SlideShare une entreprise Scribd logo
1  sur  116
Télécharger pour lire hors ligne
Nutritional Support in Critical illness Tianjin Medical University General Hospital  Emergency Center Shou songtao
[object Object],Definition
‘ A slender and restricted diet is always dangerous in chronic and in acute diseases’ Hippocrates 400 B.C.
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
ICU Nutrition through the ages Overfeeding 1980s
[object Object],[object Object],[object Object],[object Object],[object Object]
 
 
Organisation of Nutrition Support 3. NICE Guidelines for Nutrition Support in Adults 2006 Screen Recognise Treat Oral Enteral Parenteral Monitor & Review
Screen ,[object Object],[object Object],[object Object],[object Object]
Screening in ICU ,[object Object],[object Object],[object Object]
Nutritional Assessment ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Nutritional Assessment ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Nutritional assessment ,[object Object],[object Object],[object Object],[object Object],[object Object]
Nutritional assessment ,[object Object],[object Object],[object Object],[object Object]
Nutritional assessment ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
How much to give in ICU? ,[object Object],[object Object],[object Object],[object Object],[object Object]
How much to give? ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Types of nutrition support ,[object Object],[object Object],[object Object]
Enteral nutrition ,[object Object]
Enteral Nutrition ,[object Object],[object Object]
Indications for Enteral Nutrition  ,[object Object],[object Object],[object Object],[object Object],[object Object],ASPEN. The science and practice of nutrition support. A case-Based Core curriculum. 2001; 143
Contraindications for EN ,[object Object],[object Object],[object Object],[object Object],[object Object],ASPEN. The science and practice of nutrition support. A case-based core curriculum. 2001; 143
Contraindications for EN ,[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Enteral nutrition
 
Diagram of enteral tube placement.
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
 
 
 
Enteral Formulas ,[object Object],[object Object],[object Object],[object Object]
Formula Selection ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Enteral Formulas ,[object Object],[object Object]
Enteral Formula Categories ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Enteral Formula Categories Polymeric ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Enteral Formula Categories Polymeric
Enteral Formula Categories Monomeric ,[object Object],[object Object],[object Object],[object Object]
Enteral Formula Categories Monomeric
Enteral Formula Categories Monomeric ,[object Object],[object Object],[object Object]
Enteral Formula Categories Fiber-Containing ,[object Object],[object Object],ASPEN. The science and practice of nutrition support. A case-based core curriculum. 2001; 148
Enteral Formula Categories Fiber-Containing ,[object Object],[object Object],ASPEN. The science and practice of nutrition support. A case-based core curriculum. 2001; 148
Enteral Formula Categories Fiber-Containing
Enteral Formulas: Calorie Dense ,[object Object],[object Object],[object Object]
Enteral Formulas: Calorie Dense
Enteral Formula Categories Disease Specific ,[object Object],[object Object]
Enteral Formula Categories Disease Specific
Disease Specific Formulas Diabetic ,[object Object],[object Object],[object Object]
Disease Specific Formulas: Diabetic
Disease Specific Formulas Hepatic ,[object Object],[object Object],[object Object]
Disease Specific Formulas Renal ,[object Object],[object Object],[object Object]
Disease-Specific Formulas Renal Novasource Renal
Disease Specific Formulas Immune-Enhancing ,[object Object],[object Object]
Immune-Enhancing Formulas
Disease-Specific Formula Pulmonary ,[object Object],[object Object]
Disease-Specific Formulas: Pulmonary
Enteral Formula Nutrient Sources Carbohydrate ,[object Object],[object Object]
Enteral Formula Nutrient Sources Lipids ,[object Object],[object Object],[object Object],[object Object],ASPEN. The science and practice of nutrition support. A case-based core curriculum. 2001; 148
Enteral Formulas Nutrient Sources Protein ,[object Object],[object Object],[object Object],[object Object]
Initiation of Feeds ,[object Object],[object Object],[object Object]
Assessment of Clinical Response ,[object Object],[object Object]
Enteral nutrition ,[object Object],[object Object],[object Object],[object Object],[object Object]
GI Complications ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Mechanical Complications ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Metabolic Complications ,[object Object],[object Object],[object Object],[object Object],[object Object]
Formula Complications ,[object Object],[object Object],[object Object]
Application Criterion of EN ,[object Object]
Parenteral Nutrition
Parenteral Nutrition ,[object Object],[object Object],[object Object],[object Object],[object Object]
Who Will  Benefit From Parenteral Nutrition? ,[object Object],[object Object],[object Object]
Two Main Forms of  Parenteral Nutrition ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Peripheral Parenteral Nutrition ,[object Object],[object Object],[object Object],[object Object],[object Object]
What to Do Before Starting TPN ,[object Object],[object Object],[object Object],[object Object]
Venous Access for TPN ,[object Object],[object Object],Superior Vena Cava ,[object Object],[object Object],[object Object]
 
