Critical Care Nutrition - Practice Management Guidelines - Vanderbilt University Medical Center TICU, SICU, NCU, BICU - Revised: 11/2004

Oct 4, 2026

Uploaded by Aria

Critical Care Nutrition practice management guidelines for Vanderbilt University Medical Center (TICU, SICU, NCU, BICU) address aggressive early nutrition in severely injured or surgical critical care patients. The document explains how stress and injury drive hypermetabolism, mobilizing amino acids for wound healing, immune response, and accelerated protein synthesis. It evaluates delivery routes, emphasizing benefits and risks of early enteral feeding, and integrates nutrition support with stress gastritis prophylaxis and intensive glucose/insulin management. It further outlines protocolized approaches for total parenteral nutrition and related monitoring requirements.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages44

Reading Time1 h 51 min

AccessFree to download

Statement of the Problem

Scope and Purpose

Practice Management Principles

Contents

Total Parenteral Nutrition

Total Enteral Nutrition

ICU Glucose Management & Intense Insulin Therapy

Nutritional Supplements in Critical Care

Stress Gastritis Prophylaxis

Addendum

References

Critical Care Nutrition Practice Management Guidelines Vanderbilt University Medical Center TICU, SICU, NCU, BICU Revised: 11//2004 STATEMENT OF THE PROBLEM The metabolic response to stress, surgical or traumatic injury mobilizes amino acids from lean tissues to support wound healing, immunologic response and accelerated protein synthesis. The goal of aggressive early nutrition is to maintain host defenses by supporting this hypermetabolism and preserve lean body mass. The route of nutrient administration affects these responses, and the benefits of early enteral feeding have been clearly shown. Laboratory and clinical studies reveal beneficial affects of early nutrition on the gut mucosa, immunologic integrity, survival of septic peritonitis, pneumonia, and abscess formation. Therefore the question arises as to the route to deliver nutrition to the surgical or traumatized hypermetabolic patient with multisystem injuries including severe head injuries, burns, and blunt and penetrating mechanisms. There are certainly risks and benefits to enteral and parenteral nutrition in this complicated patient population. The purpose of this review is to determine the benefits and the risks ofthe route of nutrition in the severely injured patient through peer reviewed publications over the past 25 years and to develop recommendations and guidelines from the conclusions of these studies based on the scientific methodology of these studies. In the management of the critical care patient it is very difficult to outline any one factor in the over all care of the patient. This is easily demonstrated with nutrition support. When reviewing nutrition support of the critically ill patient the timing, route of administration, formula selection, and monitoring all must be considered. As such, evidence also has demonstrated that management of stress gastritis prophylaxis overlaps the management of nutrition support and must be considered together. With in the past 4 years, EBM has demonstrated the critical importance of intense glucose / insulin management and the improved outcomes. It is clear nutrition support, and glucose management must be managed together. The group has brought 4 protocols together and overlapped them. There are basic principles for very critical care patient on a surgical service, as well as some very important exceptions as well. These will be addressed. Jose J. Diaz, MD, CNS Robert Pousman, MD Beth Mills, MS, RD, CNSD Jeff Binkley, PharmD, BCNSP P.J. O’Neill, PhD, MD Gordon Jensen, PhD, MD Critical Care Nutrition Practice Management Guidelines Vanderbilt University Medical Center TICU, SICU, NCU, BICU Revised: 11//2004 Contents: Authors 1. Flow Diagram 2. Total Parental Nutrition 3. Total Enteral Nutrition a. Gastric Residual Volume Protocol 4. ICU Glucose Management & Intense Insulin Therapy 5. Nutritional Supplements in Critical Care 6. Stress Gastritis Prophylaxis 7. Addendum a. EAST Recommendations for Trauma b. ASPEN Recommendations 8. References Diaz, Pousman, Jensen Diaz, Mills, Binkley Pousman, Diaz, Mills O’Neill, May, Miller Diaz, Mills O’ Neill Disclaimer: These protocols have been developed to assist in the decision-making processes for patient management in the intensive care units at Vanderbilt University Hospital. In no way are they intended to substitute for the independent clinical judgment of the treating physicians and staff. They have been prepared with the expectation that departure from the guidelines is appropriate at the discretion of the physician, based on each individual patient's condition and the attendant circumstances Critical Care Nutrition Practice Management Guidelines Vanderbilt University Medical Center TICU, SICU, NCU, BICU Revised: 11//2004 1. Flow Diagram Critical Care Nutrition Practice Management Guidelines Vanderbilt University Medical Center TICU, SICU, NCU, BICU Revised: 11//2004 Critical Care Nutrition Pra

FAQs

How is total parenteral nutrition (TPN) selected and managed?

TPN is used when patients cannot use the gut at goal feeds within 5 days. It specifies IV access requirements, formula selection, nutritional estimates (including IBW calculations and calorie/protein targets), and monitoring such as labs and metabolic cart use for patients on TPN beyond two weeks.

Oct 4, 2026

Uploaded by Aria