sofa score apache ii score nrs2002
TRANSCRIPT
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SOFA scoreAPACHE II score
NRS2002
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APACHE II
• APACHE II ("Acute Physiology and Chronic Health Evaluation II") is a severity-of-disease classification system. one of several ICU scoring systems.
• It is applied within 24 hours of admission of a patient to an intensive care unit (ICU): an integer score from 0 to 71 is computed based on several measurements; higher scores correspond to more severe disease and a higher risk of death.
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SOFA score
• Sequential Organ Failure Assessment score (SOFA score), is used to track a person's status during the stay in an intensive care unit (ICU). It is one of several ICU scoring systems.
• The SOFA score is a scoring system to determine the extent of a person's organ function or rate of failure.
• The score is based on six different scores, one each for the respiratory, cardiovascular, hepatic, coagulation, renal and neurological systems.
• An increase in SOFA score during the first 24 to 48 hours in the ICU predicts a mortality. Scores less than 9 give predictive mortality at 33% while above 11 can be close to or above 95%
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Respiratory system
PaO2/FiO2 (mmHg) SOFA score
< 400 1
< 300 2
< 200 and mechanically ventilated 3
< 100 and mechanically ventilated 4
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Nervous system
Glasgow coma scale SOFA score
13–14 1
10–12 2
6–9 3
< 6 4
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Cardiovascular system
Mean arterial pressure OR administration of vasopressors required
SOFA score
MAP < 70 mm/Hg 1
dop <= 5 or dob (any dose) 2
dop > 5 OR epi <= 0.1 OR nor <= 0.1 3
dop > 15 OR epi > 0.1 OR nor > 0.1 4
(vasopressor drug doses are in µg/kg/min)Drug abbreviations: dop for dopamine, dob for dobutamine, epi for epinephrine and nor for norepinephrine.
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Liver
Bilirubin (mg/dl) [μmol/L] SOFA score
1.2–1.9 [> 20-32] 1
2.0–5.9 [33-101] 2
6.0–11.9 [102-204] 3
> 12.0 [> 204] 4
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coagulation
Platelets×103/µl SOFA score
< 150 1
< 100 2
< 50 3
< 20 4
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kidney
Creatinine (mg/dl) [μmol/L] (or urine output) SOFA score
1.2–1.9 [110-170] 1
2.0–3.4 [171-299] 2
3.5–4.9 [300-440] (or < 500 ml/d) 3
> 5.0 [> 440] (or < 200 ml/d) 4
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اجزاء موجود در فرمولاسیون های تغذیه وریدی
زکیه فضیلتی
کارشناس ارشد تغذیه
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ترکیبات محلولهای تغذیه وریدی
درشت مغذی ها•پروتئینامولسیون چربیدکستروز
ریز مغذی ها•ویتامین هاعناصر کمیابالکترولیت ها
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درشت مغذی هاآمینواسیدها
پروتئین به شکل آمینواسید های کریستالی•
کیلوکالری 4گرم آمینواسید 1•
!پروتئین به عنوان منبع انرژی؟
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انواع آمینواسیدها
محلولهای آمینواسید استاندارد•
مناسب افراد دارای عملکرد ارگانی نرمال
محلول های آمینواسید اصلاح شده•
مناسب بیماران با نیازهای تغییر یافته به پروتئین
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محلولهای آمینواسید استاندارد
نیمه ضروری-غیرضروری-حاوی آمینواسیدهای ضروری•
20-% 10-% 5در غلظت های%
اسیدهای آمینه شاخه دار% 25تا 19حاوی
سی سی500درحجم
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محلول های آمینواسید اصلاح شده
فرآورده های آمینواسید طراحی شده برای انسفالوپاتی کبدیحاوی نسبت بیشترآمینواسیدهای شاخه دار به آروماتیکدر مطالعات مزیتی به آمینواسیدهای استاندارد دیده نشده
فرآورده های آمینواسید طراحی شده برای بیماران کلیویمقادیر بالاتر آمینواسیدهای ضروری وهیستیدیندر مطالعات مزیتی به آمینواسیدهای استاندارد دیده نشده
فرآورده های آمینواسید طراحی شده برای کودکانگلایسین-متیونین-مقدار کمتر فنیل آلانینآسپارتات-گلوتامات -حاوی تورین
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ملاحظات در مورد محلول های آمینواسید
دارا بودن الکترولیت ها
حاوی الکترولیت محصول شرکتB-Brun
محصول شرکت بدون الکترولیتB-Brun و شرکتFresinius kabi
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Aminoplasmal 5, 10%
23
5% 10%
Total amino acids 50g/l 100 g/l
Total nitrogen 8g/l 16.0 g/l
Caloric value(kcal/l) 200 400
Osmolarity 440mOsm/l 885 mOsm/l
• No Taurine
• Include electrolytes
• Contraindicated in new-borns or infants up to completed 2nd year
• Electrolyte concentrations ( mmol/l):
Sodium 50, K 25, Mg 2.5, Acetate 35, Cl 45, P 10, Citrate 2
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Aminoven 5, 10%
24
5% 10%
Total amino acids 50g/l 100 g/l
Total nitrogen 8g/l 16.0 g/l
Caloric value(kcal/l) 200 400
Osmolarity 495mOsm/l 990 mOsm/l
• Taurine, No electrolytes
• The administration of Aminoven is contraindicated in
neonates.
