Nutrition support in the ICU setting

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Nutrition support in the ICU setting

• It is what you dont see that really matters

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The microcirculatory environment
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Stimulus and cell response
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Glucose homeostasis
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Lipid metabolism
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Protein metabolism
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Host-microbial interaction
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Host-microbial recognition
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Gut inductive and effector sites
Per Brandtzaeg, Mucosal adaptive immunity impact
of exogenous stimuli and feeding Nutrition,
immune functions and health Euroconferences,
Paris June 9-10, 2005
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The immune system in acute inflammation
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Nutrition and microcirculation
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Trace elements and life processes
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Nucleotides cellular mechanics
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Inflammation and organ failure in the ICU
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?-3 PUFA
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Principal areas to address

• Adequacy of microcirculation
• Accurate fluid balance
• Adequate oxygenation
• Adequacy of nutrients (macro and micro)
• Appropriate access
• Accurate calorie count
• Differentiation between infection and SIRS
• Appropriate antibiotic use

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Nutrition issues in critical care

• Adequate and complete nutrient intakes
• NPO mind set
• Type of nutrient and route of delivery
• Development of immune reactions (e.g. allergy)
• Parenteral nutrition
• Antibiotics
• Effect on normal flora
• Preventive measures
• Stressful or injurious environment (e.g.
  oxidative stress)
• Use of special nutrients that become
  conditionally essential

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Who are these patients?
Group A

• Inadequate intake due to multiple etiologies
• Chronic illness
• Cardiac problems
• Pulmonary problems
• Gastrointestinal problems
• Stroke
• Depressed
• Geriatric patients

• Common Features
• No appetite
• Swallowing problems
• Malabsorption

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Group B
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Pediatric patients Priorities
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Pediatric patients Priorities

• Brain growth is pre-programmed especially high
  in the first 2 years
• Myelinization is completed by 6 to 12 months
  and in some nerves up to 2 years

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Energy reserves utilization critically ill
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Complement System
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Complement System
Antigen/ antibody complexes (adaptive
Microorganisms (innate)
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How the Complement System Works
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Current update
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