Professor Andrew Davies is an Intensivist working at Peninsula Health in Melbourne. He has performed clinical research in the field of critical care for 20 years, as a participating investigator in over 50 studies (mostly clinical trials), predominantly in the areas of critical care nutrition, mechanical ventilation and acute lung injury and severe sepsis. He is a past Vice Chair of the Australian and New Zealand Intensive Care Society Clinical Trials Group (ANZICS-CTG) with a special interest in nutrition in the ICU, and is a past Chair of the Australian and New Zealand Society of Parenteral and Enteral Nutrition (AuSPEN).
In this talk, Professor Davies tackles the often overlooked aspect of nutrition in the ICU and it’s potential benefits for our patients.
Total enteral nutrition and total parenteral nutrition in critically ill pat...Prof. Mridul Panditrao
Prof. mridul panditrao, discusses intricate problems of starvation, the pathophysiological changes, Total enteral nutrition, total parenteral nutrition, various protocols etc...
Professor Andrew Davies is an Intensivist working at Peninsula Health in Melbourne. He has performed clinical research in the field of critical care for 20 years, as a participating investigator in over 50 studies (mostly clinical trials), predominantly in the areas of critical care nutrition, mechanical ventilation and acute lung injury and severe sepsis. He is a past Vice Chair of the Australian and New Zealand Intensive Care Society Clinical Trials Group (ANZICS-CTG) with a special interest in nutrition in the ICU, and is a past Chair of the Australian and New Zealand Society of Parenteral and Enteral Nutrition (AuSPEN).
In this talk, Professor Davies tackles the often overlooked aspect of nutrition in the ICU and it’s potential benefits for our patients.
Total enteral nutrition and total parenteral nutrition in critically ill pat...Prof. Mridul Panditrao
Prof. mridul panditrao, discusses intricate problems of starvation, the pathophysiological changes, Total enteral nutrition, total parenteral nutrition, various protocols etc...
In this presentation i have tried to explain in details about the Total Parenteral Nutrition (TPN) , what is it, who needs it, and how to prepare it and the necessary procedure with instructions. It is very useful for the individuals from Nutrition, Nursing, Pharmacists, and Medical background.
Parenteral Nutrition for the oral and maxillofacial surgery patientMaxfac Center
Nutritional deficit that occurs after starvation or trauma and the various nutritional supplementation given parenterally to minimise morbidity and mortality. This topic covers the Parental Nutrition.
Mentor: Dr Saikat Saha MDS, OMFS, SIliguri, West Bengal, India
Address: MAXFAC Center for Oral and Maxillofacial and Head & Neck Surgery, Siliguri
Email : maxfacmail@gmail.com
Daily minimum nutritional requirements of the critically illRalekeOkoye
Critically ill patients have nutritional needs that are essential in their management. This is a synopsis with specific calculable applications for the daily recommended components of nutrition in critical care.
The human body is a complex machine with lots of mechanisms. but unlike a machine, once it breaks down, it is very difficult to repair it. Throughout the years, there are many ailments which has made its way to affect the human body, but here I am going to discuss one such ailment which has a high prevalence rate in the world population. Thus here I present my slides of Liver Cirrhosis, its etiology, symptoms, and most importantly how to reverse it in terms of dietary route. Hope it is clear and helps you in getting a clear knowledge of the whole concept.
The dimensions of healthcare quality refer to various attributes or aspects that define the standard of healthcare services. These dimensions are used to evaluate, measure, and improve the quality of care provided to patients. A comprehensive understanding of these dimensions ensures that healthcare systems can address various aspects of patient care effectively and holistically. Dimensions of Healthcare Quality and Performance of care include the following; Appropriateness, Availability, Competence, Continuity, Effectiveness, Efficiency, Efficacy, Prevention, Respect and Care, Safety as well as Timeliness.
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.
R3 Stem Cells and Kidney Repair A New Horizon in Nephrology.pptxR3 Stem Cell
R3 Stem Cells and Kidney Repair: A New Horizon in Nephrology" explores groundbreaking advancements in the use of R3 stem cells for kidney disease treatment. This insightful piece delves into the potential of these cells to regenerate damaged kidney tissue, offering new hope for patients and reshaping the future of nephrology.
