II. Risk Factors: ICU Malnutrition

  1. Prolonged ICU admission
  2. Intubation or Tracheostomy (may interfere with swallowing)
  3. Prolonged period of poor oral intake (bowel mucosa atrophy)
  4. Sepsis

III. Management

  1. See Enteral Nutrition
  2. See Enteral Tube Feeding
  3. See Total Parenteral Nutrition (Enteral Tube Feeding is preferred)
  4. Early initiation of Enteral Tube Feeding is preferred (first 24-48 hours of ICU admission)

IV. Complications: ICU Malnutrition

  1. Acalculous Cholecystitis
    1. Poor lipid intake results in bile stasis
    2. High mortality (up to 50%) in delayed diagnosis
  2. Muscle wasting
    1. Total body protein loss exceeds 2 pounds for a 3 week ICU admission
    2. Initial (first 10 days): Skeletal muscle is primary source of lost protein
    3. Later (after 10 days): Visceral muscle is lost
    4. Plank (1998) Ann Surg 228(2): 146-58 [PubMed]

V. Resources

  1. Internet Book of Critical Care (EM-Crit, Farkas)
    1. https://emcrit.org/ibcc/guide/

VI. References

  1. Marino (2014) The ICU Book, p. 859-73
  2. Volk (2009) Am Fam Physician 79(6): 459-64 [PubMed]

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