Supportive and Preventive Medicine
2005;33:1225-9).
Element
Importance
Considerations
Feeding
Malnutrition can lead to
impaired immune function,
in turn leading to increased
susceptibility to infection,
inadequate wound healing,
bacterial overgrowth in the GI
tract, and increased propensity
for decubitus ulcers
| β’ | Initiate enteral feeding (preferred to parenteral nutrition) |
|---|
as soon as possible, typically within the first 24β48 hr
after stabilization
| β’ | (See Fluids, Electrolytes, Acid-Based Disorders, and |
|---|
Nutrition Support chapter for a more in-depth review)
Analgesia
Analgesic and sedative
administration optimizes
patient comfort and minimizes
the acute stress response
(hypermetabolism, increased
oxygen consumption,
hypercoagulability, and
alterations in immune function)
| β’ | Pain should regularly be assessed with a validated tool |
|---|
such as the Behavioral Pain Scale (BPS) or the Critical-
Care Pain Observation Tool (CPOT)
| β’ | Preemptive analgesia should be considered for invasive |
|---|
or potentially painful clinical procedures
| β’ | (See Management of Pain, Agitation, and |
|---|
Patients chapter for a more in-depth review)
Sedation
| β’ | Sedation should be assessed and reassessed with a |
|---|
validated tool such as the Richmond Agitation-Sedation
Scale (RASS) or the Sedation Agitation Scale (SAS)
| β’ | Maintain light levels of sedation unless the patient has |
|---|
an indication for deep sedation, such as neuromuscular
blockade
| β’ | If appropriate, execute daily sedative interruption |
|---|---|
| β’ | (See Management of Pain, Agitation, and |
Patients chapter for a more in-depth review)
Thromboembolic
prophylaxis
Most ICU patients have at least
one risk factor for VTE
| β’ | Initiate appropriate prophylaxis, considering VTE and |
|---|
bleeding risks
| β’ | Mechanical prophylaxis (graduated compression |
|---|
stockings or intermittent pneumatic compression
devices) is an alternative nonpharmacologic option in
patients at high risk of bleeding
Head of bed
elevation
Elevating the head and thorax
above bed to a 30β45 degree
angle reduces the occurrence
of GI reflux and nosocomial
pneumonia in patients who are
receiving mechanical ventilation
| β’ | Where appropriate, ensure patient position periodically |
|---|
throughout the day, especially after procedures that
require the patient to lie flat