PICU

Question 1

Energy needs while intubated

Answer 1

No stress factor
No activity factor
Minimally increased from REE
Averaging REE and normal RDS energy requirements - good estimate

Question 2

TPN energy needs

Answer 2

No diet induced thermogenesis
Minimal loss in stool
~10-15% reducation

Question 3

Energy needs w/ heart defects

Answer 3

> 120 kcal/kg/day for infants prior to the repair
Generally back to norma after complete repair.

Question 4

Stages of repair of Hypoplastic Left Heart Syndrome

Answer 4

1) Norwood shortly after birth
2) Glenn about 6 months later
3) Fontan 16-36 months later

Question 5

What can indicate need for next repair of hypoplastic left heart syndrome

Answer 5

Slow growth

Question 6

Energy needs for heart defect infants on TPN

Answer 6

90-100 kcal/kg/day

Question 7

How soon should you start enteral nutrition in critically ill patients?

Answer 7

Whitin 1-2 days of PICU admission

Question 8

When should you start to consider TPN in critically ill infants?

Answer 8

1-3 days

Question 9

When should you start to consider TPN in critically ill children and adolescents?

Answer 9

4-5 days

Question 10

Should you start feeding pts in pentobarbital coma?

Answer 10

No as it is frequently associated w/ ileus

Question 11

Vasoactive agents

Answer 11

epinephrine, norepinephrine, vasopressin, milrinone, dopamine, dobutamine

Question 12

When enteral nutrition is contradicted in patients receiving vasogenic angents?

Answer 12

Hypotensive pt,
VAs being added
VAs dosing being increased
GI symptoms (BM/Flatus/Bowel Sounds/distention/NG output/acidosis)

Question 13

Which medication require sedation wean?

Answer 13

Dexmedetomidine, clonidine, midazolam, lorazepam, fentanyl, morphine, diazepam, methadone

Question 14

GI symptoms during sedation wean:

Answer 14

Loose/watery stools, vomiting, retching, gaging
-avoid major feeding changes after dose reduction

Question 15

Which forms of oxygen therapy are barriers to feeding for younger children (<10 kg)?

Answer 15

NC when oxygen requirements exceed weight in kg
Nasal CPAP,
Non-invasive mechanical ventilation

Question 16

What is chylothorax?

Answer 16

Accumulation of chyle in pleural space after damage to thoracic duct. It is a possible complication s/p cardiac surgery.

Question 17

Nutritional management of patients with chylothorax

Answer 17

Made NPO at diagnosis
Kept NPO if chest tube output remains high
May require TPN
If output significantly improved (~20 mL/kg/day or less) start diet low in LCT (only enough to prevent deficiency), supplemented w/ MCT oil. Enteral nutrition w/ specialized formula (Enfaport)
Low fat diet should be followed 4-6 weeks after resolution