Baseline Lab Investigations ,[object Object],[object Object],[object Object],[object Object],[object Object]
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
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
How Much Volume to Give? ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
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
Caloric Requirements ,[object Object],[object Object],[object Object],[object Object]
[object Object],Caloric Requirements Malnutrition -  30% Peritonitis + 15% Soft tissue trauma + 15% Fracture + 20% Fever (per  o c rise) + 13% Moderate infection +  20% Severe infection  + 40% <20% BSA burns + 50% 20-40% BSA burns + 80% >40% BSA burns + 100%
[object Object],[object Object],[object Object],[object Object],Caloric Requirements
How Much CHO & Fats? ,[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],How Much CHO & Fats?
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
How Much Protein to Give? ,[object Object],[object Object],[object Object]
Calorie : Nitrogen Ratio ,[object Object],[object Object],[object Object],[object Object]
Based on Stress & BW ,[object Object],[object Object],[object Object],[object Object]
Based on Nitrogen Balance ,[object Object],[object Object]
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
Electrolyte Requirements ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Trace Elements ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
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
Other Additives ,[object Object],[object Object],[object Object],[object Object],[object Object]
Other Additives ,[object Object],[object Object],[object Object],[object Object],[object Object]
TPN Monitoring ,[object Object],[object Object],[object Object]
Clinical Review ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Lab investigations ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Complications Related to TPN ,[object Object],[object Object],[object Object]
Mechanical Complications Related to vascular access technique ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Mechanical Complications Venous thrombosis Catheter occlusion Related to catheter in situ
Metabolic Complications ,[object Object],[object Object],[object Object],[object Object],[object Object]
Metabolic Complications ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Infectious Complications ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Stopping TPN ,[object Object],[object Object],[object Object],[object Object],[object Object]
Approach to Nutritional Support Nutritional Assessment Maintenance Repletion GI Tract Functional YES NO Enteral Nutrition Parenteral Nutrition
Advantages  - Enteral vs PN ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],ASPEN. The science and practice of nutrition support. A case-based core curriculum. 2001; 147 ADA EAL, Critical Illness, accessed 8-07
Single nutrient supplementation ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Single nutrient supplementation ,[object Object],[object Object],[object Object],[object Object]
 
Importants: ,[object Object],[object Object],[object Object],[object Object]
Maintains Stimulates  the environment defences ,[object Object],[object Object]
Thank you !!
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Contenu connexe

Tendances

Nutrition (espen &amp; aspen guidelines)
Nutrition (espen &amp; aspen guidelines)Nutrition (espen &amp; aspen guidelines)
Nutrition (espen &amp; aspen guidelines)Janvi Sarma
 
Nutrition in critically ill patients
Nutrition in critically ill  patients Nutrition in critically ill  patients
Nutrition in critically ill patients Neha Singh
 
parenteral and enteral nutrition
parenteral and enteral nutritionparenteral and enteral nutrition
parenteral and enteral nutritionShima Ghavimi, MD
 
Nutritional Support
Nutritional  SupportNutritional  Support
Nutritional SupportRia Pineda
 
Nutrition in neurological disorders
Nutrition in neurological disordersNutrition in neurological disorders
Nutrition in neurological disordersKhaled Osama
 
Chapter 15 Enteral and Parenteral Nutrition Support
Chapter 15 Enteral and Parenteral Nutrition Support Chapter 15 Enteral and Parenteral Nutrition Support
Chapter 15 Enteral and Parenteral Nutrition Support KellyGCDET
 
Nutrition for the surgical patient by Dr. Ali Mujtaba
Nutrition for the surgical patient by Dr. Ali MujtabaNutrition for the surgical patient by Dr. Ali Mujtaba
Nutrition for the surgical patient by Dr. Ali MujtabaDr Ali MUJTABA
 
Enteral and Parenteral Nutrition
Enteral and Parenteral Nutrition Enteral and Parenteral Nutrition
Enteral and Parenteral Nutrition Areej Abu Hanieh
 
Nutritional Guidelines for ICU Patients
Nutritional Guidelines for ICU PatientsNutritional Guidelines for ICU Patients
Nutritional Guidelines for ICU Patientsnutritionistrepublic
 
Total parenteral nutrition
Total parenteral nutritionTotal parenteral nutrition
Total parenteral nutritionJitendra Shukla
 
Chapter 16 Nutrition in metabolic and Respiratory Stress
Chapter 16 Nutrition in metabolic and Respiratory Stress Chapter 16 Nutrition in metabolic and Respiratory Stress
Chapter 16 Nutrition in metabolic and Respiratory Stress KellyGCDET
 
Importance of nutritional management during hospitalization
Importance of nutritional management during hospitalizationImportance of nutritional management during hospitalization
Importance of nutritional management during hospitalizationBushra Tariq
 
