Nutrition support in patients with multiple organ failure

NUTRITIONAL THERAPY IN THE TREATMENT OF ACUTE CORROSIVE INTOXICATION IN ADULTS

INTRODUCTION

Acute intoxications with corrosive substances can cause severe chemical injuries of the upper gastrointestinal tract, most often located in the mouth, pharynx, esophagus, stomach and duodenum. If a patient survives the acute phase of intoxication, regenerative response may result in esophageal and/or gastric stenosis, and increased risk of esophageal and gastric cancer. Such intoxication may be fatal due to perforation or tracheal necrosis. Enteral nutrition is a nutritional method when nutritional substances are administered through specially designed tubing placed through the nose or percutaneously, directly into the GIT.

AIM

The aim of this study is to describe the methods of artificial nutrition in patients with acute corrosive intoxications and the importance of nutritional support in the treatment of these intoxications.

DISCUSSION

Nutrition in the treatment of acute corrosive intoxications is one of the most important therapeutic processes that largely contribute to faster recovery of the post-corrosive injuries of upper GIT, stabilization of biologic, immunologic and metabolic parameters, and reduction of length of stay in hospital Aim of the treatment of acute corrosive intoxications is to prevent perforation and progressive fibrosis, and esophageal and gastric stenosis. There are different and often conflicting positions, on the conservative treatment of acute corrosive intoxications in adults. Such treatment mainly consists of anti-secretory treatment, antibiotics and intensive hyper-alimentation, aiming to prevent late post-corrosive intoxications.

CONCLUSION

It is considered that nutritional support plays a major role in maintenance of metabolic processes and prevention of severe metabolic complications that could additionally aggravate the condition and impair the treatment.

The role of parenteral nutrition as a supplement to enteral nutrition in patients with severe brain injury

Enteral nutrition (EN) is the preferred and safe route of feeding in surgical patients incapable of self-nutrition. We describe three patients with severe brain insult and recurrent sepsis, who despite the early introduction of EN, remained hypoalbuminaemic, hypoproteinaemic and developed peripheral oedema. This state persisted, despite increasing the caloric and protein intake via the enteral route. However, after a short course of supplemental parenteral nutrition (PN), albumin and total protein levels improved, with resolution of peripheral oedema. We hypothesize that, in certain critically ill neurosurgical patients on EN, gastrointestinal malabsorption may underlie a persistently low serum albumin, total protein and peripheral oedema. A short course of supplemental PN may help to reverse this and a normal regimen of EN can then be continued.

Nutrition Assessment of the Critically Ill Adult

Illness and injury are physiologic stressors that alter the body's metabolic and energy demands. Approximately 30 to 55% of hospitalized patients have evidence of malnutrition, which makes nutrition screening and assessment an integral part of the evaluation of the critically ill adult. Nutritional assessment relies on a complete history and physical examination, appropriate laboratory measurements, and diagnostic testing as warranted. Although a single laboratory result may be helpful for nutritional screening, there is no single parameter that is both sensitive and specific for the diagnosis of malnutrition. Instead, nutritional assessment must be ongoing and be derived from a variety of sources in order to identify nutritional trends over time. Early identification and nutritional intervention can lessen morbidity and mortality risks; however, underlying acute and/or chronic disease processes often need to be identified and corrected before the body can reverse abnormal nutrient metabolism. A comprehensive nutritional assessment, incorporated with clinical status, will provide the basis for a nutritional support plan and evaluation strategies. In order to help the advanced practice nurse determine the appropriate nutritional regimen, this article discusses the importance of the patient history, physical examination, body composition measurement techniques, and laboratory data assessment.