid emulsions added to TPN solutions typically supply 20% to 30% of total calories.
However, withholding lipids could benefit which of the following groups of patients?
Ans: Obese patients – help them mobilize fat stores, increasing insulin sensitivity
4) Which of the following patient types requires the greatest proportion of energy (calories) in
their TPN solutions?
Ans: Hypercatabolic patients

5) TPN is indicated in which of the following hospitalized patients?

Ans: Patients with bowel obstruction