What is the preferred choice between formula feed and kitchen feed for Intensive Care Unit (ICU) patients?

Formula Feed vs Kitchen Feed in ICU Patients

Formula feed is preferred over kitchen feed (blenderized diets) for ICU patients due to nutritional consistency, reduced infection risk, and lower incidence of tube clogging. 1

Evidence Supporting Commercial Formula Feeds

• Kitchen-made (blenderized) diets are nutritionally inconsistent, have a short shelf-life, and carry a higher risk of infection through contamination with various microorganisms 1
• Commercial formula feeds provide consistent nutritional content and are specifically designed to meet the needs of critically ill patients 2
• Tube clogging is a significant concern with kitchen-made diets, which can interrupt nutritional delivery in critically ill patients 1
• For technical reasons related to tube clogging and infection risk, the European Society for Clinical Nutrition and Metabolism (ESPEN) guidelines explicitly recommend against using kitchen-made diets for tube feeding in the hospital setting 1

Benefits of Commercial Formula Feeds

• Commercial enteral formulas provide standardized macro and micronutrient content that can be selected based on patient needs 3
• Specialized therapeutic enteral formulas contain specific pharmaconutrients that may attenuate hyperinflammatory responses and enhance immune function 3
• Commercial formulas allow for more precise control of caloric and protein delivery, which is crucial in the ICU setting where requirements are often 25-30 kcal/kg/day and 1.3-2.0 g protein/kg/day 1
• Formula feeds can be selected based on specific patient needs (standard, high-protein, immune-modulating) 1

Types of Commercial Formulas for ICU Patients

• Whole protein formulas are appropriate for most ICU patients as no clinical advantage has been shown for peptide-based formulas 1
• Specialized formulas may be beneficial in specific situations:
  • Immune-modulating formulas (enriched with arginine, nucleotides, and omega-3 fatty acids) may benefit trauma patients and those with mild sepsis 1
  • Glutamine-supplemented formulas are recommended for burned and trauma patients 1
  • Formulas containing omega-3 fatty acids and antioxidants may benefit patients with ARDS 1

Special Considerations

• During the acute phase of critical illness, energy provision should be limited to 20-25 kcal/kg BW/day to avoid overfeeding 1, 2
• During recovery/anabolic phase, energy provision should be increased to 25-30 kcal/kg BW/day 1, 2
• Feeding should start at a low flow rate (10-20 ml/h) and increase gradually due to limited intestinal tolerance 1
• Target intake may take 5-7 days to achieve in critically ill patients 1

Common Pitfalls to Avoid

• Overfeeding during the acute phase of illness (>25 kcal/kg/day) may worsen outcomes 2
• Ignoring feeding intolerance can lead to abandonment of enteral nutrition altogether 2
• Failing to monitor for refeeding syndrome, especially when initiating nutrition in malnourished patients 2
• Hyper-alimentation (providing more energy than actually expended) should be avoided in critically ill patients 1

While home-made diets might be considered in the home care setting, the hospital environment—particularly the ICU—requires the standardization, safety, and reliability that commercial formula feeds provide 1.