Nutritional support for critical ill patients

There are a number of reasons for critically ill animals to be at high risk for becoming malnourished. Moreover, critically ill animals undergo several metabolic alterations that further increase this risk for malnutrition. The risk of malnutrition in this patient population relates to inadequate food intake because it is not uncommon for inappetence to be one of the main clinical problems in animals requiring medical care. Animals are frequently presented to veterinarians for loss of appetite, an inability to tolerate feedings, and persistent vomiting, or diarrhoea that accompanies many disease processes. Because malnutrition can occur quickly in these animals, it is vital that we identify animals at risk for malnutrition, and initiate early nutritional support for these patients. The goals of nutritional support are to treat malnutrition when present and, just as important, to prevent malnutrition from developing in patients at risk. 

Whenever possible, the enteral route should be used because it is the safest, most convenient, and most physiologically sound method of nutritional support. Ensuring the successful nutritional management of critically ill patients involves selecting the right patient, making an appropriate nutritional assessment, and implementing a feasible and effective nutritional plan. 

This clinical review aims to clarify the consequence of inadequate nutritional intake and provide guidance for initiating effective nutritional supportive measures. By improving the way we support patients with nutrition, we can ensure they have the best chance for making successful recoveries.

Daniel L. Chan, DVM, DACVECC, DECVECC, DACVN, FHEA, MRCVS

Table of content:

- Introduction 
- Importance of Nutritional Support
- Pathophysiology of Malnutrition
- Nutritional Assessment
- When to initiate feeding
- Choosing the most appropriate feeding tube
- Placement of feeding tubes 
- Meeting Nutritional Needs and Special Considerations 
- Nutritional Plan
- Implementing Nutritional Plan
- Monitoring and Reassessment
- Complications
- Conclusions

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