Ensuring patients have adequate nutrition is vital to their recovery.
According to Kara Burns, MS, MEd, LVT, VTS (Nutrition), VTS-H (Internal Medicine, Dentistry), inadequate nutrition in ICU patients makes it even more difficult to treat their underlying disease. This population requires nutrients on a daily basis to maintain optimal immune function, tissue synthesis, tissue repair, and proper drug metabolism. During her presentation at the virtual North American Veterinary Conference (NAVC) Veterinary Meeting & Expo (VMX), she addressed the importance of nutrition in critical care patients and outlined tips to meet their needs.
Before starting feeding
Burns advised before beginning feeding patients to ensure they are stable and not in shock, as this could reduce blood flow to the gastrointestinal (GI) tract and increase other complications. The patient should also be well hydrated. Electrolytes should be monitored before feeding and throughout the process.
Early enteral and semi-elemental nutrition
Introducing enteral feeding as soon as possible promotes early recovery, and this can be achieved by administering an antiemetic drug at admission. Some benefits of this method include reducing cytokine production, modulating the acute phase response, reducing catabolism, preserving proteins, and stimulating regeneration of the intestinal mucosa.
“In these [critical] Early nutritional support is essential for patients because we know that diet spares endogenous proteins, which is critical to successful outcomes,” Burns said.
Burns recommended a semi-elemental diet because it is easily absorbed and digested by the gastrointestinal tract. This monomeric feeding uses small molecular weight compounds as nutrients so the tract does not have to expend significant energy to break them down.
“An ER and ICU patient has no energy left, so the energy is better used to heal the rest of the body and repair itself,” Burns shared.
Nourish the GI tract
When an animal is seriously ill, the body’s main goal is to support key organs such as the heart, brain, liver, and lungs so that blood flow to the gastrointestinal tract is reduced, which in turn reduces motility or movement of the gastrointestinal tract slowed down. Therefore, according to Burns, maintaining the health and function of the gastrointestinal tract and its enterocytes is particularly important in these patients.
“The gastrointestinal tract is lined with cells called enterocytes. These enterocytes help digest, absorb, and transport a variety of nutrients throughout the body. Important nutrients taken up by enterocytes include the protein building blocks, which are peptides, carbohydrates, saccharides, fats or lipids, water, vitamins, and these ions or minerals,” Burns said.
In prioritizing enterocyte health, veterinarians provide the maximum absorbable nutrients in the GI tract. In addition, enterocytes form a tight seal to protect the body from harmful bacteria or toxins, which ergo is also beneficial for intensive care patients.
feeding tubes
Burns urged participants to use feeding tubes with patients in critical condition. “Feeding tubes save lives, but they’re not used as often as they should,” she said.
The types of feeding tubes include nasoesophageal/nasogastric tubes, esophagostomy tubes, gastrostomy tubes, and jejunostomy tubes. Each serves its own function and can be used based on a patient’s anesthesia needs, duration of feeding needs, placement needs and beyond.
Although complications associated with feeding tubes are rare, Burns says there are a few to look out for: aspiration, slippage, vomiting, constipation, and infection (particularly stoma infection).
Take away
Burns concluded the presentation by concluding that poor nutrition leads to poor outcomes, early enteral and semi-elemental feeding leads to early recovery, and feeding tubes save lives. Although this is often not the priority when a patient is in critical condition, ensuring adequate nutritional intake is key to their recovery.
relation
Burns K. Nutrition in critical care. Presented at: Veterinary Meeting and Expo; virtual. January 16, 2022. https://player.vimeo.com/video/666517819
