NUTRITION SUPPORT THERAPY PROTOCOL IN CICU

Introduction

Early nutrition in critically ill patient are very crucial in order to predict the prognosis of the
patient. It will benefit in terms of providing adequate nutrition, provides fuels for cellular metabolism, to
prevents protein and muscle wasting, decrease ventilator time, helps prevent infection or ventilator
acquired pneumonia (VAP), decrease ICU length of stay, promotes healthy wound healing and reduces
mortality. Gut disuse may cause loss of functional and structural integrity of the GI tract and is
associated with increased complications. These changes are time dependent; h the longer they are left
NPO, the greater the complication. Hence, appropriate nutrition regime or protocols should be
established in our settings in order to deliver the best critical care nutrition and promote good
cooperation in healthcare team

Initiation of Nutrition Support Therapy

1. All patient post-operatively who needs enteral feeding should be started on trophic feeds within
24-48 hours of post operation unless contraindicated.

2. Patient are preferably started with pump- assisted feeding

STAGE 1 : Start feeding with 1 scoop Peptamen at 10ml/hour for 4 hours with 2 hours rest.
Maintain feeding rate for 24 hours. Check for gastric aspirate, abdominal distention,
vomiting and diarrhea.

STAGE 2 : Once tolerated stage 1, Increase feeding to 2 scoops Peptamen at 20 ml/hour for 4
hours with 2 hours rest. Maintain feeding rate for 24 hours. Check for gastric aspirate,
abdominal distention, vomiting and diarrhea.

STAGE 3 : Once tolerated stage 2, increase feeding to 3 scoops Peptamen at 30ml/hour for 4
hours with 2 hours rest. Maintain feeding rate for 24 hours. Check for gastric aspirate,
abdominal distention, vomiting and diarrhea

3. Once patient could tolerate 30 ml/hr. without complication, optimize enteral nutrition support
by referring to the dietitian as soon as possible.

4. Reassess the energy and protein requirement for each individual.