This document provides national guidelines and protocols for critical care nutrition practice in India. It discusses why adequate nutrition is important for critically ill patients, when to start enteral or parenteral nutrition, how to determine caloric and protein needs based on patient characteristics, appropriate routes of administration, contraindications, complications, and disease-specific nutrition protocols. The key recommendations are to start early enteral nutrition within 48 hours when possible, provide 1.2-2 g/kg protein and 20-35 kcal/kg calories based on weight status, and use enteral over parenteral nutrition when GI function allows.
Early Enteral Nutrition in Critically Ill Patients is the best for helping early recovery, decreasing hospital stay and decreasing malnutrition in ICU
How? When? Formulas used? Access forms?
Intensive care patients are deprived of enteral or parenteral nutrition. This article gives you detailed information of all your queries regarding Nutrition in ICU patients
Early Enteral Nutrition in Critically Ill Patients is the best for helping early recovery, decreasing hospital stay and decreasing malnutrition in ICU
How? When? Formulas used? Access forms?
Intensive care patients are deprived of enteral or parenteral nutrition. This article gives you detailed information of all your queries regarding Nutrition in ICU patients
Nutrition in Acute Pancreatitis (According to ESPEN guidelines 2002 and ACG g...Jibran Mohsin
This presentation compares the European Society of Parenteral & Enteral Nutrition (ESPEN) 2002 guidelines and American College of Gastroenterology (ACG) 2013 guidelines regarding nutrition in patients of acute pancreatitis
التغذية لمرضي الجراحة
للزملاء المتقدمين لامتحانات اجنبية زي MRCS
و للزملاء اللي منتقلين حديثا للعمل بالمملكة المتحدة او بينوو العمل فيها
تابعونا علي الصفحة الجراح
https://www.facebook.com/algarra7/
عنوان الفيديوعلى اليوتيوب
https://youtu.be/PNe2e41pv_w
Role of vitamin c and thiamine in sepsisAnkit Gajjar
Advance treatment of sepsis and septic shock to improve outcome.
vitamin C, thiamine and hydrocortisone combination is studied well and prooven to beneficial
Welcome to Secret Tantric, London’s finest VIP Massage agency. Since we first opened our doors, we have provided the ultimate erotic massage experience to innumerable clients, each one searching for the very best sensual massage in London. We come by this reputation honestly with a dynamic team of the city’s most beautiful masseuses.
Antibiotic Stewardship by Anushri Srivastava.pptxAnushriSrivastav
Stewardship is the act of taking good care of something.
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
WHO launched the Global Antimicrobial Resistance and Use Surveillance System (GLASS) in 2015 to fill knowledge gaps and inform strategies at all levels.
ACCORDING TO apic.org,
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
ACCORDING TO pewtrusts.org,
Antibiotic stewardship refers to efforts in doctors’ offices, hospitals, long term care facilities, and other health care settings to ensure that antibiotics are used only when necessary and appropriate
According to WHO,
Antimicrobial stewardship is a systematic approach to educate and support health care professionals to follow evidence-based guidelines for prescribing and administering antimicrobials
In 1996, John McGowan and Dale Gerding first applied the term antimicrobial stewardship, where they suggested a causal association between antimicrobial agent use and resistance. They also focused on the urgency of large-scale controlled trials of antimicrobial-use regulation employing sophisticated epidemiologic methods, molecular typing, and precise resistance mechanism analysis.
Antimicrobial Stewardship(AMS) refers to the optimal selection, dosing, and duration of antimicrobial treatment resulting in the best clinical outcome with minimal side effects to the patients and minimal impact on subsequent resistance.
