VETTECH U 2024 / HOUSTON, TX
LIFELINES: THE CRITICAL ROLE OF TUBE FEEDING KARA M. BURNS, MS, MEd, LVT, VTS (NUTRITION) PRESIDENT, PET NUTRITION ALLIANCE
Sponsored by
SATURDAY AM • SEPTEMBER 21 10:30 – 11:45 AM
WHAT PATIENTS SHOULD BE FED? In the past, nutritional support was not considered necessary until animals had inadequate intake for 10 days. This concept currently is outdated and unfounded. Evidence suggests a more appropriate goal in most cases is to initiate nutritional support within 3 days of hospitalization (at the latest). 3-5 Evaluating nutritional status may be challenging for healthcare team members. Historical weight loss may provide some evidence of inadequate intake and body condition scoring may be helpful to assess fat loss but is not as sensitive for muscle wasting. Laboratory abnormalities may not be present or may be nonspecific. Because of the limitations in assessing nutritional status, early risk factors must be identified that predispose patients to malnutrition. The risk factors to consider are: • History of inadequate nutritional intake lasting more than 5 days. • Serious underlying disease (e.g., severe trauma, sepsis, peritonitis, acute pancreatitis, major gastrointestinal surgery). • Large protein losses (e.g., protracted vomiting, diarrhea, protein-losing nephropathies, draining wounds, burns).
Nutritional support of critically ill patients has historically been considered a supportive measure of low priority. However, advances in both human and veterinary medicine have demonstrated that nutritional support is an important therapeutic modality and can aid in the management of diseases. In diseased states, the inflammatory response triggers alterations in cytokines and hormone concentrations and shifts metabolism toward a catabolic state. 1 With insufficient food intake, the predominant energy source is derived from accelerated proteolysis, which is an energy-consuming process. Thus, critically ill animals may preserve fat deposits in the face of lean muscle tissue loss. 1 The goal of nutritional support in these catabolic patients is to feed the catabolism with exogenous sources of protein and fat thus sparing endogenous protein that is critical to recovery. Malnutrition in veterinary patients is believed to increase morbidity and mortality. 2,3 In the GI tract, transit times increase, absorptive capabilities decrease, villous atrophy occurs, and there is an increased risk of bacterial translocation. In the kidneys, excretion of urinary calcium and phosphorus increases, ability to excrete acid decreases, gluconeogenesis increases, and glomerular filtration rate decreases. Malnutrition has been documented to decrease humoral immunity and barrier function (skin and mucosal surfaces), inflammatory response, leukocyte motility, and bactericidal activity. Patients are at risk for pulmonary complications as a result of decreased response to hypoxia, decreased lung elasticity, and secretion production, altered permeability and decreased tidal volume. Cardiovascular complications include increased incidence of arrhythmias and decreased weight of the heart muscle. Protein malnutrition may also alter the normal or expected metabolism of certain drugs, which may increase or decrease their therapeutic effect even when given at recommended dosages.
Patients with these risk factors are candidates for nutritional support.
As with any intervention in critically ill animals, nutritional support may pose some risk. The risk of complications increases with disease severity. To minimize risks, patients must be cardiovascularly stable before nutritional support begins. If the patient is found to be in shock, perfusion of the gastrointestinal tract is reduced in favor of maintaining adequate perfusion of heart, brain, and lungs.3,5 With reduced perfusion, processes such as gastrointestinal motility, digestion, and nutrient assimilation
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SEPTEMBER 20-22, 2024 | PROCEEDINGS | VETGIRLONTHERUN.COM
VETTECH U
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