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.
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.
CRISPR-Cas9, a revolutionary gene-editing tool, holds immense potential to reshape medicine, agriculture, and our understanding of life. But like any powerful tool, it comes with ethical considerations.
Unveiling CRISPR: This naturally occurring bacterial defense system (crRNA & Cas9 protein) fights viruses. Scientists repurposed it for precise gene editing (correction, deletion, insertion) by targeting specific DNA sequences.
The Promise: CRISPR offers exciting possibilities:
Gene Therapy: Correcting genetic diseases like cystic fibrosis.
Agriculture: Engineering crops resistant to pests and harsh environments.
Research: Studying gene function to unlock new knowledge.
The Peril: Ethical concerns demand attention:
Off-target Effects: Unintended DNA edits can have unforeseen consequences.
Eugenics: Misusing CRISPR for designer babies raises social and ethical questions.
Equity: High costs could limit access to this potentially life-saving technology.
The Path Forward: Responsible development is crucial:
International Collaboration: Clear guidelines are needed for research and human trials.
Public Education: Open discussions ensure informed decisions about CRISPR.
Prioritize Safety and Ethics: Safety and ethical principles must be paramount.
CRISPR offers a powerful tool for a better future, but responsible development and addressing ethical concerns are essential. By prioritizing safety, fostering open dialogue, and ensuring equitable access, we can harness CRISPR's power for the benefit of all. (2998 characters)
3. MALNUTRITION IS A STATE OF NUTRITION IN WHICH
A DEFICIENCY OR IMBALANCE OF ENERGY, PROTEIN &
OTHER NUTRIENTS CAUSE MEASURABLE ADVERSE
EFFECTS ON TISSUE/ BODY FORM & FUNCTION &
CLINICAL OUTCOME.
4. MALNUTRITION
FACTORS FAVOURING THE DEVELOPMENT OF
MALNUTRITION IN THE CRITICALLY ILL
POOR INTAKE
HYPER METABOLISM
STRESS
SURGERY
EXOGENOUS STEROIDS
5. MALNUTRITION CONSEQUENCES
WEIGHT LOSS
WEAKNESS & FATIGUE
IMPAIRED VENTILLATORY DRIVE
POOR WOUND HEALING
IMPAIRED IMMUNE FUNCTION
DEPRESSION
DEATH
6.
7. WHY FEED CRITICALLY ILL
PROVIDE NUTITIONAL SUBSTRATES TO MEET
PROTEIN & ENERGY REQUIREMENTS
HELP PROTECT VITAL ORGANS & REDUCE
BREAK DOWN OF SKELETAL MUSCLE
TO PROVIDE NUTRIENTS NEEDED FOR REPAIR &
HEALING OF WOUNDS AND INJURIES.
TO MAINTAIN GUT BARRIER FUNCTION
TO MODERATE STRESS RESPONSE & IMPROVE
OUTCOME.
TO REDUCE MORBIDITY & MORTALITY
9. ENTERAL NUTRITION
ENTERAL NUTRITION supplimentation of calories,
protein, electrolytes, vitamins, minerals, trace elements
& fluids via an intestinal route.
GASTRIC ---- orogastric /naso gastric ryles
PEG, PRGT, Surgical gastrostomy tubes
POST PYLORIC --- distal parts of alimentary tract 1st
2nd duodenum, jejunum.
Early vs late enteral nutrition.
10.
11.
12. ENTERAL NUTRITION
WHY EN….
preserves structural integrity and maintains barrier
function of mucosa → Protects against invasion by enteric
pathogens (Translocation)
Favors intestinal villous integrity and function, and reduces
gut hyper permeability
Maintains GI tract functions including GALT and MALT and
production and secretion of IgA and hormones
Promotes gut motility, thus paving the way for oral feeding
Significant reduction in incidence of infections in pts with early
EN.