ENTERAL NUTRITION.pptx
ENTERAL NUTRITION.pptxENTERAL NUTRITION.pptx
ENTERAL NUTRITION.pptxAreej87
 
Enteral nutrition - Modes, Indications, Complications
Enteral nutrition - Modes, Indications, ComplicationsEnteral nutrition - Modes, Indications, Complications
Enteral nutrition - Modes, Indications, ComplicationsChetan Ganteppanavar
 
Chapter 13 Nutrition and care Assessment
Chapter 13 Nutrition and care Assessment Chapter 13 Nutrition and care Assessment
Chapter 13 Nutrition and care Assessment KellyGCDET
 

Tendances (20)

Nutrition (espen &amp; aspen guidelines)
Nutrition (espen &amp; aspen guidelines)Nutrition (espen &amp; aspen guidelines)
Nutrition (espen &amp; aspen guidelines)
 
Nutrition in critically ill patients
Nutrition in critically ill  patients Nutrition in critically ill  patients
Nutrition in critically ill patients
 
Enteral nutrition
Enteral nutritionEnteral nutrition
Enteral nutrition
 
parenteral and enteral nutrition
parenteral and enteral nutritionparenteral and enteral nutrition
parenteral and enteral nutrition
 
Nutritional Support
Nutritional  SupportNutritional  Support
Nutritional Support
 
Nutrition in neurological disorders
Nutrition in neurological disordersNutrition in neurological disorders
Nutrition in neurological disorders
 
Chapter 15 Enteral and Parenteral Nutrition Support
Chapter 15 Enteral and Parenteral Nutrition Support Chapter 15 Enteral and Parenteral Nutrition Support
Chapter 15 Enteral and Parenteral Nutrition Support
 
Nutrition for the surgical patient by Dr. Ali Mujtaba
Nutrition for the surgical patient by Dr. Ali MujtabaNutrition for the surgical patient by Dr. Ali Mujtaba
Nutrition for the surgical patient by Dr. Ali Mujtaba
 
Enteral nutrition
Enteral nutritionEnteral nutrition
Enteral nutrition
 
Enteral and Parenteral Nutrition
Enteral and Parenteral Nutrition Enteral and Parenteral Nutrition
Enteral and Parenteral Nutrition
 
Nutritional Guidelines for ICU Patients
Nutritional Guidelines for ICU PatientsNutritional Guidelines for ICU Patients
Nutritional Guidelines for ICU Patients
 
Surgical nutrition
Surgical nutritionSurgical nutrition
Surgical nutrition
 
Total parenteral nutrition
Total parenteral nutritionTotal parenteral nutrition
Total parenteral nutrition
 
Chapter 16 Nutrition in metabolic and Respiratory Stress
Chapter 16 Nutrition in metabolic and Respiratory Stress Chapter 16 Nutrition in metabolic and Respiratory Stress
Chapter 16 Nutrition in metabolic and Respiratory Stress
 
Importance of nutritional management during hospitalization
Importance of nutritional management during hospitalizationImportance of nutritional management during hospitalization
Importance of nutritional management during hospitalization
 
Clinical nutrition
Clinical nutritionClinical nutrition
Clinical nutrition
 
ENTERAL NUTRITION.pptx
ENTERAL NUTRITION.pptxENTERAL NUTRITION.pptx
ENTERAL NUTRITION.pptx
 
Enteral nutrition - Modes, Indications, Complications
Enteral nutrition - Modes, Indications, ComplicationsEnteral nutrition - Modes, Indications, Complications
Enteral nutrition - Modes, Indications, Complications
 
Nutrition in surgery
Nutrition in surgeryNutrition in surgery
Nutrition in surgery
 
Chapter 13 Nutrition and care Assessment
Chapter 13 Nutrition and care Assessment Chapter 13 Nutrition and care Assessment
Chapter 13 Nutrition and care Assessment
 

Similaire à Nutritional Support

Enteric nutrition part 1 ( In Maxillofacial, Head and Neck Surgery )
Enteric nutrition part 1 ( In Maxillofacial, Head and Neck Surgery )Enteric nutrition part 1 ( In Maxillofacial, Head and Neck Surgery )
Enteric nutrition part 1 ( In Maxillofacial, Head and Neck Surgery )Maxfac Center
 
Nutritional support in surgical patients
Nutritional support in surgical patientsNutritional support in surgical patients
Nutritional support in surgical patientsOmarAlaidaroos3
 
vdocument.in_nutritional-support-55849fd534680.ppt
vdocument.in_nutritional-support-55849fd534680.pptvdocument.in_nutritional-support-55849fd534680.ppt
vdocument.in_nutritional-support-55849fd534680.pptabdiazizhamud1
 
