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Nutrition in critical care is in the spotlight
at the moment. Several large randomised
controlled trials have been completed
recently all with one big problem -the
nutrition interventions were 5-7 days. 66%] energy and 48% [13-63%] protein) 1 .
Moreover, patients got closest to their
energy and protein needs when they
received oral nutrition combined with
gastric feeding 1 .
Most of the trials have shown no
differences or only small differences
with questionable clinical importance
between study arms. Why might this be?
One explanation may be that nutrition is
not important in critical care. However,
that’s probably not the case. A more
likely explanation is that we don’t' fully
understand when nutrition is important is
most important in critical illness. Patients recovering from critical illness
experience complex and multifactorial
issues around appetite and taste, the way
they feel about their body and eating, and
physical weakness 2, 3 . Furthermore, hospital
and food service system practices such as
removal of gastric tubes prior to oral intake
impact a patient’s ability to eat but has
never been addressed in any large studies
to date 2-4 .
I have over 14 years experience as an
academic clinical dietitian and I’ve always
found it strange that we try so hard in the
ICU, only to send our patients to the ward
where they stay longer and receive less
nourishment. Recently, we investigated
this by following 32 patients from ICU to
hospital discharge at two hospitals and
assessed nutrition intake three times
a week. To understand more about the impact of
nutrition and the issues patients face in
the later stages of critical illness, our team
is currently running a pilot, randomised,
feasibility trial with 14 hospitals around
Australia and New Zealand. With a sample
size of 240 patients, this trial will generate
knowledge that has not existed before.
In the meantime, I encourage dietitians
to advocate for patients in the ICU. Help
the treatment team understand the impact
of gastric tube removal and reinforce the
importance of continuing nutrition care as
patients transition to the ward. A little extra
effort can have a meaningful impact on the
recovery process.
The majority of patients received oral
nutrition alone (55% of study days) and
nutrition intake varied according to how
much nutrition support they received.
Energy and protein provision as a
proportion of estimated requirements was
the lowest in patients who received oral
intake with no oral nutrition supplements
(median [interquartile range]: 37% [21-
LEARN MORE:
@ICUnutrition
@emma-ridley
1. Ridley EJ, Parke RL, Davies AR, et al. What Happens to Nutrition Intake in the Post-Intensive Care Unit Hospitalization Period? An
Observational Cohort Study in Critically Ill Adults. JPEN J Parenter Enteral Nutr 2019; 43: 88-95. 2018/06/21. DOI: 10.1002/jpen.1196.
2. Merriweather JL, Salisbury LG, Walsh TS, et al. Nutritional care after critical illness: a qualitative study of patients' experiences.
J Hum Nutr Diet 2016; 29: 127-136. 2014/12/20. DOI: 10.1111/jhn.12287.
3. Merriweather J, Smith P and Walsh T. Nutritional rehabilitation after ICU - does it happen: a qualitative interview and observational study. J
Clin Nurs 2014; 23: 654-662. 2013/05/29. DOI: 10.1111/jocn.12241.
4. Chapple LA, Chapman M, Shalit N, et al. Barriers to Nutrition Intervention for Patients With a Traumatic Brain Injury. JPEN J Parenter Enteral
Nutr 2017: 148607116687498. 2017/01/26. DOI: 10.1177/0148607116687498.
© Dietitian Connection
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Infuse | December 2019