13. FORMULATIONS
STANDARD Isotonic to serum
caloric density of 1 Kcal/ml
lactose free
mixture of simple & complex carbo
protein content abt 40g/1000ml
long chained fatty acids
essential vitamins & minerals.
▪ CONCENTRATED: critically ill pt require volume restriction.
Composition is same as standard but only caloric density is high 1.2,
1.5, 2.0 Kcal/ml
▪ Hyperosmolarity of fee ds leads to diarrhea, symptoms like
dumping syndrome.
Tolerated poorly if delivered rapidly in tubes placed beyond pylorus.
14. FORMULATIONS- PREDIGESTED.
PREDIGESTED: protein is hydrolysed in short chain
peptides, carbs in less complex form, total fat is decreased,
with an increased MCT
Caloric density of 1 or 1.5 kcal/ml
Used in thoracic duct leak, chylothorax,
Digestive Defects (mal absorbtion synd.)
Failure to tolerate standard enteral nutrition.
Studies no difference in mortality, inf complications,
or the incidence of diarrhea.
15. COMPOSITION
STANDARD EN delivers 50% cal from carbs
30% cal from FATS
CARBs/FAT
LOW CARB/ HIGH FAT
30% CAL FROM carb
55% cal from FATS
Acure resp failure.
Now not recommended.
17. COMPOSITION
OMEGA 3 FATTY ACIDS/ ANTIOXIDANTS:
Antiinflammatory effect in the lung.
ALI/ARDS
multicenter trial ARDS clinical trial network.
272 vent Pts -- EN with omega & without omega
Fewer ventillator free days, fewer ICU days, fewer organ
failue free days but increased mortality.
Supplementation is not recommended in critical Pt
Unlikely to be beneficial & mayb harmful.
18. COMPOSITION
GLUTAMINE
Precursor for nucleotide synthesis & imp fuel source for
rapidly dividing cells that is depleted in hypercatabolic Pts.
Metabolised in liver, kidneys into glutamate & NH3
Accumulation of these byproducts may lead to adverse
effects – encephalopathy.
Not recommended
ARGININE, IMMUNONUTRITION.
NOT RECOMMENDED
20. Parenteral nutrition
PARENTERAL NUTRITION support provision of calories,
protein, electrolytes, vitamins, minerals, trace elements & fluids
via an IV ROUTE.
Delivered CVC- IJV, SC, PICC
as high osmotic load
Dedicated port for TPN – TPN related INFECTIONS
PN –more diluted – peripheral line – PERIPHERAL
PARENTERAL NUTRITION.
TPN
PPN
25. Complications of TPN
MONITORING: Pt on TPN monitor I/O, fluid overload.
LABS electrolytes, Ca, Mg, PO4, Glucose daily
Bilirubin, AST,ALT, Triglyceride once aweek.
COMPLICATIONS:
BLOODSTREAM INFECTIONS:
increase risk of acquiring infections in pts c TPN
than Pts with CVC without TPN.
CRBSI Prev.BUNDLE , dedicated ports.
HYPERGLYCEMIA common in Pts c TPN.
metaanalysis of 6 RT 264 critical pts c acute pancreatitis
incidence of hyperglycemia X2 greater among pts with TPN than
with Pts with enteral nutrition.
Metabolic complications. Dyselectroltemia.
26. EN vs TPN
Maintenance of gut integrity
Prevention of bacterial (or endotoxin) translocation
Maintenance of adequate splanchnic blood flow
Maintenance of adequate immune functions of the gut
Avoidance of catheter-related sepsis
Cost
35. Additional 1 lt of ENTERAL FEED will not produce any adverse effects,
so can be safely started in pts with recent GI ANASTOMOTIS & SHOULDN’T
Be delayed.
45. ENTERAL VS PARENTERAL NUTRITION
Recommend use of ENTERAL NUTRITION for
critically ill Pt with an intact GI TRACT.
EARLY vs DELAYED NUTRIENT INTAKE
Recommend early EN within 24 -48 hrs
following
admission in ICU in critically ill.
