You may be planning on soon heading to hear Prof Paul Weishmyer speak on PN, but in the mean time why not participate in NEJM’s ongoing critical care series which this week asks for your opinion on the management of nutrition in a critically unwell ICU patient.
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A well-nourished 77-year-old man whose medical history includes treated hypertension and hypercholesterolemia, previous heavy alcohol intake, and mild cognitive impairment was admitted to the intensive care unit (ICU) of a university hospital from the operating room after a Hartmann’s procedure performed for fecal peritonitis due to a perforated sigmoid colon.
On arrival in the ICU, he was in septic shock. He is undergoing mechanical ventilation with the use of a low-tidal-volume protocol with positive end-expiratory pressure (PEEP). His arterial blood pressure is supported with a norepinephrine infusion. Analgesia is provided by a continuous morphine infusion. Slight bleeding from the surgical site and from the areas around arterial and central venous catheters is most likely due to low-grade disseminated intravascular coagulation and does not currently merit any specific treatment other than withholding previously prescribed heparin and repeating the laboratory tests in 8 to 12 hours (as reviewed in case 7) .
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Poll Question
What strategy would you use to provide nutrition for this patient?
1. Initiate total parenteral nutrition as soon as possible after the patient’s arrival in the ICU.
2. Await the return of bowel sounds and then initiate enteral nutrition.
3. Initiate enteral nutrition within 24 to 48 hours after ICU admission and then initiate parenteral nutrition on day 7 if the caloric target is not being met.
4. Initiate parenteral nutrition as soon as possible after the patient’s arrival in the ICU and then start enteral nutrition once bowel sounds return.
The poll closes soon, so vote now (here).
