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Nutrition

ASPEN guidelines for nutrition in Adult Critically Ill Patients 2016

Guidelines from the Society of Critical Care Medicine (SCCM) and the American Society of Parental and Enteral Nutrition (ASPEN) in the assessment and provision of nutrition on ITU. This is quite a long document but usefully has questions and answers/recommendations in bold and the quality of evidence e.g. level 1 or expert consensus. I would certainly read the highlights if exploring nutrition in ICU

NICE Guidance CG32: Nutrition Support In Adults (2017/2006)

NICE Guidance CG32: Nutrition Support In Adults updated 2017 from original in 2006 (online version). Not specific to critical care, so you don't need to read all of it, but an essential mention in answering a question about nutrition support.

 

It defines which patients are malnourished and those at risk of malnutrition in which nutrition support should be considered. It defines those at risk of refeeding syndrome and how to manage this. It also provides guidance on when to consider TPN. 

Malnourished (any of the following)

  • BMI < 18.5 

  • unintentional weight loss > 10% within last 3–6 months

  • BMI <20 and unintentional weight loss > 5% within 3–6m  

 

At risk of malnutrition

  • Eaten little or nothing for more than 5 days and/or are likely to eat little or nothing for 5 days or longer

  • A poor absorptive capacity and/or high nutrient losses and/or increased nutritional needs from causes such as catabolism. 

Never Events and Patient Safety Alerts regarding safe NG placement

Unrecognised misplaced NG tubes in the lung with subsequent initiation of feeding, flushing or medicines constitutes a Never event in the NHS.

 

An understanding of the latest Never Event list and the common problems of NG placement and the national patient safety guidance on the topic would fit within curriculum domain 11.4: minimising the risk of critical incidents. 

See safety alert here and here and here

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