A 46-year-old female patient with class 3 (BMI > 40kg/m2) obesity has been admitted to your ICU with community-acquired pneumonia. She is sedated and ventilated with no other organ dysfunction. You are considering starting nutritional therapy.
A) A number of metabolic derangements affect fuel utilization:
c) Nutritional Regimen
High protein (anabolic) hypocaloric feeding (reduced complications from overfeeding) should be provided to the obese critically ill patient regardless of whether the route of nutrition therapy is enteral or parenteral
The spectrum of metabolic derangements present in the obese ICU patient is detailed elsewhere. In short, these are the major metabolic abnormalities one can expect from an obese patient in the ICU:
Assessment of nutritional status is also detailed elsewhere; in brief the assessment takes the shaped of a structured approach, from history to investigatons:
Nutrition for the obese ICU patient is presently a topic of hot debate. The most recent suggestions are summarised elsewhere. In short, the published consensus statements suggest we follow a certain pattern:
http://www.criticalcarenutrition.com/ is an excellent resource for all things nutrition-related.
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