Monitoring Nutritional Support In Intensive Care Unit: Nestle

Speaker: Dr. Pravin Amin, MD, FCCM Presented at: CRITICARE 2011 New Delhi, Workshop on Nutrition in Critical Care

Summary

This talk covers the recognition of the importance of nutritional care as a key component in managing all types of diseases and highlights the troubles that one may associate undernourishment with. It details protocols for nutritional monitoring while addressing the principles of nutritional assessment and monitoring. The talk further goes to explain the effects of rapid repletion of nutrients and points out other short term problems that one may face. It sets out protocols for nutritional, anthropometric and clinical monitoring along with recommending hospital protocols for laboratory monitoring. The talk also gives an overview of energy expenditure measurements and other monitoring tools for practitioners.

Nutritional Monitoring has a growing recognition of the importance of nutritional care as a key component in the management of virtually all acute and chronic diseases. Under-nutrition is common, especially in hospital patients and this is associated with impaired immune responses, reduced muscle strength, impaired wound healing, increased susceptibility to infection, leading to increased morbidity and mortality. There are various protocols for nutritional monitoring. It is important to note that there have been no trials to investigate prospectively the diagnostic efficacy or cost-effectiveness of monitoring. There is evidence that having an agreed protocol for monitoring, as a part of a Nutrition Support Team, leads to more elective detection and earlier treatment of biochemical abnormalities. NST will prescribe and deliver PN more appropriately and will also detect a greater number of abnormalities as a result of having a protocol for monitoring.

The principles of nutritional assessment and monitoring are initial assessment, monitoring and evaluation of the support provided and detection & management of metabolic complication. Initial assessment is performed before nutrition support has commenced. Biochemical status at the outset is assessed. It also helps to establish the nutritional regimen especially if patients are to receive parenteral nutrition. Monitoring and evaluation of the support is provided once EN is fully established and there is a little need for detailed biochemical monitoring, it can be judged by improvement in weight and wellbeing. Biochemical testing is required if there is a change in the patient’s condition or inadequate progress is being made. Patients receiving PH require more intensive biochemical monitoring especially if there are continued losses, if the clinical condition of the patient changes. Trends of results are of special importance.

Indirect Calorimetry measures EE by calculating the patient’s metabolic rate through measurements of oxygen consumption (VO2) and carbon dioxide production (VCQ2). Indirect Calorimetry can accurately measure metabolic rate and predict energy requirements for critically ill patients. VQ and VCO values are then converted to an REE via a metabolic computer using the Weir equation.