Nutrition in ICU by Shilpi Pandey, SGPGIMS, Lucknow

Summary

Dr. Shilpi presents an in-depth overview of nutrition in ICU patients, emphasizing the importance of nutritional support in critically ill individuals. The presentation covers goals of ICU nutrition, macronutrient distribution, and energy requirement calculations, including stress and activity factors. Various assessment methods—anthropometric, biochemical, clinical, and dietary—are discussed. Enteral nutrition is highlighted as the preferred route, with details on tube feeding, feeding formulas, and disease-specific diets. Parenteral nutrition is considered when enteral feeding is insufficient. The role of antioxidants in preventing organ failure is also explained. Overall, timely, personalized nutrition is essential to enhance recovery, immune function, and reduce complications in ICU patients.

Takeaways

• 🍽️ Nutrition support is essential for critically ill patients, providing calories, protein, electrolytes, vitamins, minerals, and fluids.
• 💊 About 60% of ICU patients suffer from gut dysfunction due to impaired digestion, absorption, or gastrointestinal issues.
• 🎯 The goal of ICU nutrition is to preserve lean body mass, limit protein catabolism, boost immunity, improve wound healing, and correct electrolyte disturbances.
• 📊 Nutritional assessment includes anthropometric measurements, biochemical markers, clinical evaluation, and dietary intake analysis.
• 🧮 Energy requirements in ICU are calculated using Basal Energy Expenditure (BEE), stress factors, and activity factors, with simplified kcal/kg formulas for different patient conditions.
• 🥛 Enteral nutrition is the preferred feeding route, including oral, nasogastric, gastrostomy, or jejunostomy feeds.
• ⏱️ Tube feeding can be continuous or intermittent, with careful monitoring of gastric residuals and patient tolerance.
• 🥗 Enteral diets may be blenderized, commercial standard, elemental, or disease-specific (renal, hepatic, pulmonary, diabetic, high-protein).
• 💉 Parenteral nutrition is used when enteral feeding is insufficient or not tolerated, providing macronutrients, electrolytes, vitamins, and trace elements intravenously.
• 🛡️ Antioxidants like vitamin E, vitamin C, and selenium play a vital role in protecting against oxidative stress and organ failure in ICU patients.
• ⏰ Early nutrition within 12–24 hours of ICU admission reduces mortality and hospital stay, highlighting the importance of timely intervention.

Q & A

What is the goal of nutrition support in ICU patients?

The goal of nutrition support in ICU patients is to provide adequate calories, protein, fats, carbohydrates, vitamins, and minerals to preserve lean body mass, limit protein catabolism, boost immune function, improve wound healing, and correct any acid-base and electrolyte disturbances.

Why is nutritional assessment important in ICU patients?

Nutritional assessment in ICU patients is crucial to determine their specific nutritional needs, identify deficiencies, and tailor appropriate nutrition support to improve recovery and prevent complications. Methods such as anthropometric, biochemical, clinical, and dietary assessments help in this evaluation.

What are the common methods used to calculate energy requirements in ICU patients?

Energy requirements in ICU patients can be calculated using formulas such as the Harris-Benedict equation for Basal Energy Expenditure (BEE), along with stress and activity factors. Alternatively, a simple formula based on weight and patient condition can also be used.

What is the role of enteral nutrition in ICU patients?

Enteral nutrition provides necessary calories and nutrients when a patient is unable to consume food orally but has a functioning gastrointestinal (GI) tract. It can be delivered via oral feeds or through a tube (e.g., nasogastric tube) into the stomach or small intestine.

What are the different types of enteral feeding methods used in ICU?

The types of enteral feeding methods include continuous feeding, where nutrition is given 24/7; intermittent feeding, given in intervals with breaks; and bolus feeding, where set amounts are given at specific times, typically using a syringe.

What are the main complications associated with enteral nutrition in ICU?

Common complications of enteral nutrition include gastrointestinal problems such as vomiting and diarrhea. To mitigate these, regular checks such as gastric residual volume measurements, appropriate feeding volume adjustments, and careful monitoring are essential.

How do you decide which enteral feeding formula to use for a patient?

The choice of enteral feeding formula depends on the patient's medical condition, such as the need for high-protein, low-salt, or calorie-dense formulas, as well as factors like the patient's tolerance and gastrointestinal function. Examples include standard formulas, blenderized diets, and specialized formulas like those for diabetic or renal patients.

What is the difference between standard and elemental enteral nutrition formulas?

Standard enteral formulas contain intact proteins and carbohydrates, while elemental formulas consist of partially or fully broken-down nutrients, making them ideal for patients with compromised digestion or absorption.

What is parental nutrition, and when is it necessary for ICU patients?

Parental nutrition involves providing nutrients intravenously, typically when enteral feeding is insufficient or not possible. It is necessary when patients cannot meet their nutritional needs through oral or enteral routes, such as in cases of severe GI dysfunction.

What are some key components of a typical parental nutrition formula?

A typical parental nutrition formula contains amino acids, hypertonic dextrose, electrolytes, vitamins, minerals, and fat emulsions. These components are delivered intravenously, either via central or peripheral venous access, depending on the patient's condition.