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Malnutrition Post ICU

The average post ICU patient is likely to have muscle wasting and muscle weakness.



Watch this animation for information on ICU acquired weakness

With the COVID -19 pandemic, there has been an increase in admissions to the intensive care unit (ICU) due to acute respiratory complications, leading to more patients requiring support post ICU.1 ICU stays and principally ICU duration have been shown to contribute to worsening malnutrition, with skeletal muscle mass loss being prominent.2

Muscle wasting together with muscle weakness is prominent post discharge from ICU and it is known that patients can lose up to 1kg3 per day of lean body mass during their ICU stay. This is associated with impaired immune function, delayed healing, weakness, pressure sores and increased mortality.4

Importance of Nutrition Post ICU

Post ICU, nutrition support plays a vital role to replenish nutritional losses and help regain the muscle strength. By increasing protein and energy intakes to meet nutritional requirements recovery and rehabilitation can be optimal. Nutrition support should also include adequate supply of vitamin and minerals.5

Patients often find it challenging to meet full nutritional requirements through food alone due to poor appetite6,7 changes in taste6,7, nausea8, and/or malabsorption.8

Therefore patients can struggle to meet their energy and protein needs from food alone achieving less than 50% of their requirements9. The appropriate use of oral nutritional supplements (ONS) can help patients to meet their nutritional requirements of energy and protein following ICU discharge.

Identification of malnutrition

Identification of malnutrition through screening is imperative and the national institute for health and care excellence (NICE) has highlighted this.5 During COVID-19 outbreak it is still important to identify malnutrition through a validated tool and to initiate a treatment plan.5

ONS Post ICU

High protein, high energy, ready to drink ONS in a low volume (125ml), could be helpful for the post ICU patient to improve their energy and protein intake as they may struggle with a larger volume ONS or mixing a powdered supplement due to muscles weakness.

Smaller volume ONS are also associated with significantly better compliance of 90% or more compared to ‘standard’ ONS (typically 200ml or more, 78%).10,14 A wide variety of flavours is also associated with improved compliance.12

High protein ONS has also been associated with clinical benefits in a range of patients including:13

- Improved functional outcomes
- Reduced complications
- Reduced hospital admissions
- Decreased length of stay

Fortisip Compact Protein is a high protein, high energy, ready to drink ONS in a low volume (125ml), available in 8 flavours. 2 bottles of Fortisip Compact Protein per day could help to fill an energy and protein gap in your patients with muscle wasting and muscle weakness, whilst providing approximately half of their daily vitamin and mineral requirements.11,12

Clinical benefits have typically been seen with prescribing 1-3 ONS per day for a mean period of 3 months13.
How to prescribe Fortisip Compact Protein: 250ml (2 bottles) per day for 12 weeks.

Total volume for the 12 weeks 21,000ml (168 bottles).

For more information about Fortisip Compact Protein, visit https://www.nutriciahcp.com/adult/products/Fortisip_Compact_Protein/ or download the product datacard here.

Effective management in the community

Managing malnutrition often involves many health care professionals. However, patients may present in the primary care setting at any time post their ICU discharge and therefore GP’s may be best placed to recognise and treat the patients who are malnourished.

Utilising the malnutrition pathway can help identify if a patient is at risk of malnutrition. Click here to access the pathway.

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Content provided by Nutricia Ltd.

Nutricia

Fortisip Compact Protein is a food for special medical purposes for the dietary management of disease related malnutrition and must be used under medical supervision.
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