Nutrition of Critical Care Patients

There is often a passionate focus on specialized medical and surgical management of the critical care patients in our veterinary intensive care units. However, we often forget to consider our patients more basic needs including securing an adequate daily energy and nutrient intake.

Critical care patients are subjected to a multitude of investigative procedures such as specific blood analyzes or imaging and tissue sampling under sedation or anesthesia. in most cases the patient has to be in a fasted state and therefore the time left to nurse and feed the patient is limited.

Critically ill patients often present to us in a catabolic state. they have been inappetent or anorexic for days and the ongoing disease process or inflammation sometimes lead to a state of hypermetabolism. in these patients, the nutritional demands are increased and they will need even more intensive nutritional therapy. However, for most intensive care patients, the preceeding inappentence and fasting has resulted in a systemic accommodation and decreased physical activity resulting in a decreased metabolic rate. therefor the energy requirement of most critical care patients is often met by feeding the resting energy requirement.

The positive impact of nutrition in critical care patients has been demonstrated in both humans and animals, in dogs diagnosed with parvovirus or severe acute pancreatitis, minimal enteral nutrition in spite of continuous vomiting results in faster recovery and improved prognosis. Minimal enteral nutirition stimulate enterocyte resistance, mucus production and decrease the risk of bacterial translocation (1,2,3). [...]