Johannesburg - In the ICU, patients spending more than 48 hours there are at risk of malnutrition due to various factors, including sedation and ventilation, that hinder normal eating and drinking.
Dietitians, integral members of the ICU multidisciplinary team, conduct thorough assessments, considering weight, height, medical condition, blood markers, history, and lifestyle.
They tailor nutritional plans, calculating protein, vitamins, minerals, calories, and collaborate on fluid requirements. Depending on the patient's condition, they may employ methods like naso-gastric (NG) feeding tubes or parenteral nutrition (PN) for those unable to tolerate oral intake.
Non-sedated ICU patients often have poor oral intake due to various factors. Adequate nutrition is critical in the ICU, as it supports the immune system, recovery, and overall health.
Director: Newtricion Wellness Dieticians Omy Naidoo said global statistics reveal that ICU patients typically only receive 60% of their nutritional needs, impacting their outcomes and increasing the risk of ICU acquired weakness.
“The bottom line is clear: nutrition is fundamental for ICU patients' well-being, yet deficits are common. Dietitians play a crucial role in optimising nutrition, helping patients fight illness and recover better. Nutrition might not be the first thought in the ICU, but it's an essential part of comprehensive patient care. Critical illness requires more nutrients in the form of protein and energy in order for the body to fight the illness. This is what is called catabolic. Very often, the patient is unable to meet this requirement,” he said.
Naidoo added that if awake and eating the oral diet, or if patient is sedated, tube feeding may not be the target. These daily deficits contribute to higher risk for death and poorer recovery chances from critical illness. Underfeeding in the ICU is a global issue.
“We then would formulate a plan which could include oral supplements, or tube feeding and/or intravenous nutrition if the patient's gut is not absorbing well. Factors include blood values, disease severity, nutritional status, and various others. We used weight based formulas to calculate the patients requirements.’’
Naidoo said naso-gastric is often the best way to get nutrients into the body.
“If the gut works, we use it, as its been shown to be the best route of feeding. The gut is the biggest part of the immune system, so feeding via the gut helps to enhance the immune response to fight the critical illness. However, if the patient's gut isn’t absorbing, we often have to use intravenous nutrition. The misconception is that if the patient is eating orally, they are meeting their requirements, but the question is how much are they eating and off what?” he said.
He said that oral nutrition supplements are often used to help patients, as well as modify the diet, to assist with nausea and vomiting, knowing that less spicy and fatty foods are beneficial to patients with nausea and vomiting.