CRITICAL CARE
Nutritional
Support for
Critically Ill
Patients
Dr Mirinda van Schoor BVSc(Hons), MMedVet(Med) [email protected]
Edited: Dr L.L. van der Merwe
The five standardised vital signs which are now considered to make up part of the clinical
examination now include temperature, pulse, respiration, pain assessment as well as nutritional assessment.
Detailed descriptions of nutritional assessment guidelines are available as part of a nutrition toolkit published on the WSAVA website (www.wsava.org/nutrition) by the WSAVA Global Nutrition Community.
Apart from obtaining a thorough nutrition history, animals should be weighed on a daily basis and additional parameters such as body condition score, muscle
condition score, serum proteins and serum electrolytes are assessed depending on the case.10 The nutritional plan should be evaluated daily and adjusted according to the patient’s changing needs. A very useful
WSAVA monitoring sheet is available for adaptation /
use in the hospital.10
Assisted feeding using feeding tubes can improve outcome and decrease duration of hospitalisation in critically ill dogs and cats.
Providing resting energy requirements (RER) will prevent the deleterious effects of malnutrition. It is easy
to implement and needs to be considered as part of
the therapeutic plan in small animal patients. Yet , despite the benefits of nutritional support of ill animals,
this aspect is often ignored or delayed. The veterinarian is focused on the medical or surgical condition
alone rather than the patient as a whole.
vet360
Issue 06 | DECEMBER 2015 | 30
Rationale for implementing nutrition in a critically ill
patient
It is widely accepted and makes clinical sense that feeding patients with critical illnesses will be of benefit to
them and aid in their recovery. Documented effects
of malnutrition include alterations in energy and substrate metabolism, compromised immune function and
delayed wound healing.3 A 2010 study concluded that
energy supply, even when only supplying levels close
to resting requirements, was positively associated with
recovery.2
It has been demonstrated that healthy animals which
suffer malnutrition mainly metabolise and lose fat. This
is known as “simple starvation”.3 Injured or sick animals
will mainly metabolise lean body (muscle) mass if malnourished and this is known as "stressed starvation" and
results from an elevation in catecholamines, glucocorticoids and glucagon as well as peripheral insulin resistance.3 Stressed starvation is the reason why critical care
clinicians advocate early enteral nutrition.
The Nutritional Plan
When patients are not consuming adequate calories to
supply the body with energy, the clinician will have to
make a decision as to whether or not to feed the patient