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Critical Care Nutrition Guidelines: Ali/ards
Appropriate TUBE FEEDING
patientS may include:
Patients in the ICU who
are intubated with
Acute Lung Injury (ALI):
PaO2/FiO2 <300mmHg
or
Acute Respiratory Distress
Syndrome (ARDS):
PaO2/FiO2 <200mmHg.
n Any intubated patient with
increased calorie and protein
needs due to hypermetabolism
associated with respiratory failure.
ENTERAL FORMULA
Selection Criteria:
Concentrated formula, as fluid
restriction may help to minimize fluid
accumulation around the lungs,
associated with pulmonary edema.
n ENTERAL FORMULA OPTIONS
Peptamen® af Provides:
n
n
n
Added long-chain omega-3
fatty acids plus an appropriate
n6 to n3 ratio to help minimize the
inflammatory cytokine production
associated with n6 fatty acids.
n
n n n
n
n
n
Added antioxidants to help neutralize
free radicals.
n
1.2 calories
25% protein
Peptide-based
50% mct
epa & dha
n6:n3 of 1.8:1
Antioxidant rich in
vitamins a,c,e and
minerals selenium
and copper
Added prebiotics
Crucial® Provides:
n
n
n
n
n
n
n
n
1.5 calories
25% protein
Peptide-based
50% mct
epa & dha
n6:n3 of 1.5:1
Antioxidant rich in
vitamins a,c,e and
minerals selenium
and copper
Added arginine
High protein to help minimize loss
of lean body mass during the acute
phase response.
n TUBE FEEDING CONSIDERATIONS
Balanced peptide profile to help
enhance protein absorption.
n High arginine diet to help restore the
immune system in potentially argininedeficient patients (if patient was not
admitted with underlying infection).
n
n n
Initiate
as soon as hemodynamically stable, gastric or small
bowel access is available, and no contraindications exist.
Initiate
slowly at full strength and advance as tolerated, with
goal to meet at least 60% of needs enterally.
Nestlé Nutrition has endeavored to include in this document such clinical information that it believes to be accurate and reliable as of the date of publication. Nestlé Nutrition makes no representation or warranty, express or implied, as to the accuracy or completeness of
the information and shall have no liability relating to or resulting from the use of such information. The information contained in this document is not intended as a replacement for medical advice, standards of care, approved practices or policies of a particular physician
and/or healthcare facility, all of which should be considered.
See also:
Al-Saady, NM, Balckmore CM, Bennett, ED. High fat, low carbohydrate enteral feeding lowers PaO2 and reduces the period of ventilation in artificially ventilated patients. Intensive Care Medicine 1989; 15: 290-295.
Chin, R, Haponik, EF. Nutrition, Respiratory Function and Disease. Modern Nutrition in Health and Disease. Lea & Febiger: Philadelphia, 1994;1374-1390.
Gadek, JE, DeMichele SJ, Karlstad MD, et al. Effect of enteral feeding with eicosapentaenoic acid, g-linolenic acid, and antioxidants in patients with acute respiratory distress syndrome. Critical Care Medicine 1999; 27: 1409-1420.
Hogg, J, Klapholz, A, Reid-Hector, J. Pulmonary Disease. In Gottschlich M, (ed), The Science and Practice of Nutrition Support, A Case-based Core Curriculum. Dubuque: Kendall/Hunt, 2002; 575-599.
Meredith JW, et al. Visceral protein levels in trauma patients are greater with peptide diet than with intact protein diet. The Journal of Trauma. 1990; 30(7): 825-829.
Mizock BA. Nutritional support in acute lung injury and ARDS. Nutrition and Clinical Practice 2001;16:319-328.
McCarthy, MS, Deal LE. Nutritional Support in Respiratory Failure. Nutritional Considerations in the Intensive Care Unit. Dubuque: Kendall/Hunt, 2002; 187-197.
Ochoa, Juan B et al. A Rational Use of Immune Enhancing Diets: When Should We Use Dietary Arginine Supplementation? Nutrition in Clinical Practice 2004;19:216-225.
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ESSENTIALS OF CRITICAL CARE NUTRITION