According to the 2019 report, in the US, more than 2.8 million antibiotic-resistant infections occur each year, and more than 35000 people die. In addition to this, it also mentioned that 223,900 cases of Clostridoides difficile occurred in 2017, of which 12800 people died. The report did not include viruses or parasites
VISION
Being proactive
Supporting optimal animal and human health
Exploring ways to reduce overall use of antimicrobials
Using the drugs that prevent and treat disease by killing microscopic organisms in a responsible way
GOAL
to prevent the generation and spread of antimicrobial resistance (AMR). Doing so will preserve the effectiveness of these drugs in animals and humans for years to come.
being to preserve human and animal health and the effectiveness of antimicrobial medications.
to implement a multidisciplinary approach in assembling a stewardship team to include an infectious disease physician, a clinical pharmacist with infectious diseases training, infection preventionist, and a close collaboration with the staff in the clinical microbiology laboratory
to prevent antimicrobial overuse, misuse and abuse.
to minimize the developme
CHAPTER 1 SEMESTER V - ROLE OF PEADIATRIC NURSE.pdfSachin Sharma
Pediatric nurses play a vital role in the health and well-being of children. Their responsibilities are wide-ranging, and their objectives can be categorized into several key areas:
1. Direct Patient Care:
Objective: Provide comprehensive and compassionate care to infants, children, and adolescents in various healthcare settings (hospitals, clinics, etc.).
This includes tasks like:
Monitoring vital signs and physical condition.
Administering medications and treatments.
Performing procedures as directed by doctors.
Assisting with daily living activities (bathing, feeding).
Providing emotional support and pain management.
2. Health Promotion and Education:
Objective: Promote healthy behaviors and educate children, families, and communities about preventive healthcare.
This includes tasks like:
Administering vaccinations.
Providing education on nutrition, hygiene, and development.
Offering breastfeeding and childbirth support.
Counseling families on safety and injury prevention.
3. Collaboration and Advocacy:
Objective: Collaborate effectively with doctors, social workers, therapists, and other healthcare professionals to ensure coordinated care for children.
Objective: Advocate for the rights and best interests of their patients, especially when children cannot speak for themselves.
This includes tasks like:
Communicating effectively with healthcare teams.
Identifying and addressing potential risks to child welfare.
Educating families about their child's condition and treatment options.
4. Professional Development and Research:
Objective: Stay up-to-date on the latest advancements in pediatric healthcare through continuing education and research.
Objective: Contribute to improving the quality of care for children by participating in research initiatives.
This includes tasks like:
Attending workshops and conferences on pediatric nursing.
Participating in clinical trials related to child health.
Implementing evidence-based practices into their daily routines.
By fulfilling these objectives, pediatric nurses play a crucial role in ensuring the optimal health and well-being of children throughout all stages of their development.
CHAPTER 1 SEMESTER V PREVENTIVE-PEDIATRICS.pdfSachin Sharma
This content provides an overview of preventive pediatrics. It defines preventive pediatrics as preventing disease and promoting children's physical, mental, and social well-being to achieve positive health. It discusses antenatal, postnatal, and social preventive pediatrics. It also covers various child health programs like immunization, breastfeeding, ICDS, and the roles of organizations like WHO, UNICEF, and nurses in preventive pediatrics.
Leading the Way in Nephrology: Dr. David Greene's Work with Stem Cells for Ki...Dr. David Greene Arizona
As we watch Dr. Greene's continued efforts and research in Arizona, it's clear that stem cell therapy holds a promising key to unlocking new doors in the treatment of kidney disease. With each study and trial, we step closer to a world where kidney disease is no longer a life sentence but a treatable condition, thanks to pioneers like Dr. David Greene.
India Clinical Trials Market: Industry Size and Growth Trends [2030] Analyzed...Kumar Satyam
According to TechSci Research report, "India Clinical Trials Market- By Region, Competition, Forecast & Opportunities, 2030F," the India Clinical Trials Market was valued at USD 2.05 billion in 2024 and is projected to grow at a compound annual growth rate (CAGR) of 8.64% through 2030. The market is driven by a variety of factors, making India an attractive destination for pharmaceutical companies and researchers. India's vast and diverse patient population, cost-effective operational environment, and a large pool of skilled medical professionals contribute significantly to the market's growth. Additionally, increasing government support in streamlining regulations and the growing prevalence of lifestyle diseases further propel the clinical trials market.
