Nutritional Support in the Care of the Adult with Critical Illness, Third Edition

The metabolic alterations resulting from trauma and other severe injuries are well recognized. This response is characterized by an increase in protein catabolism which outstrips the concomitant increase in synthesis. The result is net overall catabolism with degradation of muscle and fat mass. In addition, gluconeogenesis and lipolysis are accelerated, and oxidation of mixed carbon sources — including glucose, amino acids, and fatty acids of all chain lengths — occurs to satisfy increased energy demands. Endocrine changes are characterized by increased plasma concentrations of glucagon, cortisol, and catecholamines driving catabolism. Catabolism is also favored by the induction of inflammatory mediators, such as interleukins 1 and 6 and tumor necrosis factor.1

The importance of providing nutritional support early in the course of traumatic injury and critical illness has been demonstrated over the past 30 years. Although nutritional support cannot prevent the catabolism found in such conditions, it can attenuate the process if administered judiciously and appropriately managed. It has become clear that early feeding, particularly enteral feeding may be associated with fewer infections, shorter hospital stays, and reduced hospital charges. In addition, it has also become clear that blood glucose regulation is of paramount importance when providing nutrition, particularly parenteral nutrition. Finally, “specialized” nutrients and agents may be administered (e.g., glutamine, arginine, oxandrolone, antioxidants and certain fatty acids), which further modify the metabolic response to injury and possibly aid in the recovery process.

The foundation for modern-day nutrition support will be discussed first by reviewing the metabolic response to starvation and injury. Subsequently, nutritional assessment of the patient and developing a comprehensive nutrition plan will be detailed. Finally, adjuncts to nutrition support and handling nutrition-related complications will be discussed.

This continuing education activity is designed to help you earn 12.0 continuing education credits for dietetics (CDR CPEU).

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    Learning Objectives

    After completing this activity, nutrition professionals will better be able to:

    1. Differentiate between the metabolic response to critical illness and starvation.
    2. Predict energy and protein requirements of adults with critical illness.
    3. Predict potential complications of nutritional support in adults with critical illness.
    4. Recognize different feeding strategies for various metabolic profiles in adults with critical illness.
    5. Incorporate the use of specialized nutritional agents in adults with critical illness.

    Additional Information

    CDR Activity Type: 
    102
    CPE Level: 
    2
    Course summary
    Available credit: 
    • 12.00 CDR
    Course opens: 
    01/16/2025
    Course expires: 
    01/15/2028
    Cost:
    $115.95
    Rating: 
    0

    Kris M. Mogensen, MS, RD-AP, LDN, CNSC, is a registered dietitian with a Master of Science degree in human nutrition from Framingham State University. She has over 30 years of experience in clinical nutrition and managing patients who are critically ill. She currently is a Team Leader Dietitian Specialist at Brigham and Women’s Hospital, Boston, MA. Kris has co-authored numerous articles in professional journals, textbook chapters, and professional manuals and conducts research evaluating the impact of malnutrition on clinical outcomes in adults with critical illness. She lectures nationally and internationally on nutrition support and medical nutrition therapy.

    Kris serves as the Secretary/Treasurer on the ASPEN Board of Directors and is past Chair of the ASPEN Malnutrition Committee and ASPEN Clinical Practice Committee. She serves as a peer reviewer for a number of journals including Nutrition in Clinical Practice and the Journal of Parenteral and Enteral Nutrition (JPEN).

    Disclosures:

    Kris M. Mogensen, MS, RD-AP, LDN, CNSC, faculty for this activity, has the following relevant financial relationship(s) with ineligible companies to disclose: she is an advisory board member for American Regent. All relevant financial relationships listed for this individual have been mitigated.

    The planners for this educational activity have no relevant financial relationship(s) with ineligible companies to disclose.

    An “ineligible company” includes any entity whose primary business is producing, marketing, selling, re-selling, or distributing healthcare products used by or on patients.

    In support of improving patient care, Great Valley Publishing Company (publisher of Wolf Rinke Associates) is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.

    This activity will also award credit for dietetics (CDR CPEU).

    RDs and DTRs are to select activity type 102 in their Activity Log. Sphere and Competency selection is at the learner’s discretion.

    Available Credit

    • 12.00 CDR

    Price

    Cost:
    $115.95
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