Page 32 - Critical Care Notes

4223_Tab01_001-044 29/08/14 10:46 AM Page 26

BASICS
the trace elements chromium, copper, manganese, selenium, and zinc have
been shown to improve patient outcomes.
Types of Tube Feedings

■ Intermittent or bolus feedings: A set volume of formula is delivered at spec -
ified times.
■ Continuous feedings: A set rate of formula is delivered over a period of
time.
■ Cyclic feedings: Similar to a continuous feeding, but the infusion is stopped
for a specified time within a 24-hr period, usually 6–10 hr.
Gastric Access
■ Nasogastric tube (NGT)
■ Oral
■ Percutaneous endoscopic gastrostomy (PEG)
■ Nasoduodenal tube (NDT)
■ Low-profile gastrostomy device (LPGD)
Small Bowel Access
■ Nasal-jejunal tube (NJT)
■ Percutaneous endoscopic jejunostomy (PEJ)
The following are based on the Guidelines for the Provision and Assessment
of Nutrition Support Therapy in the Adult Critically Ill Patient: Society of Critical
Care Medicine (SCCM) and American Society for Parenteral and Enteral
Nutrition (A.S.P.E.N.), 2009 and the Canadian Clinical Practice Guidelines for
Nutrition Support in Mechanically Ventilated, Critically Ill Adult Patients 2009
Clinical Practice Guidelines:
■ Feedings should be instituted within the first 24–48 hr of ICU admission.
■ In the ICU patient population, neither the presence nor absence of bowel
sounds or evidence of passage of flatus and stool is required for the initia-
tion of enteral feeding.
■ In patients requiring significant hemodynamic support including high-dose
catecholamine agents, alone or in combination with large-volume fluid or
blood product resuscitation to maintain cellular perfusion, enteral nutrition
should be withheld until the patient is fully resuscitated and/or stable.
■ Either gastric or small bowel feeding is acceptable in the ICU setting.
■ Consider administration of metoclopramide (Reglan) at the initiation of
feeding or if the gastric residual volume is >250 mL on two consecutive
checks.

26