Nutritioninicu 120119095954-phpapp02
Nutritioninicu 120119095954-phpapp02Nutritioninicu 120119095954-phpapp02
Nutritioninicu 120119095954-phpapp02Dana Perez
 
Nutrition in surgical patients
Nutrition in surgical patientsNutrition in surgical patients
Nutrition in surgical patientsAjayKumar4497
 
Perioperative nutrition
Perioperative nutritionPerioperative nutrition
Perioperative nutritionAsif Ansari
 
Total parental nutrition
Total parental nutritionTotal parental nutrition
Total parental nutritionBe Akash Sah
 
Total parentral nutrition
Total parentral nutritionTotal parentral nutrition
Total parentral nutritionsania2014
 
nutrition sakib.pptx
nutrition sakib.pptxnutrition sakib.pptx
nutrition sakib.pptxNAZMUS SAKIB
 
total parenteral nutrition
total parenteral nutritiontotal parenteral nutrition
total parenteral nutritionBilalzaibZaib
 
nutrition_in_surgery.ppt
nutrition_in_surgery.pptnutrition_in_surgery.ppt
nutrition_in_surgery.pptJayaramPandey1
 
Nutrition in Specific Diseases.ppt
Nutrition in Specific Diseases.pptNutrition in Specific Diseases.ppt
Nutrition in Specific Diseases.pptekramy abdo
 
Total Parenteral Nutrition (TPN)
Total Parenteral Nutrition (TPN)Total Parenteral Nutrition (TPN)
Total Parenteral Nutrition (TPN)Dr. Ankit Gaur
 

Similaire à Nutritional Support (20)

Enteric nutrition part 1 ( In Maxillofacial, Head and Neck Surgery )
Enteric nutrition part 1 ( In Maxillofacial, Head and Neck Surgery )Enteric nutrition part 1 ( In Maxillofacial, Head and Neck Surgery )
Enteric nutrition part 1 ( In Maxillofacial, Head and Neck Surgery )
 
Nutritional support in surgical patients
Nutritional support in surgical patientsNutritional support in surgical patients
Nutritional support in surgical patients
 
vdocument.in_nutritional-support-55849fd534680.ppt
vdocument.in_nutritional-support-55849fd534680.pptvdocument.in_nutritional-support-55849fd534680.ppt
vdocument.in_nutritional-support-55849fd534680.ppt
 
Nutrition
NutritionNutrition
Nutrition
 
Nutritioninicu 120119095954-phpapp02
Nutritioninicu 120119095954-phpapp02Nutritioninicu 120119095954-phpapp02
Nutritioninicu 120119095954-phpapp02
 
Nutrition in surgical patients
Nutrition in surgical patientsNutrition in surgical patients
Nutrition in surgical patients
 
Perioperative nutrition
Perioperative nutritionPerioperative nutrition
Perioperative nutrition
 
Total parental nutrition
Total parental nutritionTotal parental nutrition
Total parental nutrition
 
NUTRITION IN CRITICALLY ILL PATIENTS.pdf
NUTRITION IN CRITICALLY ILL PATIENTS.pdfNUTRITION IN CRITICALLY ILL PATIENTS.pdf
NUTRITION IN CRITICALLY ILL PATIENTS.pdf
 
Nutrition in sick children
Nutrition in sick childrenNutrition in sick children
Nutrition in sick children
 
Total parentral nutrition
Total parentral nutritionTotal parentral nutrition
Total parentral nutrition
 
Updated tpn last
Updated tpn lastUpdated tpn last
Updated tpn last
 
nutrition sakib.pptx
nutrition sakib.pptxnutrition sakib.pptx
nutrition sakib.pptx
 
total parenteral nutrition
total parenteral nutritiontotal parenteral nutrition
total parenteral nutrition
 
Nutrition in ICU
Nutrition in ICUNutrition in ICU
Nutrition in ICU
 
Nutrition in ICU.ppt
Nutrition in ICU.pptNutrition in ICU.ppt
Nutrition in ICU.ppt
 
nutrition_in_surgery.ppt
nutrition_in_surgery.pptnutrition_in_surgery.ppt
nutrition_in_surgery.ppt
 
Nutrition in Specific Diseases.ppt
Nutrition in Specific Diseases.pptNutrition in Specific Diseases.ppt
Nutrition in Specific Diseases.ppt
 
Total Parenteral Nutrition (TPN)
Total Parenteral Nutrition (TPN)Total Parenteral Nutrition (TPN)
Total Parenteral Nutrition (TPN)
 
NUTRITIONAL CARE PLAN
NUTRITIONAL CARE PLANNUTRITIONAL CARE PLAN
NUTRITIONAL CARE PLAN
 

Plus de Deep Deep

Poison2 1285794193199-phpapp01
Poison2 1285794193199-phpapp01Poison2 1285794193199-phpapp01
Poison2 1285794193199-phpapp01Deep Deep
 
Mayo Clinic Notes On Tof
Mayo Clinic Notes On TofMayo Clinic Notes On Tof
Mayo Clinic Notes On TofDeep Deep
 
Orthopaedics Surgery Tutor.Com
Orthopaedics Surgery Tutor.ComOrthopaedics Surgery Tutor.Com
Orthopaedics Surgery Tutor.ComDeep Deep
 
Certain Gastrointestinal Disorders Can Be Life Threatening And Require Emerge...
Certain Gastrointestinal Disorders Can Be Life Threatening And Require Emerge...Certain Gastrointestinal Disorders Can Be Life Threatening And Require Emerge...
Certain Gastrointestinal Disorders Can Be Life Threatening And Require Emerge...Deep Deep
 
Introduction
IntroductionIntroduction
IntroductionDeep Deep
 
What Is Jaundice
What Is JaundiceWhat Is Jaundice
What Is JaundiceDeep Deep
 
Stress Ulcer Prophylaxis Introduction
Stress Ulcer Prophylaxis IntroductionStress Ulcer Prophylaxis Introduction
Stress Ulcer Prophylaxis IntroductionDeep Deep
 
Infectious Disease
Infectious DiseaseInfectious Disease
Infectious DiseaseDeep Deep
 
SEXUALLY TRANSMITTED DISEASES
SEXUALLY TRANSMITTED DISEASESSEXUALLY TRANSMITTED DISEASES
SEXUALLY TRANSMITTED DISEASESDeep Deep
 
Infections Of The Skin And Its Appendages
Infections Of The Skin And Its AppendagesInfections Of The Skin And Its Appendages
Infections Of The Skin And Its AppendagesDeep Deep
 
Urinary Tract Infection
Urinary Tract InfectionUrinary Tract Infection
Urinary Tract InfectionDeep Deep
 
Infectious Disease
Infectious DiseaseInfectious Disease
Infectious DiseaseDeep Deep
 
Infectious Disease Git
Infectious Disease GitInfectious Disease Git
Infectious Disease GitDeep Deep
 
Sexually Transmitted Diseases ...
Sexually Transmitted Diseases                                                ...Sexually Transmitted Diseases                                                ...
Sexually Transmitted Diseases ...Deep Deep
 
Chapter 3 Lower Respiratory Tract Infections
Chapter 3 Lower Respiratory Tract InfectionsChapter 3 Lower Respiratory Tract Infections
Chapter 3 Lower Respiratory Tract InfectionsDeep Deep
 
金教案2 3
金教案2 3金教案2 3
金教案2 3Deep Deep
 
Upper Respiratory Infections
Upper Respiratory InfectionsUpper Respiratory Infections
Upper Respiratory InfectionsDeep Deep
 
张结教案4
张结教案4张结教案4
张结教案4Deep Deep
 
张结 3 1 1
张结 3 1 1张结 3 1 1
张结 3 1 1Deep Deep
 
张结 1 1 2003
张结 1 1 2003张结 1 1 2003
张结 1 1 2003Deep Deep
 

Plus de Deep Deep (20)

Poison2 1285794193199-phpapp01
Poison2 1285794193199-phpapp01Poison2 1285794193199-phpapp01
Poison2 1285794193199-phpapp01
 
Mayo Clinic Notes On Tof
Mayo Clinic Notes On TofMayo Clinic Notes On Tof
Mayo Clinic Notes On Tof
 
Orthopaedics Surgery Tutor.Com
Orthopaedics Surgery Tutor.ComOrthopaedics Surgery Tutor.Com
Orthopaedics Surgery Tutor.Com
 
Certain Gastrointestinal Disorders Can Be Life Threatening And Require Emerge...
Certain Gastrointestinal Disorders Can Be Life Threatening And Require Emerge...Certain Gastrointestinal Disorders Can Be Life Threatening And Require Emerge...
Certain Gastrointestinal Disorders Can Be Life Threatening And Require Emerge...
 
Introduction
IntroductionIntroduction
Introduction
 
What Is Jaundice
What Is JaundiceWhat Is Jaundice
What Is Jaundice
 
Stress Ulcer Prophylaxis Introduction
Stress Ulcer Prophylaxis IntroductionStress Ulcer Prophylaxis Introduction
Stress Ulcer Prophylaxis Introduction
 
Infectious Disease
Infectious DiseaseInfectious Disease
Infectious Disease
 
SEXUALLY TRANSMITTED DISEASES
SEXUALLY TRANSMITTED DISEASESSEXUALLY TRANSMITTED DISEASES
SEXUALLY TRANSMITTED DISEASES
 
Infections Of The Skin And Its Appendages
Infections Of The Skin And Its AppendagesInfections Of The Skin And Its Appendages
Infections Of The Skin And Its Appendages
 
Urinary Tract Infection
Urinary Tract InfectionUrinary Tract Infection
Urinary Tract Infection
 
Infectious Disease
Infectious DiseaseInfectious Disease
Infectious Disease
 
Infectious Disease Git
Infectious Disease GitInfectious Disease Git
Infectious Disease Git
 
Sexually Transmitted Diseases ...
Sexually Transmitted Diseases                                                ...Sexually Transmitted Diseases                                                ...
Sexually Transmitted Diseases ...
 
Chapter 3 Lower Respiratory Tract Infections
Chapter 3 Lower Respiratory Tract InfectionsChapter 3 Lower Respiratory Tract Infections
Chapter 3 Lower Respiratory Tract Infections
 
金教案2 3
金教案2 3金教案2 3
金教案2 3
 
Upper Respiratory Infections
Upper Respiratory InfectionsUpper Respiratory Infections
Upper Respiratory Infections
 
张结教案4
张结教案4张结教案4
张结教案4
 
张结 3 1 1
张结 3 1 1张结 3 1 1
张结 3 1 1
 
张结 1 1 2003
张结 1 1 2003张结 1 1 2003
张结 1 1 2003
 

Dernier

Role of Soap based and synthetic or syndets bar
Role of  Soap based and synthetic or syndets barRole of  Soap based and synthetic or syndets bar
Role of Soap based and synthetic or syndets barmohitRahangdale
 
historyofpsychiatryinindia. Senthil Thirusangu
historyofpsychiatryinindia. Senthil Thirusanguhistoryofpsychiatryinindia. Senthil Thirusangu
historyofpsychiatryinindia. Senthil Thirusangu Medical University
 
Basic structure of hair and hair growth cycle.pptx
Basic structure of hair and hair growth cycle.pptxBasic structure of hair and hair growth cycle.pptx
Basic structure of hair and hair growth cycle.pptxkomalt2001
 
"Radical excision of DIE in subferile women with deep infiltrating endometrio...
"Radical excision of DIE in subferile women with deep infiltrating endometrio..."Radical excision of DIE in subferile women with deep infiltrating endometrio...
"Radical excision of DIE in subferile women with deep infiltrating endometrio...Sujoy Dasgupta
 
SGK RỐI LOẠN TOAN KIỀM ĐHYHN RẤT HAY VÀ ĐẶC SẮC.pdf
SGK RỐI LOẠN TOAN KIỀM ĐHYHN RẤT HAY VÀ ĐẶC SẮC.pdfSGK RỐI LOẠN TOAN KIỀM ĐHYHN RẤT HAY VÀ ĐẶC SẮC.pdf
SGK RỐI LOẠN TOAN KIỀM ĐHYHN RẤT HAY VÀ ĐẶC SẮC.pdfHongBiThi1
 
High-Performance Thin-Layer Chromatography (HPTLC)
High-Performance Thin-Layer Chromatography (HPTLC)High-Performance Thin-Layer Chromatography (HPTLC)
High-Performance Thin-Layer Chromatography (HPTLC)kishan singh tomar
 
DNA nucleotides Blast in NCBI and Phylogeny using MEGA Xi.pptx
DNA nucleotides Blast in NCBI and Phylogeny using MEGA Xi.pptxDNA nucleotides Blast in NCBI and Phylogeny using MEGA Xi.pptx
DNA nucleotides Blast in NCBI and Phylogeny using MEGA Xi.pptxMAsifAhmad
 
Physiology of Smooth Muscles -Mechanics of contraction and relaxation
Physiology of Smooth Muscles -Mechanics of contraction and relaxationPhysiology of Smooth Muscles -Mechanics of contraction and relaxation
Physiology of Smooth Muscles -Mechanics of contraction and relaxationMedicoseAcademics
 
power point presentation of Clinical evaluation of strabismus
power point presentation of Clinical evaluation  of strabismuspower point presentation of Clinical evaluation  of strabismus
power point presentation of Clinical evaluation of strabismusChandrasekar Reddy
 
SGK NGẠT NƯỚC ĐHYHN RẤT LÀ HAY NHA .pdf
SGK NGẠT NƯỚC ĐHYHN RẤT LÀ HAY NHA    .pdfSGK NGẠT NƯỚC ĐHYHN RẤT LÀ HAY NHA    .pdf
SGK NGẠT NƯỚC ĐHYHN RẤT LÀ HAY NHA .pdfHongBiThi1
 
Male Infertility Panel Discussion by Dr Sujoy Dasgupta
Male Infertility Panel Discussion by Dr Sujoy DasguptaMale Infertility Panel Discussion by Dr Sujoy Dasgupta
Male Infertility Panel Discussion by Dr Sujoy DasguptaSujoy Dasgupta
 
Generative AI in Health Care a scoping review and a persoanl experience.
Generative AI in Health Care a scoping review and a persoanl experience.Generative AI in Health Care a scoping review and a persoanl experience.
Generative AI in Health Care a scoping review and a persoanl experience.Vaikunthan Rajaratnam
 
Breast cancer -ONCO IN MEDICAL AND SURGICAL NURSING.pptx
Breast cancer -ONCO IN MEDICAL AND SURGICAL NURSING.pptxBreast cancer -ONCO IN MEDICAL AND SURGICAL NURSING.pptx
Breast cancer -ONCO IN MEDICAL AND SURGICAL NURSING.pptxNaveenkumar267201
 
Bulimia nervosa ( Eating Disorders) Mental Health Nursing.
Bulimia nervosa ( Eating Disorders) Mental Health Nursing.Bulimia nervosa ( Eating Disorders) Mental Health Nursing.
Bulimia nervosa ( Eating Disorders) Mental Health Nursing.aarjukhadka22
 
Mental health Team. Dr Senthil Thirusangu
Mental health Team. Dr Senthil ThirusanguMental health Team. Dr Senthil Thirusangu
Mental health Team. Dr Senthil Thirusangu Medical University
 
Trustworthiness of AI based predictions Aachen 2024
Trustworthiness of AI based predictions Aachen 2024Trustworthiness of AI based predictions Aachen 2024
Trustworthiness of AI based predictions Aachen 2024EwoutSteyerberg1
 

Dernier (20)

Role of Soap based and synthetic or syndets bar
Role of  Soap based and synthetic or syndets barRole of  Soap based and synthetic or syndets bar
Role of Soap based and synthetic or syndets bar
 
How to master Steroid (glucocorticoids) prescription, different scenarios, ca...
How to master Steroid (glucocorticoids) prescription, different scenarios, ca...How to master Steroid (glucocorticoids) prescription, different scenarios, ca...
How to master Steroid (glucocorticoids) prescription, different scenarios, ca...
 
American College of physicians ACP high value care recommendations in rheumat...
American College of physicians ACP high value care recommendations in rheumat...American College of physicians ACP high value care recommendations in rheumat...
American College of physicians ACP high value care recommendations in rheumat...
 
historyofpsychiatryinindia. Senthil Thirusangu
historyofpsychiatryinindia. Senthil Thirusanguhistoryofpsychiatryinindia. Senthil Thirusangu
historyofpsychiatryinindia. Senthil Thirusangu
 
Basic structure of hair and hair growth cycle.pptx
Basic structure of hair and hair growth cycle.pptxBasic structure of hair and hair growth cycle.pptx
Basic structure of hair and hair growth cycle.pptx
 
"Radical excision of DIE in subferile women with deep infiltrating endometrio...
"Radical excision of DIE in subferile women with deep infiltrating endometrio..."Radical excision of DIE in subferile women with deep infiltrating endometrio...
"Radical excision of DIE in subferile women with deep infiltrating endometrio...
 
SGK RỐI LOẠN TOAN KIỀM ĐHYHN RẤT HAY VÀ ĐẶC SẮC.pdf
SGK RỐI LOẠN TOAN KIỀM ĐHYHN RẤT HAY VÀ ĐẶC SẮC.pdfSGK RỐI LOẠN TOAN KIỀM ĐHYHN RẤT HAY VÀ ĐẶC SẮC.pdf
SGK RỐI LOẠN TOAN KIỀM ĐHYHN RẤT HAY VÀ ĐẶC SẮC.pdf
 
High-Performance Thin-Layer Chromatography (HPTLC)
High-Performance Thin-Layer Chromatography (HPTLC)High-Performance Thin-Layer Chromatography (HPTLC)
High-Performance Thin-Layer Chromatography (HPTLC)
 
DNA nucleotides Blast in NCBI and Phylogeny using MEGA Xi.pptx
DNA nucleotides Blast in NCBI and Phylogeny using MEGA Xi.pptxDNA nucleotides Blast in NCBI and Phylogeny using MEGA Xi.pptx
DNA nucleotides Blast in NCBI and Phylogeny using MEGA Xi.pptx
 
Physiology of Smooth Muscles -Mechanics of contraction and relaxation
Physiology of Smooth Muscles -Mechanics of contraction and relaxationPhysiology of Smooth Muscles -Mechanics of contraction and relaxation
Physiology of Smooth Muscles -Mechanics of contraction and relaxation
 
Biologic therapy ice breaking in rheumatology, Case based approach with appli...
Biologic therapy ice breaking in rheumatology, Case based approach with appli...Biologic therapy ice breaking in rheumatology, Case based approach with appli...
Biologic therapy ice breaking in rheumatology, Case based approach with appli...
 
power point presentation of Clinical evaluation of strabismus
power point presentation of Clinical evaluation  of strabismuspower point presentation of Clinical evaluation  of strabismus
power point presentation of Clinical evaluation of strabismus
 
SGK NGẠT NƯỚC ĐHYHN RẤT LÀ HAY NHA .pdf
SGK NGẠT NƯỚC ĐHYHN RẤT LÀ HAY NHA    .pdfSGK NGẠT NƯỚC ĐHYHN RẤT LÀ HAY NHA    .pdf
SGK NGẠT NƯỚC ĐHYHN RẤT LÀ HAY NHA .pdf
 
Male Infertility Panel Discussion by Dr Sujoy Dasgupta
Male Infertility Panel Discussion by Dr Sujoy DasguptaMale Infertility Panel Discussion by Dr Sujoy Dasgupta
Male Infertility Panel Discussion by Dr Sujoy Dasgupta
 
Generative AI in Health Care a scoping review and a persoanl experience.
Generative AI in Health Care a scoping review and a persoanl experience.Generative AI in Health Care a scoping review and a persoanl experience.
Generative AI in Health Care a scoping review and a persoanl experience.
 
Rheumatoid arthritis Part 1, case based approach with application of the late...
Rheumatoid arthritis Part 1, case based approach with application of the late...Rheumatoid arthritis Part 1, case based approach with application of the late...
Rheumatoid arthritis Part 1, case based approach with application of the late...
 
Breast cancer -ONCO IN MEDICAL AND SURGICAL NURSING.pptx
Breast cancer -ONCO IN MEDICAL AND SURGICAL NURSING.pptxBreast cancer -ONCO IN MEDICAL AND SURGICAL NURSING.pptx
Breast cancer -ONCO IN MEDICAL AND SURGICAL NURSING.pptx
 
Bulimia nervosa ( Eating Disorders) Mental Health Nursing.
Bulimia nervosa ( Eating Disorders) Mental Health Nursing.Bulimia nervosa ( Eating Disorders) Mental Health Nursing.
Bulimia nervosa ( Eating Disorders) Mental Health Nursing.
 
Mental health Team. Dr Senthil Thirusangu
Mental health Team. Dr Senthil ThirusanguMental health Team. Dr Senthil Thirusangu
Mental health Team. Dr Senthil Thirusangu
 
Trustworthiness of AI based predictions Aachen 2024
Trustworthiness of AI based predictions Aachen 2024Trustworthiness of AI based predictions Aachen 2024
Trustworthiness of AI based predictions Aachen 2024
 

Nutritional Support

  • 1. Nutritional Support in Critical illness Tianjin Medical University General Hospital Emergency Center Shou songtao
  • 2.
  • 3. ‘ A slender and restricted diet is always dangerous in chronic and in acute diseases’ Hippocrates 400 B.C.
  • 4.
  • 5.
  • 6. ICU Nutrition through the ages Overfeeding 1980s
  • 7.
  • 8.  
  • 9.  
  • 10. Organisation of Nutrition Support 3. NICE Guidelines for Nutrition Support in Adults 2006 Screen Recognise Treat Oral Enteral Parenteral Monitor & Review
  • 11.
  • 12.
  • 13.
  • 14.
  • 15.
  • 16.
  • 17.
  • 18.
  • 19.
  • 20.
  • 21.
  • 22.
  • 23.
  • 24.
  • 25.
  • 26.
  • 27.  
  • 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
  • 30.  
  • 31.  
  • 32.  
  • 33.
  • 34.
  • 35.
  • 36.
  • 37.
  • 39.
  • 41.
  • 42.
  • 43.
  • 44. Enteral Formula Categories Fiber-Containing
  • 45.
  • 47.
  • 48. Enteral Formula Categories Disease Specific
  • 49.
  • 51.
  • 52.
  • 54.
  • 56.
  • 58.
  • 59.
  • 60.
  • 61.
  • 62.
  • 63.
  • 64.
  • 65.
  • 66.
  • 67.
  • 68.
  • 70.
  • 71.
  • 72.
  • 73.
  • 74.
  • 75.
  • 76.  
  • 77.
  • 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
  • 80.
  • 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
  • 82.
  • 83.
  • 84.
  • 85.
  • 86.
  • 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
  • 88.
  • 89.
  • 90.
  • 91.
  • 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
  • 93.
  • 94.
  • 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
  • 96.
  • 97.
  • 98.
  • 99.
  • 100.
  • 101.
  • 102.
  • 103. Mechanical Complications Venous thrombosis Catheter occlusion Related to catheter in situ
  • 104.
  • 105.
  • 106.
  • 107.
  • 108. Approach to Nutritional Support Nutritional Assessment Maintenance Repletion GI Tract Functional YES NO Enteral Nutrition Parenteral Nutrition
  • 109.
  • 110.
  • 111.
  • 112.  
  • 113.
  • 114.
  • 116.