Feeding and nutrition are extremely important in critically unwell patients

• Critically illness is a highly catabolic state, with rapid loss of muscle bulk and strength

• Many patients may have prolonged periods where they are unable to eat normally

 

Types of feeding:

• Ward diet

• Continuous enteral feeds

  • Contains all required nutrients including fibre

  • Various available preparations are utilised for specific patient groups

    • Eg. Diabetic, renal insufficiency, fluid restriction, low residue, etc.

  • Administered at a continuous rate via enteral tube (nasogastric, orogastric or percutaneous gastric tube)

    • Commence at 40ml/hr, then uptitrate to target rate by 10mg/hr every 24 hours for nasogastric feeding

    • Feeds are up-titrated more slowly in proned patients, and paused prior to turns

• Total parenteral nutrition

  • Balanced solution of all required nutrients

  • Includes carbohydrates, fats, proteins, minerals, electrolytes, vitamins and trace elements

  • Run at a constant rate

    • Cyclic regime may be used if LFT derangement occurs​

  • Requires central access (PICC or CVC)

  • Significant associated risks including hyperglycaemia, hepatic dysfunction, fluid overload, central line complications and infections (especially fungal infection)

 

Principles of feeding

• Feeding should be commenced early if prolonged intubation is anticipated

• Enteral nutrition is preferred to TPN

  • More physiological, stimulates bowel

  • Lower rates of complications

  • Improved glycaemic control

• Monitor for re-feeding syndrome with commencement of both enteral and parenteral feeds in at-risk patients