When people leave the intensive care unit (ICU), they often struggle to eat enough food by mouth because they’re still weak and recovering. This study looked at 90 patients to understand how they ate their meals and what happened when hospitals used feeding tubes longer. Researchers found that patients who got tube feeding for longer periods actually ate less food by mouth, even though they got enough total nutrition from combining tube feeding and regular meals. The study suggests that the way hospitals manage nutrition during recovery might affect how much patients eat on their own.

The Quick Take

  • What they studied: How much food ICU survivors eat at each meal and whether using feeding tubes longer changes how much they eat by mouth
  • Who participated: 90 adults who spent at least 3 days in the ICU and were using feeding tubes when they left. About 24 were studied before a new nutrition plan was introduced, and 66 were studied after.
  • Key finding: Patients who used feeding tubes for longer periods ate less food by mouth, but their total nutrition (from both tube feeding and regular meals) was actually better. Patients ate about the same amount at breakfast, lunch, and dinner.
  • What it means for you: If you or a loved one is recovering from critical illness, the way hospitals manage feeding tubes might affect how quickly you return to eating regular food. This suggests doctors should think carefully about how long to use feeding tubes, as longer use may reduce appetite for regular meals.

The Research Details

This study compared two groups of ICU survivors during their first 14 days of recovery on a regular hospital ward. The first group (24 patients) was studied before hospitals implemented a new nutrition plan, and the second group (66 patients) was studied after the new plan was put in place. Researchers carefully tracked everything these patients ate and drank, including food they ordered, food they actually consumed, and nutrition from feeding tubes. They looked at patterns across breakfast, lunch, and dinner to see if patients ate differently at different times of day.

The researchers used statistical tests to compare how much energy (calories) and protein patients got from regular meals versus tube feeding. They also compared the two groups to see how the new nutrition plan changed eating patterns. This type of study is called a ‘before-and-after’ comparison, which helps researchers understand if a change in hospital practice actually makes a difference.

Understanding how ICU survivors eat during recovery is important because eating enough food helps people regain strength and leave the hospital sooner. If feeding tubes accidentally make people less interested in eating regular food, that could slow down recovery. This research helps hospitals figure out the best way to support nutrition without accidentally making patients depend too much on tubes.

This study has some strengths: it carefully tracked actual food intake rather than just guessing, it included a reasonable number of patients, and it compared two different approaches. However, it was conducted at only one hospital in the Netherlands, so results might be different in other places. The study didn’t randomly assign patients to different groups, which means some differences could be due to other factors we don’t know about. The researchers did measure actual food consumption rather than relying on patient memory, which makes the data more reliable.

What the Results Show

When looking at all the food that was ordered for patients, each main meal contained about 481-555 calories and 22-28 grams of protein. However, patients actually ate much less—only about 302-354 calories and 14-15 grams of protein per meal. Importantly, patients ate roughly the same amount at breakfast, lunch, and dinner, suggesting their bodies might have a limit for how much they can eat at one time during recovery.

When the hospital introduced the new nutrition plan that used feeding tubes for longer, something interesting happened: patients ate even less food by mouth. Before the new plan, patients used feeding tubes for about 3 days on average; after the plan, they used them for about 5 days. This longer tube feeding meant patients got less nutrition from regular meals.

However, the total nutrition picture improved. Patients receiving the new plan got about 2,115 calories per day total (combining tube feeding and regular meals) compared to 1,816 calories before. They also got 108 grams of protein daily instead of 91.5 grams. This means that even though patients ate less food by mouth, they weren’t going hungry because the tube feeding made up the difference.

The study found that the amount of food hospitals ordered for patients was fairly consistent across meals, but patients consistently ate only about 60% of what was offered. This suggests that weakness or lack of appetite during recovery limits how much patients can eat, not the availability of food. The even distribution of eating across meals suggests that ICU survivors may have a natural ‘per-meal limit’ during early recovery—they can only handle a certain amount at one time, regardless of which meal it is.

Previous research has shown that ICU survivors often don’t eat enough during recovery, which can slow their healing. This study adds new information by showing that feeding tubes might actually reduce how much patients eat by mouth, even though they help ensure adequate total nutrition. This finding is important because it suggests a trade-off: feeding tubes guarantee nutrition but may reduce the stimulus for patients to eat regular food.

This study was conducted at only one hospital in the Netherlands, so results might be different in other countries with different food cultures or hospital practices. The study didn’t randomly assign patients to receive different nutrition plans, so some differences between groups might be due to other factors. The study only followed patients for 14 days, so we don’t know what happens to eating patterns after that. Additionally, the study didn’t track why patients ate less—whether it was due to weakness, lack of appetite, difficulty swallowing, or other reasons. Finally, we don’t know if the patients who received the new nutrition plan were different in important ways from those who didn’t.

The Bottom Line

Based on this research, hospitals should carefully consider how long to use feeding tubes in ICU survivors, as longer use may reduce how much patients eat by mouth. However, feeding tubes are still important for ensuring adequate nutrition during early recovery. The best approach likely involves using feeding tubes strategically while also encouraging patients to eat regular food as soon as they’re able. Patients and families should discuss with their medical team when it’s appropriate to reduce tube feeding and increase regular meals. Confidence level: Moderate—this is one study at one hospital, so more research is needed.

This research is most relevant to ICU survivors, their families, and hospital staff managing nutrition during recovery. It’s particularly important for people recovering from serious illnesses or injuries that required ICU care. The findings may be less relevant to people recovering from minor illnesses or those who never needed ICU care. Healthcare providers should use this information to develop better nutrition plans for ICU survivors.

Based on this study, the first 14 days after leaving the ICU are critical for nutrition. Patients should expect gradual improvement in their ability to eat regular food over this period. Most patients in the study were eating some regular food within 2 weeks, though they may not have returned to normal eating amounts. Full recovery of normal eating patterns may take longer than 14 days.

Want to Apply This Research?

  • If you’re recovering from ICU care, track your daily calorie and protein intake from both regular meals and any tube feeding. Record the amount of food you ordered versus what you actually ate at each meal to identify patterns. This data helps your medical team adjust your nutrition plan.
  • Work with your healthcare team to gradually increase regular food intake while reducing tube feeding. Set small, achievable goals like finishing half your breakfast one day, then three-quarters the next day. Celebrate small victories in eating more regular food.
  • Monitor your energy levels and strength as your eating changes. Keep a simple log of meals eaten and how you felt afterward. Share this with your doctor weekly to adjust your nutrition plan. Track your weight weekly, as stable or improving weight suggests adequate nutrition.

This research describes patterns in one hospital and should not replace personalized medical advice from your healthcare team. Decisions about feeding tubes and nutrition during ICU recovery should be made with your doctor, who understands your specific medical situation. If you’re recovering from critical illness, work closely with your medical team and a registered dietitian to develop a nutrition plan tailored to your needs. This information is for educational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment.