Trauma, Critical Illness, CVA(Stroke), Major Surgery, Sepsis​

Critical Care is the complex medical management of a seriously ill or injured person.

Acute impairment of 1 or more vital organ systems may develop. The metabolic response to critical illness, traumatic injury, serious fractures, sepsis (life – threatening organ dysfunction caused by dysregulated response to infection), burns or mayor surgery, involves most metabolic pathways, leading to accelerated catabolism ( breakdown) of lean body (muscle ) mass. An altered hormonal state results in disturbed, poor use of carbohydrate, protein, fat and oxygen.

The first emphasis of critical care, when the patient is admitted to ICU or ACU, is establishing hemodynamic stability ( maintenance of breathing, circulation fluid / blood volume; tissue oxygenation; acid-base neutrality ) This will determine when nutrition support can commence.

Nutritional status assessment under these circumstances is complex as the acute-phase response leads to altered circulating proteins due to inflammatory injury.

Use of Nutrition Risk Screening tools, published guidelines, physical assessment,  interpretation of blood results, by the experienced dietitian is essential, combined with ongoing communication  with the physician and critical care unit staff.

The goals of Medical Nutrition Therapy include:

• Minimization of starvation;
• Prevention and correction of nutrient deficiencies;
• Provision of adequate calories while minimizing associated metabolic complications;
• Fluid and electrolyte management;
• Support of glycemic ( blood glucose ) control

Nutritional requirements for energy, protein, fat, vitamins, minerals, trace elements and fluid are individually calculated, and frequently adjusted as the patient’s condition changes.

The preferred route for nutrient delivery is an orally consumed diet of whole foods. In some instances, limited oral food intake may be sufficiently supported by the use of liquidised high density nutritional supplements.

However, critically ill patients are most often unable to eat (for eg  with endotracheal intubation / ventilator dependence ) Impairment of chewing, swallowing, depression, loss of appetite, or post traumatic shock, may delay oral intake.

Early Enteral feeding ( via a tube placed into the gut ) should then be initiated within 48hours of admittance to the Critical Care Unit, as the most preferred route of feeding.

Parenteral nutrition ( intravenous feeding of nutrient directly into the bloodstream ) is indicated when the patient is unable to tolerate adequate nutrients orally or via enteral feeding, because the intestine has lost its function for nutrient absorption temporarily or permanently.