Nutritional support in intensive care: tube feeding and drip feeding

Intensive care units look after people who are very ill. The NHS explains that most people in an ICU have problems with one or more organs, and that the equipment they are connected to monitors their health and supports bodily functions until they recover. People may be on a ventilator, sedated or too unwell to eat and drink.

ICUsteps, the charity for people who have been through intensive care, notes that while someone is in intensive care they may be fed through a tube inserted into the nose and down into the stomach, or by a drip straight into a vein, and that the body will have used its stored fat and muscle for energy to help fight the illness.

Nutrition matters because the body is working hard to fight illness and to repair itself. Feeding in intensive care is a way of providing fluid and nutrients when normal eating is not possible.

There are two broad routes, and the choice depends on whether the gut can be used. BAPEN, the British Association for Parenteral and Enteral Nutrition, describes them as follows.

BAPEN says enteral feeding implies feeding into the gastrointestinal tract using a tube, and that common underlying problems leading to tube feeding include neurological disorders affecting swallowing, head and neck malignancy and oesophago-gastric disease. The NHS describes the tubes used in intensive care as placed in the nose, through a small cut made in the tummy, or into a vein.

Families may notice a feeding tube on a visit, among the other tubes, wires and cables that the NHS says may look alarming at first. The NHS advises asking staff to explain what these are if you would like to know, and says you may hear alarms and bleeps from the equipment that help staff monitor their patients.

BAPEN explains that parenteral nutrition provides nutrients by the intravenous route. In general, it says, it should only be used when it is not possible to supply nutrition using the gut, that is, when intestinal failure is present. Total parenteral nutrition implies that all of the macronutrient, micronutrient and fluid requirements are met by an intravenous nutrient solution and no significant nutrition is obtained from other sources.

BAPEN also describes intestinal failure as a reduction of gut function below the minimum necessary for absorption, such that intravenous supplementation is required to maintain health. It classifies intestinal failure by timescale, from an acute short-term, usually self-limiting condition such as a post-operative ileus, to a chronic condition needing nutrition support over months or years.

BAPEN has separate sections on parenteral nutrition access routes, complication management and monitoring, which reflects that intravenous feeding is a specialist treatment that needs careful oversight.

Returning to normal eating can be harder than people expect. ICUsteps lists reasons: you do not feel hungry, your mouth is too sore to eat, food tastes different or it hurts to swallow. It suggests starting with small portions and eating more often through the day, with small meals and two or three snacks, and that specially prepared milk drinks and desserts like those given in hospital, which contain lots of vitamins and minerals, can be bought.

It also says to take your time when eating, that if some foods taste very salty or sweet it is likely that your taste buds are taking time to get back to normal, and that this is common and will soon improve. Strong antibiotics and steroids can lead to infections such as oral thrush, which can make it painful to swallow, and a GP can treat it easily.

Drinking enough matters. ICUsteps says dehydration can dry out your skin, make you produce less urine, which can have a bad effect on your kidneys, and make you feel very weak and tired, so drink regularly through the day. It advises talking to your GP if you have trouble getting back to your normal weight, your bowel movements do not return to normal, there is blood in your urine or you get severe indigestion, and says a GP may be able to offer advice or refer you to a dietitian.

The NHS says many people who leave an ICU make a good recovery, but that sometimes there can be lingering problems such as weakness and stiffness, extreme tiredness, loss of appetite and weight loss, sleep problems, depression, anxiety or post-traumatic stress, and problems with mental abilities. These problems can last several months, and it advises getting medical advice if they are persistent for you or a loved one. Some people may require ongoing rehabilitation.

For families, the NHS says that the ICU staff will be on hand to answer questions and that you can ask staff to explain the equipment, and it points to ICUsteps and the Intensive Care Society as sources of more information and support.

If you or a relative has had a long stay, tell your GP about lingering problems with eating or weight, as ICUsteps advises, and ask about dietetic support and rehabilitation.