Pn algorithm
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1) The document provides guidelines for administering parenteral nutrition (PN) to critically ill patients in the ICU. 2) It outlines strategies to maximize enteral nutrition (EN) before using PN, such as implementing a feeding protocol and using prokinetics to increase EN tolerance. 3) If EN is not possible, it recommends providing hypocaloric PN without IV lipids, or low dose EN with IV glutamine to improve outcomes.
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Pn algorithm
- 1. PN to be delivered <10 days and patient well-nourished? 1) Provide hypocaloric PN♦ . 2) Withhold IV lipids♦ . 1) Provide required energy level. 2) Provide IV lipids. All strategies to maximize EN implemented? (e.g. protocol outlining acceptable gastric residual volume of 250 ml; prokinetic(s)* provided; small bowel feeding tube placed). 1) Implement strategies as noted above. 2) Increase EN to goal rate as tolerated. 1) Provide low dose EN*. 2) Provide IV glutamine♦ . If IV N/A consider enteral glutamine (0.25 gm/kg/day - 0.5 gm/kg/day mixed in 50 ml saline; delivered in divided doses). ICU GUIDELINE: PARENTERAL NUTRITION (PN) Yes No Formatted by: J. Greenwood, RD. for CCN. Update 7/4/2010 www.criticalcarenutrition.com NoYes ♦In critically ill patients hyperglycemia should be avoided (blood sugar > 10 mmol/L). Target blood glucose 8.0 mmol/L (7.0 – 9.0 mmol/L) * Unless contraindicated ♦ Evidence-based recommendation; all other information opinion-based.