GUIDELINES ON NUTRITIONAL SUPPORT  
                IN ICU  
                 
                 
                 
                 
                 
                                     
                 
                 
                 
                Developed by: 
                 
                Faculty of Critical Care  
                The College of Anaesthesiologists of Sri Lanka 
                In collaboration with 
                Nutrition Division of Ministry of Health of Sri Lanka 
                 
                 
                 
                 
                 
                Publication Date:     January 2014 
                Date for Review:      January 2016 
                   THE COLLEGE OF ANAESTHESIOLOGISTS OF SRI LANKA 
                   WORKING GROUP 
                   Correspondance: anascol@sltnet.lk 
                   Dr Vihara Dassanayake 
                   Dr Bimal Kudavidanage 
                   Dr Chamila Jayasekera 
                   Dr Kanishka Indraratna 
                   Dr Saman Karunathillake 
                   Dr Sidarshi Kiriwattuduwa 
                   Dr Chamila Pilimathalawwe 
                   Dr Tharanga Perera 
                   Dr Buddhika Vidanagama 
                   Dr Buddhika Habaragamuwa 
                   Dr S Mathanalagan 
                          2    Guidelines on Nutritional Support in ICU 
                               The College of Anaesthesiologists of Sri Lanka 
                               January 2014 
               CONTENTS 
               Introduction                                                                  4 
               Assessment of Nutritional Status                                             4 
               Calculation of Energy & Nutrition Requirement                                 5 
               Establishing Enteral Feeding in ICU                                           5 
               Suggested Algorithm for Establishing Enteral Nutrition                        8 
               Practice Recommendations for Enteral Nutrition                                9 
               Establishing Parenteral Nutrition ICU                                         11 
               Calculation of Parenteral Nutrition for a 70kg patient                        13 
               Practice Recommendations for Parenteral Nutrition                             14 
               Monitoring a Patient on Parenteral Nutrition                                  15 
               Nutrition Guide in Special Circumstances                                      16 
               References                                                                    19 
               Appendices 
                      1. Definitions – Malnourished, At risk of Malnourishment
                             Re-feeding Syndrome                                             20 
                      2. Calculation of Energy & Nutrient Requirement                        21 
                      3. Placement of Naso-gastric/Oro-gastric Tube                          22 
                      4. Proximate Energy & Nutrient Content of Common Food Items
                             of Sri Lanka                                                    23 
                     3  Guidelines on Nutritional Support in ICU 
                        The College of Anaesthesiologists of Sri Lanka 
                        January 2014 
              INTRODUCTION 
              These guidelines apply to nutritional support in adult patients in critical care units of Sri Lanka. In 
              this document, enteral feeding refers to non-volitional delivery of nutrients via a tube into the 
              gastrointestinal tract, and parenteral feeding refers to aseptic intravenous delivery of sufficient 
              nutrients where adequate alimentary 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. 
              (Appendix 1)  
              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. 
              Assessment of Nutritional Status 
              Traditional nutritional assessment tools are not validated for use in the critical care setting. The 
              assessment usually include  
                   Evaluation of weight loss
                   Previous nutrient intake
                   Level of disease severity
                   Co morbid conditions
                   Function of the gastrointestinal tract
                   4  Guidelines on Nutritional Support in ICU 
                      The College of Anaesthesiologists of Sri Lanka 
                      January 2014