Nutrition in polytraumatized patients
Polyitrauma is a set of injuries presented by the same action, this occurs in normally healthy patients and with a good state of health, but, although it happens in this way the originated metabolic changes make the patient can enter into a severe nutritional risk
Through studies carried out, it has been detected that in the nutrition of polytraumatized patients, several aspects should be considered one of them is to assess the risk presented in the patient (surgical risk) .This risk patients who have a weight loss of more than 10% and those who have a decrease in visceral protein due to albumin or other disorders, when a patient is well nourished, it can support up to a week without feeding without having to have nutritional support
Nutrition in polytraumatized patients
When a patient has polytrauma has a high nutritional risk and metabolic alterations, so it is very important to be valued in order to identify if requires nutritional assessment in addition to nutritional support; This should begin when the patient is not covering their nutritional requirements by oral route at a period of 5-10 days after having entered
Energy requirements
Through studies it has been detected that a patient of this type is in a hypermetabolic situation by increasing their energy expend
When a patient has a spinal trauma that includes paraplegia or tetraplexia unlike other trauma it causes the patient to have a decrease in caloric expenditure
The optimal caloric needs for this type of patients are 1.4-1.6 multiplied by the result of the Harris Benedict equation or can be a fixed amount estimated 25-30 kcal/kg/day and in patients who are presented in barbiturate coma or with some spinal cord lesion you must calculate with an 85- 100 of the value of Harris Benedict or 20-22 kcal/kg/day
Due to the hypercatabolism situation, these patients require an increase in protein, so the protein should provide at least 15% of total calories although the appropriate amount is 20% while nitrogen grams must be 80: 1 120: 1, carbohydrates are located at 4 mg/kg, insulin supply to maintain blood glucose below 110 mg/dl is also recommended
Preferable ways for nutrient contribution
As in any pathology the most recommended nutrition is enteral nutrition, it must always be the first to be considered, the enteral approach must be applied as soon as possible but when the patient requires surgery, it would be very important to apply the nutrition probe During surgery or insertion of naso-enteral probe or gastrostomy probe in addition to properly carrying the use of drugs to achieve effective nutrition
In unstable hemodynamic patients, the presence of enteral nutrition intolerance is common because large amounts of gastric waste can be presented in addition to bronco aspiration so it is preferable to use jejunostomy or nasogastroyunal probe
Another problem that can occur in this type of patients is the early parenteral food use presenting an inappropriate supply of nutrients (proteins, fats, carbohydrates and vitamins)
The ideal is to apply parenteral nutrition only when I do not have access to parenteral feed right way.
recommendations
- Enteral nutrition should always be the first option as a food method.
- The energy expenditure requirement must always be presented through indirect calorimetry.
- The nutritional contribution must be hyperproteic due to the patient’s situation.
- Only in the event that the patient presents an intolerance to enteral nutrition or that the necessary requirements are not covered.
Parenteral nutrition is not indicated for patients presenting a traumatic aggression of mild intensity.
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