Who Are The Critically Ill

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Full thickness
Burns trauma sepsis
Who Are The Critically Ill?
GI Cardiac Renal Cancer
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Injury, Trauma, Surgery Neurohormonal
Activation of the Stress Response Glucocort
icoid Catecholamine Activation, Hi
GlucagonInsulin Ratio, Growth Hormone
Release Tachycardia, Tachypnea,
Hyperglycemia, Mobilization of Body Fat,
Massive Catabolism of Skeletal Muscle
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In Critical Illness, Timing of Assessment
is Extremely Important!
Why?????
Metabolism in critical injuries Goes through at
least three Distinct phases Ebb (1st 24 hrs
post-injury) Flow (Days 2-5) Anabolic (7-10 days)
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Whats Going On During Ebb?
Low cardiac output low tissue
perfusion. Main priority is maintaining tissue
perfusion. (RESUSCITATION) Substrate
utilization depressed cell functions depressed.
Increased catecholamines (epinephrine, norepine
phrine) increase production of energy
substrates (glucose, ffa, amino acids) to ESCAPE
injury, MAINTAIN blood volume.
NO ADDITIONAL NUTRITION SUPPORT NEEDED!!!!!!!
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Whats up in Flow? High
cardiac output Growth hormone, glucagon,
cortisol all increased (catabolic
hormones) These cause increase insulin
secretion Insulin resistance may develop and
cause hyperglycemia. Increase BMR glycogen
now depleted. Positive N balance cannot be
achieved.
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Nutrition Support in Stress
Immediate Needs to Sustain Life Restore blood
flow Maintain oxygen transport Prevent/treat
infections.
If malnourished, introduce nourishment cautiously,
if not--
Refeeding syndrome malabsorption,
cardiac insufficiency, respiratory distres
s, CHF, etc.
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Fluid and Electrolytes Many types
of stress can cause massive fluid
losses. Examples Severe burns lose
12-15 of BW is FIRST 24 hours!
Vomiting, diarrhea, wounds, bleeding, and
FEVER