They have known for a long time that certain patients in the intensive care unit recover faster and have better clinical outcomes if they receive enough nutrition. Often, critically ill patients require tube feeding in order to get the nutrition and calories they need while receiving respiratory therapy and mechanical ventilation.
Patients In The ICU
However, many patients in the ICU have their feeding tubes taken out and are encouraged to eat and drink, as soon as they no longer need this respiratory therapy. Our research shows that more than half of patients in intensive care units don't get enough nutrition because they eat less than a third of their meals.
Of particular concern are patients who stay in intensive care for longer periods and whose nutritional intake remains poor even after they leave the ICU.
Malnutrition in the ICU
Over the years, research has helped us understand some of the reasons (physiological and psychological) why ICU patients' nutritional intake can be low. In the initial stages of critical illness, mechanical ventilation, sedation and a low level of consciousness mean that most patients need to receive nutrition continuously through a tube inserted through their nose and into the stomach. This is called Enteral Nutrition.
Research into how to improve nutrition in tube-fed patients is vast. However, despite improvements in feeding practices, malnutrition remains a problem for some patients in intensive care. Fewer studies have focused on the nutritional intake of patients who do not have a breathing tube in place or who can "theoretically" eat and drink.
We know that a reduced level of consciousness, poor appetite, taste changes, pain, poor sleep, anxiety, low mood, social isolation, routine changes and an inability to lift cutlery are common barriers.
The purpose of our research was to explore if oral nutritional intake was adequate in critically ill patients after removal of their feeding tubes. We also wanted to identify factors that contributed to patients poor oral intake. We conducted our research at an 18-bed general ICU for adults and children with a variety of serious conditions, post surgery or acute illness.
We do not know at what point they started to take an adequate diet as there was limited follow-up post ICU. However, research has shown that this poor intake sometimes persists beyond seven days for a large proportion of post ICU patients. However much more research is needed into this aspect of nutrition post ICU.
Long-term ICU patients
Such patients are typically classified as long-term. They have been very sick, often requiring multiple lifesaving therapies during their acute phase, but are stabilized, recovering and entering the rehabilitation phase. They are often in the ICU for more than five days and have been receiving enteral nutrition via their feeding tube.
Unfortunately, this muscle weakness (which can be profound) and ongoing fatigue that long-term patients experience, makes it incredibly challenging for them to move, or even pick up and hold cutlery. In our study, more than a quarter of the patients were physically unable to feed themselves and were reliant on busy nursing staff to ensure they received meals.
Patients' food intake should be monitored and documented, and ICU dietitians should be involved in assessing when a patient is ready to have their feeding tube removed. Patients in the ICU should also have nutritional drink supplements regularly offered in addition to an oral diet that is nutritious, delicious and appetizing.