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    Nutritional Needs With Sepsis

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    The document discusses nutritional needs for patients with sepsis. It notes that sepsis is a leading cause of death in hospitals. It then discusses how a hospital (UPH) improved outcomes for sepsis patients by streamlining their sepsis screening process and order sets. This reduced mortality and increased the number of sepsis patients who survived and days spent out of the hospital. The rest of the document outlines the metabolic response to stress in sepsis, importance of macronutrients and micronutrients, enteral vs parental nutrition, and nutritional considerations in the acute, chronic and recovery phases of sepsis.

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    Nutritional Needs With Sepsis

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    api-319236078
    236 views19 pages
    The document discusses nutritional needs for patients with sepsis. It notes that sepsis is a leading cause of death in hospitals. It then discusses how a hospital (UPH) improved outcomes for sepsis patients by streamlining their sepsis screening process and order sets. This reduced mortality and increased the number of sepsis patients who survived and days spent out of the hospital. The rest of the document outlines the metabolic response to stress in sepsis, importance of macronutrients and micronutrients, enteral vs parental nutrition, and nutritional considerations in the acute, chronic and recovery phases of sepsis.

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    The document discusses nutritional needs for patients with sepsis. It notes that sepsis is a leading cause of death in hospitals. It then discusses how a hospital (UPH) improved outcomes for sepsis patients by streamlining their sepsis screening process and order sets. This reduced mortality and increased the number of sepsis patients who survived and days spent out of the hospital. The rest of the document outlines the metabolic response to stress in sepsis, importance of macronutrients and micronutrients, enteral vs parental nutrition, and nutritional considerations in the acute, chronic and recovery phases of sepsis.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    236 views19 pages

    Nutritional Needs With Sepsis

    Uploaded by

    api-319236078
    The document discusses nutritional needs for patients with sepsis. It notes that sepsis is a leading cause of death in hospitals. It then discusses how a hospital (UPH) improved outcomes for sepsis patients by streamlining their sepsis screening process and order sets. This reduced mortality and increased the number of sepsis patients who survived and days spent out of the hospital. The rest of the document outlines the metabolic response to stress in sepsis, importance of macronutrients and micronutrients, enteral vs parental nutrition, and nutritional considerations in the acute, chronic and recovery phases of sepsis.

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    © All Rights Reserved
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    of 19

    Nutritional Needs

    with Sepsis
    Sepsis
     Leading cause of death in US hospitals
     19% of patients will be re-hospitalized within 30 days
     Mortality increases 8% for every hour treatment is delayed.
     6% of all hospitalizations are due to sepsis
     35% of all deaths in the hospital are due to sepsis

    source: Sepsis Alliance (sepsis.org)


    UPH and Sepsis
    In 2018 UPH:
     implemented a more efficient sepsis screening process
     Reduced screening from 19 questions to 2
     Revamped inpatient EPIC order set proven to decrease mortality
     Sepsis alerts improve ability to rapidly respond to patients developing
    sepsis
    From these changes:
     33 additional patients with sepsis survived
     1,227 additional days out of the hospital for patients with sepsis
     Variable cost decreased by $871 per patient with sepsis.
    Outline
     Review Metabolic Response to Stress
     Main Indicator for Sepsis
     How the Stress Response Effects Macronutrients
     Importance of Micronutrients and Replacement
     Enteral Nutrition vs Parenteral Nutrition
     Timing of Nutrition
     Acute, Chronic, and Recovery Phase
    Review
    Lactate
    Elevated levels are indicative of poor diagnosis and prognosis
    Diagnosis >4 mmol/L

     Switch to less efficient anaerobic metabolism


     Impaired organ perfusion or absence of tissue hypoperfusion
     Mortality cut in half if lactate clearance by 10% in first 6 hours
    Macronutrients
     Hyperglycemia
     Impairs ability to combat infection
     Protein Catabolism
     Altered concentrations of circulating AA
     Critically ill Pt can lose up to 1 kg lean body mass per day
     Increased Lipolysis
     Increased TAG and decreased lipoproteins
    Micronutrients
    Lower levels of micronutrients are associated with increased risk of
    death and MODS

     Selenium
     Antioxidant and anti-inflammatory properties
     Zinc
     Cellular homeostasis, immune function and response to stress
     Thiamine
     essential for aerobic nutrient metabolism
    Nutrient Replacement
     Glutamine replacement had increased hospital LOS and mortality even though
    low levels are associated with worse prognosis
     Can be added as a supplement to PN
     Omega 3 replacement resulted in increased vent days and a trend towards
    mortality (Study stopped early)
     Thiamine deficiency occurs in up to 35%of septic shock patients
     200 mg 2x/d for 1 week
     Vitamin D deficiency is linked to postoperative complications and adverse
    outcomes
     Hospital survival improved with a single dose of 540,000 IU vitamin D followed by 5
    months of maintenance doses
    EN vs PN
    Enteral Nutrition unless contraindicated -> improved outcomes, fewer infections,
    and improved gut integrity
    Recent TPN studies, no increased infection risk if balanced lipid solution

     PN can be delayed for 7 days in those who present with normal nutritional status,
    any improvements seen are likely modest
     ASPEN: any Pt at high nutrition risk/severely malnourished exclusive PN should be
    initiated as soon as possible following ICU admission if EN is not feasible
     30-50% of critically ill patients are malnourished upon admission
    Timing of Nutrition
     Pt receive trophic or full feeds in first 6 days -> no change in vent
    time, infections, mortality, or 1 year physical function
     Pt receive early PN or delayed till day 8 -> late PN was 6% more
    likely to be discharged alive from ICU/hospital, fewer infections
     Initiate PN or EN if Pt is not meeting needs by day 3 -> no change in
    ICU stay or mortality, decrease in days on vent

    In patients without baseline malnutrition, delay in full nutrition up to 6


    days is likely safe.
    Metabolic response to stress is not suppressed by feedings
    Acute Phase
    < 4 days

     Kcal 15-20 kcal/kg (or 80% of needs)


     Protein 1.0-1.2 g/kg

     10-20 kcal/hr up to 500 kcal/day for first 24-48 hours


     Advance to 80% of targeted needs
     1.2-2.0 g/kg protein
    Chronic Phase
    4 days – 2 weeks

     Kcal 25-30 kcal/kg


     Protein 1.2-2.0 g/kg
     Most ICU Pt only get .6 g pro/kg although recommended is 1.2-2.0
    Recovery Phase
    After 2 weeks – up to 2 years

     Kcal 45-60 kcal/kg


     5000 kcal/d for 6 months-2years to fully regain LBM and weight
     2.0 g/kg Protein
    After Discharge
     Patients averaged 700 kcal/day after leaving hospital
     Entire population ate < 50% of needs
     Strongly recommend all patients an oral supplement 3-12 months
    following discharge
     $1 spent on supplements saved over $52 in hospital costs
    Questions?

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