Following extubation all critically ill patients are at risk for decreased nutritional intake. What strategies might be useful in ensuring adequate nutrition in this case study?
What will be an ideal response?
Suggested response: The patient presented with pre-existing malnutrition. A low rate of enteral nutrition was provided in ICU to prevent refeeding syndrome but parenteral nutrition was not commenced so nutritional adequacy would be insufficient to meet metabolic requirements. Resumption of oral intake postextubation is a time when patients are at risk for hypocaloric intake. In this case study, the patient might have benefited from the initiation of parenteral nutrition early in the ICU admission and this could have continued postextubation. Likewise, the nasogastric tube could have remained in place to allow enteral nutrition support to continue. As futile care was determined on day 4 of ICU admission, the issue of iatrogenic malnutrition is a moot point but should be a consideration for other patients in whom ongoing medical management is not considered futile. 3
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