Brain-injured critically ill patients admitted to the intensive care unit (ICU) go through an elevated metabolic rate and protein catabolism, leading to a high hazard of energy and protein deficits. Both are related to a higher rate of infectious complications, extended ICU and hospital duration of stay, unfavorable neurological outcomes, and higher mortality. Early enteral nutrition feed in ICU is suggested to improve outcomes and should be initiated within 48 h after admission to the ICU in hemodynamically stable patients. The properties of semi elemental feed in ICU might theoretically improve gastrointestinal tolerance in brain-injured patients, known to suffer gastroparesis.

Despite published guidelines, brain-injured critically ill patients are generally underfed and obtain insufficient energy and protein intake. Among the numerous reasons that have been advanced to explain this is intolerance of enteral nutrition feed in ICU, associated with impaired gastrointestinal mobility, that’s common in brain-injured critically ill patients. Gastroparesis and diarrhea during EN have been reported in, respectively, 20% and 70% of brain-injured critically ill patients. Gastroparesis and diarrhea would possibly alter nutrient absorption and make contributions to inadequate energy and protein intake and could lead physicians to consider interrupting EN.

The efficacy of semi elemental feed in ICU, whey hydrolyzed protein (WHP) diet has been stated in various nutritionally high-risk patient populations including – Crohn’s disease, short bowel syndrome, acute and chronic pancreatitis, cerebral palsy, cystic fibrosis, human immunodeficiency virus, cerebrovascular accidents, critically ill, and geriatrics. Collectively, the proof from the scientific literature shows that feeding with a semi-elemental diet plays as well or is better than parenteral or amino acid-based diets in terms of tolerance, digestion, and nutrient assimilation measures across numerous disorders conditions. In research, it has been found that, out of 100 patients receiving EN, 31 had GI intolerance requiring an average ICU live of 14.4 days versus 11.3 days for every affected person without GI intolerance. The model calculated that the semi elemental feed in ICU method was cost-saving instead of the standard formula whilst only 3 instances of GI intolerance were prevented per 100 sufferers (7% of GI intolerance instances avoided). In the American setting, the model predicts that preliminary use of semi-elemental rather than standard EN can bring about cost financial savings via the reduction in length of ICU stay if >7% of GI intolerance instances are avoided. Semi elemental compared to polymeric formula no longer improves daily energy consumption or gastrointestinal tolerance of enteral nutrition.

For more information, you can enroll to the ‘Role of Semi Elemental Feed in ICU : Current Evidence’ lecture by Dr. Harish Mallapura Maheshwarappa (MBBS, MD, DNB, IDCCM, DM, EDICM), here, https://docmode.org/role-of-semi-elemental-feed-in-icu-current-evidence-dr-harish-mallapura-maheshwarappa/