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AAA-MEDICAL NUTRITION > NUTRITION IN CRITICAL CARE (AB) > Flashcards

NUTRITION IN CRITICAL CARE (AB) Flashcards

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1
Q

What is the definition of critically ill patients?

A

Patients admitted specifically in Intensive Care Unit.

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2
Q

What is systemic inflammatory response syndrome (SIRS)?

A

Exaggerated defense response to stressors like infection trauma surgery inflammation ischemia reperfusion or malignancy.

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3
Q

What are common complications of critical illness?

A

Increased infectious morbidity multi-organ failure prolonged hospitalization.

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4
Q

What are the goals of nutrition in critically ill patients?

A

Decrease hospital stay decrease morbidity rate improve patient outcomes.

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5
Q

When should nutritional therapy ideally start in critical illness?

A

Within 24-48 hours.

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6
Q

What are the effects of early enteral nutrition (EEN)?

A

Benefits include reduced complications improved outcomes.

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7
Q

What increases risk of malnutrition in critical illness?

A

Physio-metabolic changes and reduced calorie and protein intake.

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8
Q

When is parenteral nutrition (PN) considered?

A

If EN is inadequate after 7 days of ICU admission.

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9
Q

What parameters are monitored during nutrition therapy?

A

Electrolytes like sodium potassium phosphate.

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10
Q

What is Subjective Global Assessment (SGA) used for?

A

To assess nutrition status predict morbidity and mortality in malnutrition.

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11
Q

What is the Malnutrition Universal Screening Tool (MUST)?

A

Five-step tool assessing BMI weight loss and acute disease effect score.

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12
Q

What MUST score indicates high risk and requires intervention?

A

A score of 2 or more.

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13
Q

What is the gold standard for measuring energy expenditure?

A

Indirect calorimetry.

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14
Q

What does indirect calorimetry measure?

A

Oxygen consumption and carbon dioxide production.

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15
Q

Why is EN preferred over PN in critical illness?

A

Maintains gut integrity reduces infections regulates oxidative stress.

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16
Q

What are risks associated with parenteral nutrition (PN)?

A

Hyperglycemia hyperalimentation infectious complications.

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17
Q

What should you monitor for in patients on PN?

A

Signs of infection at catheter insertion site.

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18
Q

What is the first choice route for enteral feeding?

A

Nasogastric (NG) tube.

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19
Q

When is postpyloric feeding indicated?

A

When patients cannot tolerate gastric feeding.

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20
Q

What residual volume suggests feeding intolerance?

A

Greater than 500 mL.

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21
Q

What infection is linked to long-term enteral tube feeding?

A

Clostridium difficile colitis.

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22
Q

What formula feed is preferred to minimize feed contamination?

A

Scientific formula feed or closed system formula.

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23
Q

What is blenderized tube feeding (BTF) associated with?

A

High microbial contamination inconsistent nutrient delivery tube blockage.

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24
Q

What is recommended over blenderized feeds in ICU patients?

A

Standard polymeric formula feeds.

