third week of june in the MICU (read: mick-you)

after six weeks in peds, i returned from camp to begin my first week of adults rotations in the MICU. pretty intense.

the MICU (Medical Intensive Care Unit) is a section of the hospital dedicated to providing critical care services to adults with major organ failures (heart, lungs, liver, kidneys, etc.) or with multi-system failures. “critical care” basically means around the clock, comprehensive supervision.

MICU patients often present with (come to the hospital with) respiratory failure, sepsis (massive infection), shock (extremely decreased blood pressure that reduces blood flow throughout the body), hemorrhage, renal (kidney) failure, liver failure, neurological illnesses, and multi-system organ failure.

so, how do dietitians fit in? the MICU RD makes nutrition recommendations (deciding whether or not to feed, what to feed, and at what rate one should feed a patient) based on a patient’s day-to-day, and often hour-to-hour, respiratory and hemodynamic status (read: how are they breathing and what are their blood tests telling us about their nutrition status?) while also keeping in mind the patient’s medications, treatments, past medical history, etc.

nutritional needs change based on what types of treatments patients are receiving. for example, patients that are intubated with mechanical ventilation (breathing with the aid of a machine) have decreased energy needs because the machine is doing most, if not all, of the work of breathing. in plain english: they may require less calories to do the day-to-day work of living.

deciding when and if to feed a MICU patient is tricky business. in peds, the RD is constantly trying to prevent weight loss so as to protect the child’s overall growth. in pediatric malnutrition (when a child isn’t receiving enough nutrients to promote growth), weight loss occurs first, then a child stops growing (length ceases), then brain growth (or head circumference) declines. scary stuff.

in adults, one goal is to protect lean body mass, or provide enough calories, protein, and fluid so the patient doesn’t begin to break down her own endogenous sources of protein (i.e., break down muscles like the heart or the diaphragm for energy).

in our hospital, adult patients are “flagged” once they have been NPO (nil per os, or nothing by mouth, or they haven’t had anything to eat or drink) for longer than three days. enteral nutrition (via a tube) or parenteral nutrition (via the veins) are both options for nutrition support if the patient is unable to take anything by mouth. once the route of nutrition is decided, the RD must choose a formula with adequate and appropriate amounts of calories, protein, electrolytes, fat, fluid, and in some cases, carbohydrate.

i’ll try to find an interesting MICU case i worked on, as it’s a pretty daunting task to try to describe the inner workings of the MICU, or the nutritional needs of the critically ill, in laymen’s terms without an example.

more to come!