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Resource type: Article

Nutritional support

Why is nutrition so important in Intensive Care?

Being very ill can increase the rate at which the body uses up energy, which means that patients can  lose a lot of weight while they're in Intensive Care.Another common effect of very severe illness is muscle wasting,which can affect things like mobility and result in patients becoming tired very easily. Putting weight back on and regaining muscle can often take some time. It is therefore very important that patients are well fed during and after their time in Intensive Care.

How are patients fed in Intensive Care?

When a patient is connected to the ventilator or breathing machine (via a breathing tube that is inserted into their mouth), they are unable to eat normally. The most common way to feed patients in Intensive Care is to give them a liquid feed through a small tube that is passed through the nose and into the stomach (a nasogastric tube).Sometimes, if the stomach is not working properly (after an operation, for example), we give them liquid feed directly into the blood system through a drip or line that goes into a vein (total parenteral nutrition or TPN).

What does the dietitian do in Intensive Care?

A specialist dietitian will usually visit patients in Intensive Care every day. He or she will work out how much energy (calories) and protein (the building block of muscles) the patient needs in their liquid feed, in order to help reduce the loss of muscle and weight. He or she will discuss with the doctor any changes that need to be made to the type or amount of nutrition the patient is receiving.

When the patient is disconnected from the ventilator or breathing machine, he or she can usually start to eat normally again. If the patient has had a breathing tube in place for some time, however, the throat muscles can become weak and the patient may struggle to swallow effectively. Whilst this is very often temporary, a Speech and Language Therapist will usually come to see the patient,either in Intensive Care or, more commonly,on the general wards. He or she will test the strength of the patient's swallow before making recommendations or may give him or her some exercises that will help.

What happens after Intensive Care?

It is very common for patients to have a poor appetite, to feel fuller much quicker or for food to taste very different from before (often with a metallic taste). These problems, combined with feeling very weak and tired after being so ill, can make it difficult for patient to eat enough to meet their nutritional requirements.Some patients may continue to receive liquid feeding through the tube that is passed through the nose and into the stomach (the nasogastric tube) until they are able to eat more.

The dietitian will also give advice about ways to increase calorie and protein intake such as eating small and frequent meals, taking milky drinks and having snacks between meals. The dietitian may also recommend trying liquid supplements, such as high calorie or high protein drinks. Family members can also bring in favourite foods. Helping patients to eat at mealtimes is another way to increase food intake