Multiprofessional Critical Care Review: Pediatric (2023)-Nutritional Support

Video Transcription

Video Summary

In this video, Dr. Katri Tippo discusses nutritional therapy in pediatric critical care. She explains the metabolic stress response in critically ill children, which includes adaptations such as lipolysis and ketone production, muscle protein breakdown, and glycolysis. These adaptations can lead to negative consequences such as increased triglycerides, essential fatty acid deficiency, decreased nutrient transport proteins, and impaired wound healing. Dr. Tippo emphasizes the importance of protein balance and the challenge of providing adequate protein intake in the pediatric intensive care unit (PICU). She also discusses the estimation of energy expenditure, highlighting the limitations of equation-estimated resting energy expenditure and the importance of indirect calorimetry. Dr. Tippo discusses malnutrition in the PICU, noting that many patients acquire malnutrition during their stay. She highlights the complexity of nutritional assessment in the ICU, as traditional methods may be confounded by factors such as edema or inflammation. Dr. Tippo provides practical approaches to bedside nutrient delivery, including implementing a stepwise nutrition delivery algorithm and the use of gastric feeds when possible. She also discusses the role of parenteral nutrition and the importance of avoiding overfeeding. Lastly, Dr. Tippo touches on non-nutritional strategies to prevent muscle wasting, such as early mobilization and physical therapy.

Keywords

nutritional therapy

pediatric critical care

metabolic stress response

lipolysis

ketone production

muscle protein breakdown

glycolysis

triglycerides

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