‘The SUN Initiative’: Do we have the scope to Scale Up Nutrition in the ICU?


Nutritional support is frequently neglected in a busy intensive care unit (ICU). Calorie and protein delivery to critically ill patients remains challenging. Continued monitoring and evaluation of nutritional provision is particularly important for patients receiving enteral (EN) or parenteral nutrition support in order to identify inadequacies and determine the scope to scale up nutrition relative to evidence-based clinical practice guidelines.


Prospective study of adult patients admitted to ICU of a tertiary-care institute during a period of 254 days. Feeding guided by a feeding protocol was evaluated in clinical practice whether prescribed feeding volumes correspond with administered quantities.


330 patients between 18 and 85 years old, with 109 females and 221 males were monitored. The daily median calorie and protein delivered were 1800 ± 727kcal (75%) and 78 ± 37.6gms (79.6%) respectively. The median percent delivery improved from 39% to 100% for energy and 35.6% to 100% for protein when the feed volume was increased from 25ml/hr to 100ml/hr (p<0.0001). However, significant improvement in energy and protein delivery was not observed when the hours of feeding increased from 16hours to 20hours, as there were 287 patients who were on 50ml/hr feeding for 20hours/day. Similarly, the median calorie delivery improved from 60.4% at 1-7days to 67.8% at 8-14days of feeding. The protein delivery improved from 64% at 1-7days to 72.9% at 8-14days of feeding. Optimal improvements in the delivery of prescribed calories and protein were hindered daily by feed interruptions. In total, there were 384 interruptions and the duration of interruptions recorded for 330 patients (254 patient days) was 3776 hours (mean: 14.9 h, range: 1-24 h).


Some of the causes for discrepancies between prescribed and received EN are unavoidable, but many are not, suggesting the need for careful review and possible alteration of existing EN practices. Findings from this study are important as they form the foundation for the development of evidence-based care that is badly needed to eliminate underfeeding in this large vulnerable Indian ICU population.