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4.9 - Nutritional Assessment and Support in Intensive Care (Enteral and Parenteral Nutrition)

from Section 4 - Therapeutic Interventions and Organ Support

Published online by Cambridge University Press:  27 July 2023

By
Liesl Wandrag
Edited by
Ned Gilbert-Kawai ,
Debashish Dutta  and
Carl Waldmann
Ned Gilbert-Kawai
Affiliation:
The Royal Liverpool Hospital
Debashish Dutta
Affiliation:
Princess Alexandra Hospital NHS Trust, Harlow
Carl Waldmann
Affiliation:
Royal Berkshire Hospital, Reading
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Summary

Key Learning Points

  1. 1. Intubated patients should usually receive nutritional support within 24–48 hours of admission.

  2. 2. Enteral nutrition is the preferred route of feeding, where feasible.

  3. 3. The National Patient Safety Agency (NPSA) advises that nasogastric tubes (NGTs) should be checked after initial placement and daily before use with either chest X-ray or pH paper (pH <5.5) to ensure correct stomach placement.

  4. 4. Feeding protocols are strongly encouraged to ensure that nutritional support is initiated, increased and monitored appropriately.

  5. 5. Parenteral nutrition should start early when enteral nutrition is not feasible in high-risk or poorly nourished patients.

Keywords

enteral nutritionparenteral nutritionfeeding protocols
Type
Chapter
Information
Intensive Care Medicine
The Essential Guide
 , pp. 510 - 514
Publisher: Cambridge University Press
Print publication year: 2021

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References

References and Further Reading

Elke, G, van Zanten, ARH, Lemieux, M, et al. Enteral versus parenteral nutrition in critically ill patients: an updated systematic review and meta-analysis of randomized controlled trials. Crit Care 2016;20:117.CrossRefGoogle ScholarPubMed
Heyland, DK, Dhaliwal, R, Drover, JW, Gramlich, DA, Dodek, P; Canadian Critical Care Clinical Practice Guidelines Committee. Canadian practice guidelines for nutrition support in mechanically ventilated, critically ill adult patients. JPEN J Parenter Enteral Nutr 2003;27:355–73. [Guidelines updated: 2009]CrossRefGoogle ScholarPubMed
McClave, SA, Taylor, BE, Martindale, RG, et al. Guidelines for the provision and assessment of nutrition support therapy in the adult critically ill patient: Society of Critical Care Medicine (SCCM) and American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.). JPEN J Parenter Enteral Nutr 2016;40:159–211.CrossRefGoogle ScholarPubMed
Preiser, JC, van Zanten, AR, Berger, MM, et al. Metabolic and nutritional support of critically ill patients: consensus and controversies. Crit Care 2015;19:35.CrossRefGoogle ScholarPubMed
Singer, P, Reintam Blaser, A, Berger, MM, et al. ESPEN guideline on clinical nutrition in the intensive care unit. Clin Nutr 2019;38:48–79.CrossRefGoogle ScholarPubMed

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