Feeding Surgical Patients in the ICU – Part 1
Surgical patients who are in the intensive care unit experience a cascade of metabolic changes. This can largely be described as hypermetabolism and hypercatabolism. Hypermetabolism refers to the increased expenditure of energy that patient experiences because of the stress of surgery and critical illness. Hypercatabolism refers to
the increased destruction of tissues and the loss of needed protein and immune particles called immunoglobulins. All patients initially undergo these changes. It is the goal of surgeon to try to blunt these changes as quickly as possible.
How is this achieved? One way is through adequate nutritional therapy – that is, feeding the patient the right amount of calories and nutrients in the right way at the right time. This is so important that a whole field called surgical nutrition has developed to study these issues.
The first thing that is done is an assessment of the current nutritional status of a newly admitted surgical patient. Surgical patients with chronic diseases such as Crohn’s disease or multiple sclerosis or cancer are often malnourished to a great degree before they enter the ICU. With their tissue reserves already depleted, they are less able to tolerate even slight depletions. Many of the standard nutritional assessment tools are not accurate in these patients.
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