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25
What are complications of underfeeding in EN?
Negative energy balance poor outcomes.
26
What are complications of overfeeding in PN?
Hypercapnia refeeding syndrome.
27
What is the best calorie intake target for survival?
At least 80% of prescribed target.
28
What is permissible underfeeding?
Intentional underfeeding in obese patients to improve outcomes.
29
What is refeeding syndrome?
Severe electrolyte shifts when feeding restarts in malnourished patients.
30
What is the recommended protein requirement for critically ill patients?
1.2-2.0 g/kg/day.
31
What is the recommended calorie intake for critically ill patients?
25-30 kCal/kg/day.
32
What is the kcal:Nitrogen ratio recommended for severely hypercatabolic patients?
120:1 or 100:1.
33
How much protein is needed for a 50 kg critically ill patient?
100 g per day.
34
How many calories are needed for a 50 kg critically ill patient?
1500 kCal per day.
35
What is the MAP value indicating hemodynamic instability in critically ill patients?
Less than 65 mmHg
36
Why should bowel sounds be checked before starting EN in HD unstable patients?
To assess gut function and prevent intestinal ischemia
37
What complication can EN trigger in HD unstable patients?
Intestinal ischemia
38
When should EN be initiated in HD unstable patients?
When patient is on stable or declining doses of vasopressors and adequately volume resuscitated
39
What is the initial recommended feeding rate in HD unstable patients?
Trophic feeding at 10-20 mL/h
40
What are signs of adequate fluid resuscitation in critically ill patients?
Urine output ≥ 0.5 mL/kg/hr. MAP ≥ 65 mmHg without excessive vasopressor support. Heart rate stabilizing or decreasing. Improved capillary refill time (< 2 seconds)
41
When should EN be started once patient is stable with vasopressors?
Within 24-48 hours
42
What nutrition is recommended if shock persists and EN cannot be started?
Total parenteral nutrition (TPN)
43
How is diarrhea defined?
Passage of three or more loose or liquid stools per day or more frequent passage than normal
44
What types of formula feeds can help manage persistent diarrhea?
Mixed fiber-containing. Soluble fiber-supplemented. Small peptide-based semi-elemental formula feeds
45
Should EN be stopped in the event of diarrhea?
No. Feeds should be continued while evaluating cause
46
When can soluble fiber-containing formulas be considered in diarrhea management?
After excluding hyperosmolar agent intake and C. difficile infection
47
Is routine use of probiotics recommended for ICU patients?
No
48
When are probiotics recommended in ICU patients?
Only for select medical and surgical populations with proven safety and outcome benefits
49
What are consequences of micronutrient deficiencies in critically ill patients?
Depressed immunity. Compromised wound healing. Increased morbidity and mortality
50
Which micronutrient is considered particularly important in critical illness?
Selenium
51
What should be evaluated before micronutrient supplementation?
Preexisting micronutrient deficiency
52
Do patients on complete formula feeds need additional micronutrients?
No
53
When should micronutrients be supplemented?
In patients on blenderized feeds or PN and in TBI or perioperative surgical ICU patients
54
Is glutamine recommended in critically ill patients with multiple organ failure?
No
55
What can exogenous glutamine infusion worsen in critically ill patients?
Inflammatory response
56
What is the benefit of glutamine supplementation in critically ill surgical patients?
Reduced nosocomial infections and shorter hospital stay without reduction in mortality
57
Should EN be preferred in ICU patients with acute or chronic liver disease?
Yes
58
Are branched-chain amino acid formulations beneficial in critically ill patients with encephalopathy?
No
59
Is protein supplementation recommended in liver failure?
Yes
60
On what weight should protein-energy determination be based in liver failure?
Dry body weight or usual weight
61
Should protein restriction be done in refractory encephalopathy?
No
62
What is the recommended energy and protein intake in liver failure?
35-40 kcal/kg/day and 1.2-1.5 g/kg/day protein
63
When should EN be initiated in traumatic brain injury (TBI) patients?
Within 24-48 hours of injury once hemodynamically stable
64
What is the protein requirement range for TBI patients?
1.5-2.5 g/kg/day
65
What specialized formulation is recommended for TBI patients?
Arginine-containing immune-modulating formulations with standard enteral formula
66
What type of EN formula is preferred in acute respiratory failure (ARF)?
Calorie-dense EN formulations
67
What feeding strategy helps improve compliance in respiratory compromised patients?
Small frequent feeds
68
What electrolyte must be monitored and replaced in respiratory failure patients?
Serum phosphate
69
Is a specialty high fat/low carbohydrate formulation recommended in ICU patients with ARF?
No
70
Is there an advantage of disease-specific low-carbohydrate high-fat formulas over standard formulas in stable COPD patients?
No
71
What causes protein-energy wasting in AKI patients?
Hypercatabolism with lean body mass loss
72
What type of enteral formula should be used in ICU patients with AKI?
Standard enteral formula
73
Should protein restriction be practiced in AKI patients?
No
74
When is protein restriction practiced in kidney patients?
Only in chronic renal failure
75
What is the recommended daily protein intake for AKI patients?
1.2-1.7 g/kg actual body weight
76
When should a renal-specific specialty formulation be considered?
In case of significant electrolyte imbalance

AAA-MEDICAL NUTRITION (10 decks)

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