tailieunhanh - Ebook Core topics in mechanical ventilation: Part 2

(BQ) Part 2 book "Core topics in mechanical ventilation" presents the following contents: Nutrition in the mechanically ventilated patient, mechanical ventilation in asthma and chronic obstructive pulmonary disease, mechanical ventilation in patients with blast, burn and chest trauma injuries, ventilatory support - extreme solutions,. | Chapter 9 Nutrition in the mechanically ventilated patient CLARE REID Introduction Respiratory failure and the need for mechanical ventilation brought about by a variety of medical surgical and traumatic events makes the optimum nutritional requirements of this group of patients difficult to determine. Nonetheless nutritional support is an important adjunct to the management of patients in the intensive care unit mechanically ventilated patients being especially vulnerable to complications of under- or over-feeding. This chapter will consider the nutritional requirements route and timing of nutritional support and complications associated with feeding mechanically ventilated critically ill patients. Nutritional status and outcome The metabolic response to critical illness which features a rise in circulating levels of the counter-regulatory hormones and pro-inflammator y cytokines is characterized by insulin resistance increased metabolic rate and marked protein catabolism. The loss of lean body mass impairs function delays recovery and rehabilitation and at its most extreme may delay weaning from artificial ventilation. The degree of catabolism and its impact on outcome depends on the duration and severity of the inflammatory response. Anthropometric techniques routinely used to measure changes in body mass and composition are inaccurate in the presence of excess fluid retention and therefore the assessment and monitoring of the nutritional status in critically ill patients is difficult. A pre-illness weight and weight history may provide useful information on pre-existing malnutrition but once admitted to the intensive care unit ICU acute changes in body weight largely reflect changes in fluid balance. Assessment of nutritional status should in such cases be based on clinical and biochemical parameters. Malnourished critically ill patients are consistently found to have poorer clinical outcomes than their well-nourished counterparts 1 and up to 80 ofICU patients