Treating critical Illness involves treating the patient as a whole
In today’s era of heart attacks and strokes, admission into an intensive care unit (ICU) may be life-saving. Chances are that you have a loved one or a friend who has recently been admitted into the ICU. Here is a nutritional perspective on these cases.
When an individual becomes critically ill, the body responds by triggering “stress mechanisms” aimed at providing energy to vital organs. The body uses its stores to produce energy and activates the production of substances that can help it deal with the injury.1 This results in various consequences, including increased energy expenditure, high blood sugar and loss of muscle mass.
Patients who are critically ill often have difficulties maintaining optimum nutritional intake. Thus, these individuals usually lose weight rapidly, resulting in slower recovery and poor outcomes.2 Nutritional support then becomes crucial in order to meet energy requirements and prevent malnutrition in these patients.
The nutritional requirements of the critically ill, however, is complex.1 Caloric intake should closely match the energy expenditure of the patient. Protein intake should adequately provide the building blocks required for tissue repair and maintenance, and to prevent depletion of the body’s supply of amino acids that are essential for stress responses. Vitamins and minerals, although usually required only in small quantities, are also vital to many bodily functions that are crucial for repair and recovery.
Studies have identified specific nutrients that may have beneficial effects on the immune system, metabolism and gastrointestinal function. Arginine, omega-3 fatty acids, antioxidants and nucleotides are some of the components now being added to produce so-called ‘immune-modulating’ or ‘immune-enhanced’ diets. These components are thought to enhance immune function, and have been reported to aid wound healing and reduce hospital stay.1,2
In many of critically ill patients, nutrition support can be done through a feeding tube. It is important to use solutions that can deliver consistent amounts of readily-absorbed nutrients and can be easily adjusted to tailor to the requirements of each individual patient.
Blenderized diets have not been shown to be effective in delivering adequate nutrients and should be avoided especially in the very sick hospitalized patient (e.g. severely malnourished critical care or geriatric patient).3
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Scientific Formula |
Blenderised Feeding |
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Consistent nutrient distribution from macro and micro nutrients |
High degree of variability in nutrient content |
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Provides convenience in preparation; no special equipment is required |
Blenderised feeding requires more time and energy to prepare, thus increasing the cost. Special equipment is needed. i.e.blender or food processor, measuring utensils, access to refrigeration etc. |
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Ingredients are high quality and produced following good manufacturing procedures |
Higher incidence of bacterial contamination may occur, increasing risk of nosocomial infections.4,5 Clean food preparation technique must be emphasized. |
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Reduced length of hospital/ICU stay and reduced rates of several infections.6 |
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Administered properly, nutritional support in critical care can help preserve and improve bodily functions, hasten recovery, and most importantly, save lives.
- Preiser JC, van Zanten AR, Berger MM, et al. Crit Care. 2015;19:35.
- Debaveye Y, Van den Berghe G. Annu Rev Nutr. 2006;26:513-538.
- WHO, Technical Consultation on Hospital Nutrition Practices in South-East Asia – 2010
- Mokhalalati JK et al. Microbial, Nutritional and Physical Quality of Commercial and Hospital Prepared Tube Feeding in Saudi Arabia. Saudi Medical Journal 2004; Vol (3); 331-341
- 5.Jalali M et al. Bacterial contamination of hospital prepared enteral tube feeding formulas in Isfacan. Iran Journal of Medical Sciences 2009 May-Jun;14(3) :149-56
- 6. Kiek S et al. Commercial enteral formulas and nutritional support teams improve the outcome of home enteral tube feeding JPEN J Parenteral Enteral Nutri. 2011; 35:380
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