nutritional support

1. Nutritional Support in Critical illness Tianjin Medical University General Hospital Emergency Center Shou songtao

3. ‘ A slender and restricted diet is always dangerous in chronic and in acute diseases’ Hippocrates 400 B.C.

6. ICU Nutrition through the ages Overfeeding 1980s

10. Organisation of Nutrition Support 3. NICE Guidelines for Nutrition Support in Adults 2006 Screen Recognise Treat Oral Enteral Parenteral Monitor & Review

28. Diagram of enteral tube placement.

29. With/without endoscopic Long time with endoscopic operation Gastric tube duodenal tube gastrostomy Gastrostomy Duodenum feeding Jejunostomy feeding Decision of Selecting The Modes of Administration Enteral Nutrition Short time Tube Percutaneous tube

38. Enteral Formula Categories Polymeric

40. Enteral Formula Categories Monomeric

44. Enteral Formula Categories Fiber-Containing

46. Enteral Formulas: Calorie Dense

48. Enteral Formula Categories Disease Specific

50. Disease Specific Formulas: Diabetic

53. Disease-Specific Formulas Renal Novasource Renal

55. Immune-Enhancing Formulas

57. Disease-Specific Formulas: Pulmonary

69. Parenteral Nutrition

78. Steps to Ordering TPN Decide how much fat & carbohydrate to give Determine Total Fluid Volume Determine Non-N Caloric needs Determine Protein requirements Determine Electrolyte and Trace element requirements Determine need for additives

79. Steps to Ordering TPN Decide how much fat & carbohydrate to give Determine Total Fluid Volume Determine Non-N Caloric needs Determine Protein requirements Determine Electrolyte and Trace element requirements Determine need for additives

81. Steps to Ordering TPN Determine Total Fluid Volume Determine Caloric needs Determine Protein requirements Decide how much fat & carbohydrate to give Determine Electrolyte and Trace element requirements Determine need for additives

87. Steps to Ordering TPN Determine Total Fluid Volume Determine Caloric needs Determine Protein requirements Decide how much fat & carbohydrate to give Determine Electrolyte and Trace element requirements Determine need for additives

92. Steps to Ordering TPN Decide how much fat & carbohydrate to give Determine Total Fluid Volume Determine Protein requirements Determine Non-N Caloric needs Determine Electrolyte and Trace element requirements Determine need for additives

95. Steps to Ordering TPN Decide how much fat & carbohydrate to give Determine Total Fluid Volume Determine Protein requirements Determine Non-N Caloric needs Determine Electrolyte and Trace element requirements Determine need for additives

103. Mechanical Complications Venous thrombosis Catheter occlusion Related to catheter in situ

108. Approach to Nutritional Support Nutritional Assessment Maintenance Repletion GI Tract Functional YES NO Enteral Nutrition Parenteral Nutrition

115. Thank you !!