11:709:364 Lecture Notes - Lecture 1: Acute Respiratory Distress Syndrome, Respiratory Quotient, Cytokine Storm
3 Aug 2020
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Risk factors: older age, male sex (higher levels of angiotensin-converting enzyme 2- Covid may use ace2 receptors to enter cell: obese (cytokine storm, cardiovascular disease/htn, diabetes/hyperglycemia. Critical predictors of mortality: cardiac troponin, myoglobin, crp, il-6. Intubated patients: hypocaloric, high protein en: overfeeding increases ventilator dependence; high respiratory quotient (rq, poor outcomes for obese patients who are overfed. Ards (acute respiratory distress syndrome): mortality increases with overfeeding: advance to 80% of goal over 1 week. Hypoxemic pulmonary failure intubation: newer approach: delay intubation with prone positioning, High vasopressor requirements to maintain hemodynamic stability: risk of feeding patients on multiple, high dose vasopressors, due to reduced blood flow to gut, don"t use fiber-containing en formula (jevity, vasopressors = norepinephrine, epinephrine, vasopressin, dopamine, phenylephrine, dobutamine. High requirements for sedatives and pain medication (for intubation, proning, agitation) Propofol (sedative) is delivered in 10% ivfe (1. 1 fat kcal/ml: >500 kcal/day from fat restrict tube feeds, hypertriglyceridemia (tg > 3000), lfts increased.
