Guidelines on Nutritional Support in ICU

These guidelines apply to nutritional support in adult patients in critical care units of Sri Lanka. In this document, enternal feeding refers to non-volitional delivery of nutrients via a tube into the gastrointestinal tract, and parenteral feeding refers to aseptic intravenous delivery of nutrients is not possible.

Critically ill patients are in a catabolic state induced by severe disease and appropriate nutritional support should be initiated as early as possible, in all patients admitted to the critical care unit unless indicated otherwise. Starvation and underfeeding in critical care patients are associated with increased morbidity and mortality.

Nutritional support can be provided by enteral or/and parenteral routes, enteral being the preferred one.

It is important in patients who are malnourished and those who are at risk of malnutrition.

During a critical illness, in addition to catabolic stress, there is an increased inflammatory response leading to increased nutritional requirement. Also there is an altered gut morphology and function, causing impaired digestion and absorption.

Poor nutrition in critically ill patient causes decreased immunity, decreased respiratory muscle function and a reduced respiratory capacity, ventilator associated pneumonia, difficult weaning off ventilator and poor wound healing.

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