• No clinical studies in newborns, infants and children
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Aminoven Infant 10%
25
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درشت مغذی هادکستروز
منبع اصلی انرژی درتغذیه وریدی•
کیلوکالری انرژی3.4گرم دکستروز حاوی 1•
Serum 1/3 2/3 . 1 lit>>> 30 gr dextrose
Serum dextrose water 5% (D/W 5%) 1 lit >>> 50 gr dextrose
Serum dextrose saline (D/S) 1 lit >>> 50 gr D and saline
Serum dextrose water 10% (D/W 10%) 1 lit >>> 100 gr dextrose
Vial dextrose water 20% (D/W 20%) 50 cc >>> 10 gr dextrose
Vial dextrose water 50% (D/W 50%) 50 cc >>> 25 gr dextrose
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لیپید
منبع انرژی
منبع اسیدهای چرب ضروری
امولسیون کننده <<<حاوی فسفولیپیدهای تخم مرغ
ایزوتون کردن امولسیون <<<حاوی گلیسرول
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لیپید
انرژی هرمیلی لیتر امولسیون •
حاوی کیلوکالری%1/1 10•
کیلوکالری2حاوی % 20•
کیلوکالری3حاوی % 30•
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امولسیون های چربیملاحظات در مورد
داروی بیهوشی <<<پروپوفول •
حاویLCTاز روغن سویا
10معادل اینترالیپید%
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Lipids
30
1
• LCT
Soy bean +
safflower oil, very
rich in ω -6
PUFA(LCT)
e.g. Intralipid®
• Mixture
soy bean (LCT)
+MCT+ Olive oil
+Fish oil
e.g. SMOFlipid®
2
• MCT/LCT
50% Soy bean+50%
Coconut(MCT)oil
e.g. Lipofundin®
When parenteral nutrition with intravenous lipids is indicated, IV lipids that reduce the load of
omega-6 fatty acids/soybean oil emulsions should be considered (Canadian update 2013)
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Lipofundin
31
1000 ml emulsion contain
Lipofundin® Lipofundin®
MCT/LCT 10% MCT/LCT 20%
Soybean oil 50.0 g 100.0 g
MCT 50.0 g 100.0 g
Glycerol 25.0 g 25.0 g
Egg yolk phospholipids 8.0 g 12.0 g
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SMOFlipid® 20 %
• Active ingredients/l: • Soya-bean oil, 60.0 g
• MCT 60.0 g
• Olive oil 50.0 g
• Fish oil 30.0 g.
• Total energy: 2000kcal/l.
• Osmolality: Approx. 380 mosm/kg
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ریز مغذی ها
33
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Glycophos
Glycophos must not be given undiluted.
• Adults:
The recommended dosage is individual. The recommended daily dosage of phosphate during intravenous nutrition would normally be 10-20 mmol. This can be met by using 10-20 ml of Glycophos added to the infusion solution or to the admixture for which compatibility has been proved.
• Infants:
The recommended dosage is individual. The recommended dose for infants and neonates is 1.0-1.5 mmol/Kg body weight/day.
