Nutrition in the ICU

[Ryan999]

Has anyone ever had experience with nutrition while visiting someone in the ICU or being there yourself? My brother recently spent 6 weeks there after a car accident and needed to be fed the formula via a tube for about 4 of those weeks. I was pretty shocked to see the quality of the feed formula after looking at the ingredients but the nurses assured us that "this is no ensure, trust us this is very nutritious". Well at $80 a bottle the ingredients on the label begged to differ. I took a pic of the exact formula they were giving him.

Here are the ingredients:

Water, Corn Maltodextrin, Whey Protein Hydrolysate, Hydrolyzed Sodium Caseinate, Structured Lipid (Interesterified Marine Oil [Contains One or More of the Following: Anchovy, Menhaden, Salmon, Sardine, Tuna], Medium-Chain Triglycerides), Medium Chain Triglycerides. Less than 1% of: Canola Oil, Soy Oil, Short-chain Fructooligosaccharides, Natural & Artificial Flavor, Cellulose Gel, DATEM, Magnesium Phosphate, Calcium Carbonate, Sodium Phosphate, Potassium Chloride, Calcium Phosphate, Potassium Citrate, Ascorbic Acid, Choline Chloride, Potassium Hydroxide, Magnesium Chloride, Acesulfame Potassium, Carrageenan, Cellulose Gum, Sucralose, L-Carnitine, Taurine, Zinc Sulfate, Ferrous Sulfate, Niacinamide, d-Alpha-Tocopheryl Acetate, Calcium Pantothenate, Manganese Sulfate, Thiamine Hydrochloride, Pyridoxine Hydrochloride, Copper Sulfate, Riboflavin, Vitamin A Palmitate, Folic Acid, Chromium Chloride, Sodium Molybdate, Potassium Iodide, Sodium Selenate, Phylloquinone, Biotin, Vitamin B12, and Vitamin D3.

Corn maltodextrin for the carbs, whey and casein for protein, fish oil and MCT for fat. Then a lot of vitamins, minerals and additives.

I think the biggest improvements I can see right away are:

1. Carb source should be sugar based.

2. Marine oil should be eliminated completely.

3. Different saturated fat source for fat as opposed to MCT.

4. Eliminate all PUFA from "less than 1%" list.

5. Eliminate carrageenan and cellulose gum.

6. I'm sure the quality of the vitamins and minerals are very questionable.

Can anyone see any changes they would make if you could reformulate yourself?

You can read my brothers story here:

Support for Sean Heeney's Accident, organized by Sean Heeney

On May 18th, 2022, while driving home, a driver mistakenly pulled out in front of Sean… Ryan Heeney needs your support for Support for Sean Heeney's Accident

www.gofundme.com

(Not sure if we're allowed to post links like that here but I can delete it from the post if not).

It was a nightmare at times but we learned a lot being in at that ICU for a month and a half. From our experience, emergency medicine here in the West is very impressive in some ways (we're in Florida), but as expected the nutrition, even in trauma centers, is still in the dark ages it seems.

 

[Blossom]

Has anyone ever had experience with nutrition while visiting someone in the ICU or being there yourself? My brother recently spent 6 weeks there after a car accident and needed to be fed the formula via a tube for about 4 of those weeks. I was pretty shocked to see the quality of the feed formula after looking at the ingredients but the nurses assured us that "this is no ensure, trust us this is very nutritious". Well at $80 a bottle the ingredients on the label begged to differ. I took a pic of the exact formula they were giving him.

View attachment 48096

Here are the ingredients:

Water, Corn Maltodextrin, Whey Protein Hydrolysate, Hydrolyzed Sodium Caseinate, Structured Lipid (Interesterified Marine Oil [Contains One or More of the Following: Anchovy, Menhaden, Salmon, Sardine, Tuna], Medium-Chain Triglycerides), Medium Chain Triglycerides. Less than 1% of: Canola Oil, Soy Oil, Short-chain Fructooligosaccharides, Natural & Artificial Flavor, Cellulose Gel, DATEM, Magnesium Phosphate, Calcium Carbonate, Sodium Phosphate, Potassium Chloride, Calcium Phosphate, Potassium Citrate, Ascorbic Acid, Choline Chloride, Potassium Hydroxide, Magnesium Chloride, Acesulfame Potassium, Carrageenan, Cellulose Gum, Sucralose, L-Carnitine, Taurine, Zinc Sulfate, Ferrous Sulfate, Niacinamide, d-Alpha-Tocopheryl Acetate, Calcium Pantothenate, Manganese Sulfate, Thiamine Hydrochloride, Pyridoxine Hydrochloride, Copper Sulfate, Riboflavin, Vitamin A Palmitate, Folic Acid, Chromium Chloride, Sodium Molybdate, Potassium Iodide, Sodium Selenate, Phylloquinone, Biotin, Vitamin B12, and Vitamin D3.

