CLINICAL NUTRITION OF PATIENTS IN THE INTENSIVE CARE UNIT

Jedinica intenzivnog liječenja posebna je radna jedinica unutar bolnice U kojoj se liječe, njeguju i nadziru životno ugroženi bolesnici. Jedan od važnih aspekata liječenja ovih bolesnika je primjena kliničke prehrane koja će osigurati opskrbu organizma svim potrebnim nutrientima važnim za osiguranje homeostaze energetskih i drugih metaboličkih procesa. U većini slučajeva kod bolesnika na odjelu intenzivne njege postoji potreba za djelomičnom ili potpunom parenteralnom i enteralnom prehranom. Prije primjene bilo kakvog načina hranjenja potrebna je procjena bolesnikovog nutritivnog statusa te njegovog stanja s posebnim naglaskom na stanje gastrointestinalnog trakta. Ovisno u kakvom je stanju probavni sustav bolesnika ćemo odrediti enteralni ili parenteralni način prehrane. Enteralna prehrana se primjenjuje kod bolesnika koji imaju očuvan probavni trakt, ali prirodnim putem ne mogu unijeti dovoljnu količinu hrane. Enteralni pripravci se unose putem sonde ili stome direktno u želudac ili u početne dijelove tankog crijeva (dvanaesnik ili jejunum). Različite vrste nazalnih sondi (nazogastrična, nazojejunalna, nazoduodenalna) koriste se kod bolesnika kojima je kraće vrijeme indicirana enteralna prehrana, kod bolesnika kod kojih je ona indicirana duže vrijem postavljaju se, kirurški ili endoskopski, stome (gastrostoma,jejunostoma). Parenteralna prehrana opskrbljuje tijelo vodom, energetskim nutrijentima, aminokiselinama i drugim hranjivim tvarima putem krvožilnog sustava. Ako bolesnikovo stanje zahtjeva potpunu parenteralnu prehranu, bolesniku je potrebno ugraditi centralni venski kateter u jednu od većih središnjih vena, a ako mu je potrebna samo djelomična parenteralne prehrana pojedinih tvari, bolesnik potrebne nutrijente može primati perifernim venskim putem. Infekcija je česta komplikacija intravenozne primjene putem katetera, koja može dovesti i do fatalnih rezultata, te je zbog toga važno poduzeti pravodobne mjere te spriječiti infekciju na vrijeme i ne ugroziti život bolesnika. Važan aspekt primjene enteralne prehrane je održavanje tzv. crijevne barijere. Naime, i najmanje količine hrane u lumenu crijeva mogu spriječiti stanjivanje crijevne stijenke i atrofiju crijevnih resica i tako utjecati na smanjenje prijelaza bakterija iz crijevnog lumena u sustavni krvotok. Na taj način sprječavamo nastanak infekcije, sepse i drugih težih stanja u organizmu.The intensive care unit is a special work unit within the hospital that includes supervision, care, treatment and maintenance of the lives of critically ill or severely injured patients. Intensive care units (ICUs) require proper and properly applied nutrition of patients because quality nutrition and absorption of nutrients from the intestinal cavity are a prerequisite for maintaining the integrity of the organism and keeping homeostasis of all energy and metabolic processes. In most cases, patients in the intensive care unit need partial or complete enteral and/or parenteral nutrition. Before using any method of feeding, it is necessary to assess the patient's nutritional status and condition, with special emphasis on the condition of the gastrointestinal tract. Depending on the condition of the patient's digestive system, we will determine the enteral or parenteral diet. Enteral nutrition is used in patients who have a preserved digestive tract, but cannot naturally ingest a sufficient amount of food. Enteral preparations are administered by feeding tube or stoma directly into the stomach or into the initial parts of the small intestine (duodenum or jejunum). Different types of nasal probes (nasogastric, nasojejunal, nasoduodenal) are used in patients for whom enteral nutrition is indicated for a short period of time. In patients for whom it is indicated for a longer period of time surgical or endoscopic stomas are placed. Parenteral nutrition supplies the body with water, energy nutrients, amino acids and other nutrients through the circulatory system. If the patient's condition requires complete parenteral nutrition, the patient needs to have a central venous catheter inserted into one of the larger central veins and if he needs only partial parenteral nutrition of certain substances, the patient can receive the necessary nutrients peripherally. Infection is a common complication of intravenous catheters, which can lead to fatal results, so it is important to take timely measures and prevent infections in order not to endanger the patient's life. Due to the growing problem of malnutrition of patients in hospitals, today's priority goal of clinical nutrition is to maintain the integrity of the mucosa of the small and large intestine, with emphasis on feeding patients normal food with modifications or enteral preparations, if there are no absolute contraindications. Even small amounts of food in the intestinal lumen can prevent thinning of the intestinal wall and atrophy of the intestinal villi, and thus affect the reduction of the transition of bacteria from the intestine into the systemic bloodstream. In this way, we prevent the occurrence of infection, sepsis and other serious conditions in the body