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1、PracticalAspectsofNutritionSupportintheICUJohnW.Drover,MD,FRCSC,FACSAssociateProfessorQueen’sUniversityKingston,ONCanadawww.criticalcarenutrition.comDisclosureInformationNonewww.criticalcarenutrition.comObjectivesAttheendofthesessiontheparticipantwillbeableto:List3strategiestomaxi
2、mizethebenefitsofenteralnutrition.List2advantagesofpost-pyloricenteralfeeding.Identify1methodofgainingpost-pyloricaccessatthebedsideintheICU.OutlineReviewtherationaleforenteralfeeding.Focusonthedataregardingpost-pyloricfeeding.SpecificallyRCT’sClinicallyimportantoutcomesReviewther
3、isksofandobstaclestopost-pyloricfeeding.Developarecommendationwww.criticalcarenutrition.comCase#1Day#150yofemaleCOPDwithCAPIntubated,resuscitatedWhowouldstartENwithin24hoursofadmission?Whowouldattempttoplaceapost-pyloricfeedingtube?Case#2Day#550yofemaleCOPDwithCAPIntubated,resusci
4、tatedfeedingtubeinstomachReceivingmetoclopromideAchieving<30%ofgoal;GRV>400mlWhowouldrecommendplacementofapost-pyloricfeedingtube?NutritionintheCriticallyillEnteralnutritionstronglyrecommendedEarlyenteralnutritionrecommendedOptimizethebenefitsandminimizerisksUseoffeedingprotocolsM
5、otilityagentsforgastricfeedingSmallbowelfeedingIntra-gastricfeedingThegood:EasyaccessEarlyinitiationOftentoleratedwellThebad:Gastricresidualvolumes(GRV’s)Gastro-pharyngealrefluxRespiratoryaspirationUnrealizednutritionalgoalsPost-pyloricfeeding2RCT’sthathaveevaluatedaspiration33pat
6、ients,1st3daysGEregurg24.9%vs.39.8%(p=0.04)Furtherintosmallbowellessaspiration54patients,twiceweeklyLowrateofaspiration7%vs13%aspirationHeylandetal,CCM,2001Esparazaetal,IntCareMed,2001Post-pyloricfeeding11RCT’sofSBvsGastricfeedingMed/Surg(4),Med(3),Trauma(2),Neuro(2)N=664Onestudyu
7、sedargininecontainingdietsVariabledesignforselectionDifferentmethodsofenteralaccessOutcomesNodifferenceinmortality,LOS,ventdaysHeylandetal,JPEN2002Post-pyloricfeedingTayloretal.CCM,1999Neurotrauma,n=82Standardgastricfeeding15ml/hincreaseQ8hAggressiveSBfeeding(whenfeasible)SBaccess
8、only34%Startattargetrateandadjust
