Nutrition in ICU by Prof. Andrea Marshall

by - February 02, 2022

        Prof. Andrea Marshall was discussing nutrition in the ICU. She focused on the factors that increase the risk of malnutrition, the benefits of optimizing nutrition, during the critical illness, the nutrition support strategies, and the ways to enhance the nutrition intake to critically ill clients. One of the factors that increases the risk of malnutrition to critically ill clients is their response to metabolic stress. ICU clients have a higher energy expenditure thus an increase in energy requirement. Also, during their recovery phase a higher amount of protein is being used that is why there is a loss of lean body mass to the clients. The potential benefits of optimizing nutrition during critical illness is that it plays a key role in modulating the inflammatory response that helps to maintain the immune function and to limit the skeletal muscle metabolism. It was known that there is an absolute risk reduction in infection when clients are being fed and there is a reduction in mortality from 14% to just less than 9%. Some of the nutritional support strategies are autophagy, trophic feedings, and permissive underfeeding. Autophagy is a housekeeping system that removes the unfolded proteins, virus, and bacterias. Trophic feedings did not increase the number of ventilator free days and it also did not reduce the 60-day mortality. While in permissive feeding, it was found out that clients who receive more than most nutrition had poorer outcomes. Lastly, Prof Marshall also talked about a way to enhance the nutrition intake and that is to use an indirect calorimetry which is an actual direct measurement of the oxygen consumption in the carbon dioxide production in order to work out what the client’s energy expenditure is. The total energy expenditure consists of the basal metabolic rate, thermogenic effect of food, and physical activity. We measure this in order to achieve the steady-state that will allow in determining the degree of variability of the feedings that will be given to the client. 

        What I understand in this podcast is that nutrition is really important in clients who are in the ICU because it prevents metabolic deterioration and loss of lean body mass. That is why not only nurses are encouraged to take care of the nutritional needs of the client but as much as possible family engagement is being considered to make sure that nutrition delivery is being enhanced. Since ICU clients usually experience energy depletion, when they are discharged, they may still be in a slightly hypercatabolic which is why their nutritional requirement increases. That is why I positively agree when the speaker mentioned that family engagement should be considered because when the client is no longer under the care of the health professionals, the family will now be responsible to improve the nutrition intake of their loved ones. Maintaining an adequate intake is really important since it also helps to decrease the vulnerable period of their loved ones. 

        All clients in the ICU have different nutritional needs in a way that one may benefit from certain nutritional interventions and others may not. So, I will apply my learnings in the current practice from this podcast by following the prescription of the physician in-charge to my client that I will be handling in the future. I will deliver the right amount of proteins and calories so that the nutritional intervention that I will perform will be effective to them. However, there is still no exact right amount of nutrition to be delivered but the good thing is that research about nutrition interventions are evolving. I will keep myself updated with the evidence based practice regarding nutrition of ICU clients so that I will be able to provide an appropriate nutrition to my clients. In addition, delivering nutrition to ICU clients requires a team effort, that is why I will collaborate with other healthcare professionals so we can monitor and implement strategies together that will help improve the nutritional adequacy of our clients.

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