Mr. X is a 49-year-old African-American male admitted to a telemetry unit with acute hypoxic respiratory failure due to pneumonia. On arrival, he is orally intubated and mechanically ventilated.
His vital signs are as follows: BP 112/62, HR 124, RR 18, Temp 102.6.
Ventilator settings are: TV 700, AC mode at rate of 18/min, FiO 280%, PEEP of 8 cm H2O.
History of present illness: He has been experiencing increased shortness of breath with a productive cough for the past 3 days. He has not eaten much for the past 4-5 days due to nausea and vomiting. He smokes one pack of cigarettes per day, and has a history of alcohol abuse. His breath smells strongly of alcohol on admission.
1. What is Mr. X's expected metabolic response to his critical illness?
2. Can nutrition support improve his outcomes? If yes, how?
3. What are the consequences of malnutrition in this patient?
4. Mr. X's nitrogen requirement is 0.8-1 gram of protein/day based on a 25 kcal/kg/day estimation of caloric requirement. What modes of delivery are preferred for his nutrition? Why?
5. A small-bore feeding tube is placed. Enteral nutrition is ordered. Are there contraindications to enteral nutrition?
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