Growing Prevalence of Lifestyle Diseases
The rising incidence of lifestyle diseases such as diabetes, cardiovascular diseases, and cancer is a major trend driving the clinical trials market in India. These conditions necessitate the development and testing of new treatment methods, creating a robust demand for clinical trials. The increasing burden of these diseases highlights the need for innovative therapies and underscores the importance of India as a key player in global clinical research.
QA Paediatric dentistry department, Hospital Melaka 2020Azreen Aj
QA study - To improve the 6th monthly recall rate post-comprehensive dental treatment under general anaesthesia in paediatric dentistry department, Hospital Melaka
Telehealth Psychology Building Trust with Clients.pptxThe Harvest Clinic
Telehealth psychology is a digital approach that offers psychological services and mental health care to clients remotely, using technologies like video conferencing, phone calls, text messaging, and mobile apps for communication.
2. “Our food should be our medicine and our
medicine should be our food”
- Hippocrates
3. INTRODUCTION
• WHY?
• WHEN?
• HOW MUCH?
• ROUTE?
• CONTRAINDICATIONS?
• COMPLICATIONS?
• MONITORING?
• DISEASE SPECIFIC
4. WHY
• Catabolic stress state
• SIRS
• Complications
– Infectious
– Morbidity
– Multi-organ failure
• Adequate nutrition
– Attenuate metabolic response to stress
– Favorably modulate immune responses
– Decrease in length of hospital stay, morbidity rate
and improvement in patient outcomes
5. Nutrition Screening and Assessment
• Indirect calorimetry – best method
• Nutrition status of Indian malnourished patients
can be assessed by SGA.
• Initial monitoring of nutrition intervention must
be done on daily basis and nutrition plans should
be modified accordingly.
• It is imperative that nutritional assessment is
done by well-qualified and trained nutritionists,
dedicated to the ICU.
• Facilitation of nutrition assessment will require
good coordination between intensivist and
nutritionist.
6. WHEN
• As early as possible
• At least in first 48 hours
• HD instability
– Start after shock resuscitation
• Tube feed if cant achieve 50% of requirment in 72
hours
• 100% in 7 days
• Parenteral nutrition only if enteral nutrition
cannot be initiated in 7 days
7. Feeding practices in hemodynamically
unstable patients
• Clinical monitoring of gut functioning should be
started early when the patient is HD stable.
• Once the patient has been fluid resuscitated and
stabilized on declining doses of <2 vasopressors,
EN may be started cautiously at low rates.
• EN should be administered within 24–48 h once
the patient is stable with vasopressors.
• In persistent shock, early EN should be avoided.
8. HOW MUCH
• Dosing weight
– Actual weight
• Malnurished
• Normal weight
• Overweight
– Adjusted body weight
• Obese
• IBW + 0.25 (ABW - IBW)
9. • Calories
– 70% carbohydrate
– 30% fat
– Protein calories should not be calculated
– Start with 20 Kcal/kg
– Increase to 25-30 Kcal/kg at the end of week
– 35 Kcal/kg once stable in malnurished patient
• Protein
– Critically ill patients - 1.2 to 2 g/kg per day
– Severe burns - 2.0 g/kg per day
10. ROUTE
• Enteral - Preferred
– Oral
– NG
– NJ
• Parenteral – only when functional gut not
available
– TPN
– PPN
• Combined - no
11. ENTERAL
• Decrease the incidence of infection in critically
ill patients
• Preservation of gut immune function and
reduction of inflammation
• Clinically important and almost statistically
significant reduction in mortality
12. • Scientific formula feed should be preferred over
blenderized feeds to minimize feed contamination.
• Whenever feasible, closed system ready-to-hang
formula feeds should be preferred.
