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Nutritional Therapy.docx

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NURS 287
Rick Nilson

Nutritional Therapy: Patient Receiving Positive Pressure Ventilation  PPV and the hypermetabolism associated with critical illness can contribute to inadequate nutrition.  Patients likely to be without food for 3 to 5 days should have a nutritional program initiated.  Poor nutrition and the disuse of respiratory muscles contribute to decreased respiratory muscle strength.  Inadequate nutrition can delay weaning, decrease resistance to infection, and decrease the speed of recovery.  Enteral feeding via a small-bore feeding tube is the preferred method to meet caloric needs of ventilated patients.  Evidence-based guidelines regarding verification of feeding tube placement include: (1) x-ray confirmation before initial use, (2) marking and ongoing assessment of the tube’s exit site, and (3) ongoing review of routine x-rays and aspirate.  A concern regarding the nutritional support of patients receiving PPV is the carbohydrate content of the diet. o Metabolism of carbohydrates may contribute to an increase in serum CO level2 resulting in a higher required minute ventilation and an increase in WOB. o Limiting carbohydrate content in the diet may lower CO pro2uction. o The dietitian should be consulted to determine the caloric and nutrient needs of these patients. Weaning from Positive Pressure Ventilation and Extubation  Weaning is the process of reducing ventilator support and resuming spontaneous ventilation.  The weaning process differs for patients requiring short-term ventilation (up to 3 days) versus long-term ventilation (more than 3 days). o Patients requiring short-term ventilation (e.g., after cardiac surgery) will experience a linear weaning process. o Patients requiring prolonged PPV will experience a weaning process that consists of peaks and valleys.  Weaning can be viewed as consisting of three phases. The preweaning, or assessment, phase determines the patient’s ability to breathe spontaneously.  Weaning assessment parameters include criteria to assess muscle strength and endurance, and minute ventilation and rapid shallow
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