Perioperative

Nutrition
in Sepsis
S ITH A CHRI S TIN E, DR.

PEMBIMBING:
D R . N U R H AYAT U S M A N , S P B - K B D
Metabolism in Sepsis
Sepsis, trauma, surgery inflammation and oxidative
stress
Systemic ROS imbalance damage cell membranes,
enzymes, mitochondria, and DNA metabolic
derangements: catabolism, insulin resistance, systemic
acidosis, coagulopathy.
Malnutrition
Calculating Energy
Requirements
Resting energy requirements vary between individuals
Traditional biochemical indices: albumin, prealbumin,
transferrin -> not valid in ICU settings
Weight-based estimates:
20-40 kcal/kg/day (1,5-2 g/kg/day protein)
Obesity: 11-14 kcal/kg/day actual body weight
BMI >50 : 22-25 kcal/kg/day ideal body weight
NUTRIC score:
Nutrition Risk in Critically ill
nutrition therapy is
optimized by the use of
multidisciplinary nutrition
support teams, dietitians
and nurse-driven protocols
Enteral Nutrition (EN)
Preferred primary nutrition therapy
Risk: gut ischemia, vomiting, aspiration pneumonia
(distension, diarrhea, acidosis)
To prevent: head elevation, oropharyngeal decontamination,
continuous feeding
Be cautious in patients with persistent hypotension,
vasopressor use risk for gut ischemia
Continuous 10-20 cc/h
Target 80% caloric requirement
Parenteral Nutrition (PN)
Only initiated after trial of all enteral routes
PN decreases immune function, increase risk of infection,
prolong hospital LOS compared to EN
PN should be considered in patients with absolute or
relativecontraindications for EN, or for those who are EN
intolerant.
PN (either exclusive or supplemental) is contraindicated
in patients who are in the acute phases of sepsis or septic
shock.
Immunonutrition
Administration of enteral formulas, which reduce
oxidation and inflammation and improve immune
function.
Antioxidants and vitamins (vitamin C, E, zinc, and selenium)
Formulations containing arginine and omega-3 fatty acids are
thought to reverse T-cell suppression and decrease
inflammation.
Conclusion
Septic and surgical patients: vulnerable to the effects of
catabolism, mounting energy debt, prolonged starvation,
and malnutrition.
Tools to evaluate nutrition status: limited
Preferred therapy: EN
Thank You
References
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