Pharmacist-Led Nutritional Interventions Benefit Post-ICU Patients

With nutritional care being paramount in patients recovering from the intensive care unit (ICU), pharmacist-led interventions showed a clear benefit in improving post ICU care, according to a study published in Clinical Nutrition Open Science.¹

“The care for patients admitted to the ICU has made important progress over the last years due to better education, enhanced technology, and sophisticated devices, leading to a significant increase in ICU survival,” wrote authors of the study. “However, of those patients that survive, about 80% experience a new or worsened impairment of physical, psychological, or cognitive health, or a combination of these, also known as post intensive care syndrome (PICS).”

PICS can lead to a combination of challenges, including fatigue, dysphagia, muscle weakness, and delirium. In turn, these challenges have commonly presented the need for physical rehabilitation, cognitive training, and nutritional management. More specifically, nutritional care is significantly important in post-ICU care. Improved outcomes in post-ICU nutritional care have been known to strengthen muscle mass, promote recovery, and enhance wound healing.

Researchers explored the pharmacist’s overall place in the ICU and the role they can play in nutritional support. | image credit: Andrey Popov / stock.adobe.com

READ MORE: How Pharmacy Matches Perfectly With Nutrition

These nutritional challenges in the ICU have led to the common use of artificial nutrition. According to Kaiser Permanente, artificial nutrition in the inpatient setting includes a variety of methods for feeding and hydrating patients with food and water. While it’s not necessarily a method of feeding all inpatients, it can be facilitated through a tube from the nose to the stomach, a tube from the belly to the stomach, or an intravenous tube from the vein to the stomach.²

However, despite the importance of nutritional care in these scenarios, there are several ethical concerns and controversies surrounding artificial nutrition.

“There was a conceptual doubt about [artificial nutrition] being or not being a medical treatment, and it would be a form of nourishment, which constitutes primary care. For this reason, [artificial nutrition] has been an essential source of ethical concern and controversy,” wrote authors of a study published in Frontiers in Nutrition.³ “However, in 2021, the American Society for Parenteral and Enteral Nutrition (ASPEN) affirmed that [artificial nutrition] and hydration are medical treatments.”

With the acceptance of artificial nutrition as a medical treatment, providers commonly in ICUs, as well as pharmacists, are then typically called upon to facilitate treatment and conduct post-ICU nutritional care. Because of patients in the ICU and their potential for taking other medications on top of artificial nutrition, there is not a universally accepted approach for post-ICU nutritional management.

“The aim of this narrative review is to provide a general overview of the clinical pharmacist's role in the trajectory of the post-ICU patient in general, in the identification of pharmacotherapeutic concerns when combining artificial nutrition with other drugs in this phase,” continued authors of the current study.¹

Before delving into pharmacists as clinical support in post-ICU nutritional care, researchers explored the pharmacist’s overall place in the ICU and how they have shown capabilities in managing medications for patients with critical illnesses.

In the researchers’ exploration of previous studies on the topic, they uncovered the pharmacist’s authority in optimizing patients’ medications compared with other members of a multidisciplinary team. In the ICU specifically, pharmacists have demonstrated their ability to prevent adverse drug reactions, play a leading role in antimicrobial stewardship, and contribute to cost-effective prescribing when resources are scarce.

“A clinical pharmacist should not only play a role in the transition of medication care (reintroduction, reconciliation, education, and counseling) but should also play an important role in the nutritional support post-ICU, together with other health care professionals, the patients, and their family, as studies have shown that adequate nutritional support can contribute to a better patient outcome,” the authors wrote.¹

Throughout the researchers’ review, they highlighted the pharmacists’ role in nutritional management through 5 separate steps in an ICU stay. Pharmacists have demonstrated their ability to manage patients through medication reconciliation, review, administration, monitoring, and hospital discharge.

Now, with defined roles in the ICU and the term nutrition support pharmacist recently keyed, findings of the current study highlight the significant potential in pharmacists’ roles among multidisciplinary ICUs.

“Nutritional care is a cornerstone for patient recovery after an ICU stay,” they concluded.¹ “More attention towards documentation and communication of patients' nutritional needs, barriers to inadequate intake, and clarity of roles between the different health care workers in a [nutritional support team], in particular the pharmacist, is needed to guide future practice and improve outcomes in survivors of critical illness.”

READ MORE: Digestive Health Resource Center

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References

1. Rosseel Z, Wuyts SCM, Desmedt M, et al. Nutritional management of survivors of critical illness: the clinical pharmacists’ role. CNOS. 2025;62:127-138. https://doi.org/10.1016/j.nutos.2025.06.002

2. Artificial nutrition: what you should know. Kaiser Permanente. 2008. Accessed July 18, 2025. https://healthy.kaiserpermanente.org/content/dam/kporg/mhc/life-care-plan/pdfs/artificial-nutrition/Artificial-Nutrition-English-rev0115.pdf

3. Pereira AZ, da Cunha SFC, Grunspun H, et al. The difficult decision not to prescribe artificial nutrition by health professionals and family: bioethical aspects. Front Nutr. 2022 Mar 3;9:781540. doi: 10.3389/fnut.2022.781540.