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Glycophos
•Contra-indicationsGlycophos should not be given to patients in
a state of dehydration or with hypernatraemia,
hyperphosphataemia, severe renal insufficiency
or shock.
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Calcium Gluconate
• Usual Adult Dose for Hypocalcemia
Intravenous:
• 500 to 2000 mg (5 to 20 mL) IV one time at a rate not to exceed 0.5 to 2 mL/min.
• The dose may be increased as needed.
• The usual daily dosage ranges from 1000 to 15,000 mg (10 to 150 mL) in divided doses or as a continuous infusion. Doses may be repeated every 1 to 3 days as needed and tolerated to normalize the serum calcium level.
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Requirements of Trace Elements
37
Trace elements Requirement/day (adult)
Zn (mg)
Cr (μg)
Cu (mg)
Mn (μg)
Fe (mg)
I (μg/kg)
Mo (μg)
Se (μg)
2.5-4.0
10-15
0.3-0.5
60-100
1.0-2.0
1.0-2.0
20-130
20-40
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Tracutil
38
Contains:
• Iron 2mg
• Zinc 3.3
• Manganese 0.55mg
• Copper 0.76
• Chromium 10mcg
• Molybden 10mcg
• Selenium 24mcg
• Fluoride 570mcg
• Iodine 127 mcg
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Addamel N
39
Contains:
• Iron
• Zinc
• Manganese
• Copper
• Chromium
• Sodium molybdate
• Sodium selenite
• Sodium fluoride
• Potassium iodide
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Vitamin requirements
Vitamin Amount
Thiamine B1
Riboflavin B2
Pyridoxine B6
Cyanocobalamin B12
Niacin
Folic acid
Pantothenic acid
Biotin
Ascorbic acid
Vit. A
Vit. D
Vit. E
Vit. K
6 mg (3)
3.6 mg
6 mg (4)
5 μg
40 mg
600 μg (400)
15 mg
60 μg
200 mg (100)
3300 IU
5 μg
10 IU
150 μg 40
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Soluvit N
• Infusion concentrate of water soluble vitamins• Vitamin B1 2.5 mg
• Vitamin B2 3.6 mg
• Nicotinamide 40 mg
• Vitamin B6 4.0 mg
• Pantothenic acid 15.0 mg
• Vitamin C 100 mg
• Biotin 60 μg
• Folic acid 0.4 mg
• Cyanocobalamin 5.0 μg
41
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تغذیه وریدی ترکیبی
in 1 3یا 1TNAدر 3ترکیب •
in 1 2و امولسیون چربی جدا 1در 2ترکیب •
محلول های ترکیبی در اتاق تمیز•
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NuTRIflex® Lipid – Bag design
GT&CE | Clinical Nutrition: MCB | Page 43
Glucose
and electrolytes
Lipids:
MCT/ LCT
Filling ports
Hanger
Peel seals
Infusion port
Additives port
Amino acids
and electrolytes
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NuTRIflex Lipid® – The B. Braun 3-chamber-bag
GT&CE | Clinical Nutrition: MCB | Page 44
Graphic: B.Braun
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NuTRIflex® Lipid – Mixing procedure
Graphic: B.Braun
GT&CE | Clinical Nutrition: MCB | Page 13
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Nutriflex Lipid Peri1250ml 1875ml 2500ml
Amino acids (gr) 40 60 80
Glucose (gr) 80 120 160
Lipids (gr) 50 75 100
Total calories(kcal) 955 1435 1910
Non-protein
calories(kcal)
795 1195 1590
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Osmolarity (mOsm/L) = (grams dextrose / liter) x 5] + [grams amino acid / liter) x 10] + [(mEq cations / liter) x 2]
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Nutriflex Lipid Plus1250ml 1875ml 2500ml
Amino acids (gr) 48 72 96
Glucose (gr) 150 225 300
Lipids (gr) 50 75 100
Total calories(kcal) 1265 1900 2530
Non-protein
calories(kcal)
1075 1615 2155
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Nutriflex Lipid Special
625ml Kcal
Amino acids (gr) 35.1 140
Glucose (gr) 90 360
Lipids (gr) 25 240
Total calories(kcal) 740
Non-protein
calories(kcal)
600
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اتاق تمیز
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اتاق تمیز
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CV Line
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CV Line