Corn maltodextrin for the carbs, whey and casein for protein, fish oil and MCT for fat. Then a lot of vitamins, minerals and additives.

I think the biggest improvements I can see right away are:

1. Carb source should be sugar based.

2. Marine oil should be eliminated completely.

3. Different saturated fat source for fat as opposed to MCT.

4. Eliminate all PUFA from "less than 1%" list.

5. Eliminate carrageenan and cellulose gum.

6. I'm sure the quality of the vitamins and minerals are very questionable.

Can anyone see any changes they would make if you could reformulate yourself?

You can read my brothers story here:

Support for Sean Heeney's Accident, organized by Sean Heeney

On May 18th, 2022, while driving home, a driver mistakenly pulled out in front of Sean… Ryan Heeney needs your support for Support for Sean Heeney's Accident

www.gofundme.com

(Not sure if we're allowed to post links like that here but I can delete it from the post if not).

It was a nightmare at times but we learned a lot being in at that ICU for a month and a half. From our experience, emergency medicine here in the West is very impressive in some ways (we're in Florida), but as expected the nutrition, even in trauma centers, is still in the dark ages it seems.

It seems like hospitals consider that particular formula the best unfortunately. I agree with all your points completely but the main problem with saturated fats is they are basically solid at room temperature so it would be challenging to incorporate them into a liquid formula. Surely someone could figure out a work around somehow?
The best way I know to view it at this time is that it’s better than no food at all (but not much)! I’m definitely glad he’s out now though. Perhaps have him start on a low pufa diet? It seems like a lot of things done in hospitals are subtly harmful and most of the workers don’t realize it. :/

 

[Michaelk3]

That formula is probably healthier than what I've seen in my ICU. We use Vital HP or Nepro which are solely based from sunflower and canola oils. Literally second or third ingredients. Patients given these are known for having tube feed poops, which look identical to the liquid formula...

 

[xeliex]

Hello there - I wish you and your family a good recovery.

I worked as an ICU dietitian for 10 years. Most tube-feeding formulas can sustain life well enough with no problems. What Michaelk3 said is correct. I hate that they include so much fish oils in these formulas now.

Depending on his health and tolerance, you can probably make your own feeding formulas with your own ingredients. The key will be flushing the tube and ensuring it's clean to prevent clogs. This can be as simple as milk and honey with a capsule of b vitamins dissolved in the mix. You can also blenderize in the mix all kinds of nutrients, just be careful of overly fibrous foods.

If possible, try to do bolus feeds if he is not doing that already. That depends on his stability. But it should be the goal to stop the trickle feeds at some point.

Yes, sadly all tube feedings given in hospitals that I am aware of, suck. Pick your poison. If you ask for Jevity or Promote, you will get no fish oils but vegetable oils. Perhaps rub vitamin E on him few times a day.

 

[Rinse & rePeat]

Hello there - I wish you and your family a good recovery.

I worked as an ICU dietitian for 10 years. Most tube-feeding formulas can sustain life well enough with no problems. What Michaelk3 said is correct. I hate that they include so much fish oils in these formulas now.

Depending on his health and tolerance, you can probably make your own feeding formulas with your own ingredients. The key will be flushing the tube and ensuring it's clean to prevent clogs. This can be as simple as milk and honey with a capsule of b vitamins dissolved in the mix. You can also blenderize in the mix all kinds of nutrients, just be careful of overly fibrous foods.

If possible, try to do bolus feeds if he is not doing that already. That depends on his stability. But it should be the goal to stop the trickle feeds at some point.

Yes, sadly all tube feedings given in hospitals that I am aware of, suck. Pick your poison. If you ask for Jevity or Promote, you will get no fish oils but vegetable oils. Perhaps rub vitamin E on him few times a day.

Rubbing vitamin E on a patient without the doctors knowledge can be problematic as it thins the blood.