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Nutritional Support in Critically Ill Patients
The nutritional support in critically ill patients can be explained in 2 ways 1.Enteral Nutrition 2.Parenteral nutrition It is worth remembering that enteral nutritional is always the preferred route. The reason is clear. 1.Enteral nutrition helps mucosal integrity and thereby it minimizes the risk of bacterial colonization. 2.Reduces gastro-intestinal bleeds 3.Sepsis and its complications are reduced. There has been an extensive study done on the role of aminoacids and fatty acids but the conclusions have been inconclusive. Now lets talk about the 2.Parenteral nutrition If the enteral nutrition is not applicable or worse has failed then parenteral nutrition is the way to go. But remember that its costly affair and not many patients may be able to afford it especially if you are a doctor in the third world country. Problems with parenteral nutrition {complications} 1.Catheter related sepsis 2.Intestinal mucosal atrophy 3} Standard solutions related problems. Apart from Nutritional support lets consider the other support a critically ill patients need. 1.Ventilatory Support Modes-Controlled mandatory ventilation ---Synchronized intermittent mandatory ventilation ---Positive pressure ventilation and ---Positive controlled ventilation 2.Circulatory support ---Use of inotropes like adrenaline and nor-adrenaline and dobutamin 3.Renal Support Dialysis in critically ill patients is very helpful to maintain renal perfusion, treat sepsis and provide renal replacement therapy. Remember in the management of critically ill patients the identification and admission of such patients in High dependency units called the Intensive care units is the first step. The rest should be the Ventilatory support, Circulatory support, Renal and nutritional support. Abdul Matynne
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