Critical Illness

CI: Benefits and Risks/Harms of Implementation (2006)

Benefits and Risks/Harms of Implementing the Recommendations

Safety issues should be considered for each form of treatment recommended. A description of the general benefits and risk associated with the implementation of this guideline must be addressed.
 
To view more information, select the link to the topic listed after each potential benefit/harm.

Potential Benefits

Risk/Harm Considerations

Factors to consider when exploring treatment options include:

  • The use of immune-enhancing EN in severely ill patients may be associated with increased mortality (Immune-Enhancing Enteral Nutrition)
  • Patients admitted to the ICU should be fluid-resuscitated before early EN is attempted (Timing of Enteral Nutrition)
  • Blue dye, in excessive doses or used in patients with increased gut permeability, may increase mortality and the risks of the use of blue dye in EN outweigh the benefits. Use of blue dye in EN should be abandoned (Blue Dye Use)
  • Feeding patients in a medical ICU or surgical patients with obesity, more than 70% of estimated goal for nutrition support may be associated with less positive outcomes (Monitoring Delivery of Energy)
  • Serum glucose levels over 140mg/dL are associated with increased mortality in critically ill patients (Glucose Control: Blood Glucose Control).

Factors to consider when exploring the use of indirect calorimetry to measure RMR are below (1) (Determination of Resting Metabolic Rate)

  • Some patients may experience anxiety or claustrophobia with some gas collection devices, resulting in artificially high RMR measures. In this case, a different device should be used or the patient should not be measured.
  • Patients with severe malnutrition risk inadequate nutritional repletion by long fasts. Patients with IDDM risk hypoglycemia with longer fasts.
  • The time needed for rest extends the time invested in obtaining the measures.

References

  1. American Association for Respiratory Care (AARC). Metabolic measurement using indirect calorimetry during mechanical ventilation. Clinical practice guidelines. Respir Care. 1994; 39 (12): 1, 170-1, 175.

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