Abbott Company Sponsored Workshop on ""Managing the Critically ill: Can Nutrition play a significant role in improving outcomes?" by Dr. Ashwin Dabhi, Counseling and Consulting Physician in Metabolic and Nutritional Disorder, Sujivan Hospital, Ahmedabad,

“A slender and restricted diet is always dangerous not only in chronic

diseases but also in acute diseases.” Hippoctates 400B.C. Nutrition support

in critically ill is obligatory and least prioritized till date in this part of world. But

there has been a revolutionary change across the globe in last few years

since nutrition care is an essential and integral part of first line ICU protocol.

Nutrition care in the ICU presents several challenges because the usual

control mechanisms such as hunger and thirst may be missing. Despite the

huge body of evidence that Nutrition support is essential in ICU we face lots

of impediments to provide early and optimal Nutrition support. Throughout

ICU course patients and attending doctors faces cascades of challenges which more complicates the already fragile issues relating demands Vs. supply. Now a days it is not

uncommon to encounter patients who spend days and months in ICU struggling multidisciplinary

approaches. Most of well designed studies have suggested that both under and over feedings are

dangerous in critically ill hence the need to develop nutrition care plan which should be dynamic and

flexible enough to take care of all subsequent challenges.

Nutrition screening and assessment

The first step in providing appropriate nutrition therapy is to identify patients at risk and diagnose

nutritional problems. Nutritional screening and assessment are fundamental to an effective nutrition

therapy program. These should be routinely undertaken by appropriately trained and skilled nutrition

specialist. Screening and assessment have similar goals: to identify patients at risk of malnutrition or

patients who are malnourished. The first step in identifying risk factors for malnutrition is to observe

and interview patients. Questions that are commonly asked during screening should be easy and

include information about body weight changes within a given time frame and amount of oral intake .

By consensus and validations there is an urgent need to roll down our own assessment tool with an

Indian perspective.

Nutrition support

There are lots of myths about Nutrition support in ICU such as bowel sounds are absent , large

gastric residuals , diarrhea , proteins are restricted in ARF and so on. There are plenty of unmet

needs and there is an urgent need to change the dogmatic picture. Many a times critically ill patients

receive even less than half of the actual caloric needs.

Since there is no true biomarker of adequacy of nutritional status we solely rely on tools and

clinical skills. There is no doubt that starvations is bad for both community dwellers and critically

ill patients.Even well nourished critically ill patients passes through cascades of metabolic and

immunological events which ultimately affects host defense and both short and long term

outcome.

“ We can’t solve problems by using same kind of thinking we used them when we created them.”

- Albert Einstein

Done