• Blenderized formulae are more likely to have bacterial
contamination than other hospital prepared diets.
• Hygienic methods of feed preparation, storage, and
handling of both formula feeds and blenderized feeds
are necessary.
• Continuous formula feeding with pumps or gravity
bags can be preferably done via fine bore tubes
ENTERAL
13. CONTRAINDICATIONS
• Unresuscitated shock
• Bowel obstruction
• Severe and protracted ileus
• Major upper gastrointestinal bleeding
• Intractable vomiting or diarrhea
• Gastrointestinal ischemia
14. POSTPYLORIC FEEDS(NJ)
• Prolonged inability to tolerate gastric feedings
• Gastric outlet obstruction
• Duodenal obstruction
• Gastric or duodenal fistula
• Severe gastroesophageal reflux
15. MONITORING
• GRV
– Not strictly recommended
– Closely monitor in patient with high risk of aspiration
– Can check every 4-6 hours
– Reintroduce if less then 500 ml or 50% of feeds
– Metoclopramide,erythromycin
– Electrolytes correction
• Abdominal distention
• Bowel movements
16. STANDARD
• Isotonic to serum
• Caloric density of approximately 1 kcal/mL
• Lactose-free
• Protein content of about 40 g/1000 mL
• Mixture of simple and complex carbohydrates
• Long-chain fatty acids
• Essential vitamins, minerals, and
micronutrients
17. CONCENTRATED
• Patient requiring volume restriction
• Hyperosmolar to serum
• Caloric density 1.5 - 2.0 kcal/mL
• Dumping syndrome if it is infused rapidly
– Nausea
– Shaking
– Diaphoresis
– diarrhea
• Not in post pyloric feeds
18. PREDIGESTED
• Content
– Short chain peptides
– Simple carbohydrates
– Short chain triglycerides
• Indications
– Short gut because it is generally well tolerated
– Digestive defects
– Failure to tolerate standard enteral nutrition
– Thoracic duct leak, chylothorax or chylous ascites
22. OTHERS
• Vitamines and trace aliments
– Should be supplemented
• Fibres
– For treatment of diarrhoea / constipation
• Prebiotics / probiotics
– Antibiotic associated diarrhoea
23. HEPATIC FAILURE
• EN should be preferred in patients with acute
and/or chronic liver disease, admitted to ICU.
• No beneficial effects of branched-chain amino
acid formulations in critically ill patients with
encephalopathy who are receiving first-line
luminal antibiotics.
• Protein supplementation is recommended in
liver failure. Protein-energy determination
should be based on “dry” body weight or
usual weight instead of actual weight.
24. • Protein restriction should be avoided in
refractory encephalopathy.
• A whole-protein formula providing 35–40
kcal/kg body weight/day energy intake and
1.2–1.5 g/kg body weight/day protein is
recommended.
25. TRAUMATIC BRAIN INJURY
• Initiation of EEN after post trauma period (within
24–48 h of injury), once the patient is HD stable,
is recommended.
• Protein recommendations should be in the range
of 1.5–2.5 g/kg/day.
• Arginine-containing immune-modulating
formulations or eicosapentaenoic
acid/docosahexaenoic acid supplement with
standard enteral formula in TBI patients is
recommended.
26. ACUTE KIDENY INJURY
• Standard enteral formula is recommended for ICU patients
with AKI.
• Protein should not be restricted in patients with renal
insufficiency.
• Daily protein intake should be in the range of 1.2–1.7 g/kg
actual body weight in AKI patients.
• More protein on dialysis patient
• Provision of adequate non protein calories should be
maintained to achieve total energy intake in patients with AKI.
• In case of significant electrolyte imbalance, a specialty
formulation designed for renal failure should be considered.
• Low potassium and low phosphate diets can be implemented
where corresponding serum levels are high.
27.
28. “To eat is a necessity, but to eat
intelligently is an art”
THANK YOU