A day in the life of an ICU dietitian: nutrition as part of the critical care team
Starting the day: prioritising patient care
As an ICU dietitian, no two days are the same. Every patient brings a unique clinical challenge, and every nutrition plan is shaped by collaboration with the wider multidisciplinary team. Critical care nutrition is not just about prescribing a feed; it is about understanding the whole patient, their illness, their treatments, their recovery goals and how nutrition can support them throughout their ICU journey.
My day begins by triaging ICU admissions from the previous 24 hours. Our team of three dietitians covers three intensive care units at St George’s Hospital in Tooting: General ICU, Neuro ICU and Cardiothoracic ICU, as well as the Major Trauma Ward. We start by reviewing new admissions, screening clinical notes and identifying patients at nutritional risk who may benefit from dietetic input. We then balance these new referrals with the patients already under our care before catching up as a team to coordinate our workload.
Working as part of the multidisciplinary team
My first clinical meeting of the day is our Neuro ICU multidisciplinary rehabilitation round. This brings together occupational therapy, speech and language therapy, physiotherapy and dietetics alongside our specialist clinical nurse specialist. Together, we review each patient’s progress, discuss therapy input, agree priorities and set goals to support recovery. This conversation is invaluable in guiding which patients require dietetic review and ensuring nutrition goals align with wider rehabilitation plans. Our ICU medical colleagues will be starting their daily assessments at the same time so they are on hand for any additional questions we may have.
Another important part of my morning may involve reviewing patients requiring intravenous parenteral nutrition. These cases highlight the importance of teamwork, as decisions often require close coordination between ICU clinicians, gastrointestinal surgical teams, pharmacists and the nutrition team. With nutrition needing to be prescribed and ordered within specific timeframes, effective communication is essential to ensure patients receive the right support at the right time.
Understanding the whole patient
When assessing ICU patients, I look beyond their feed prescription. Many patients require nasogastric feeding because they are unable to eat or drink safely, perhaps due to mechanical ventilation, sedation, dysphagia or the severity of their illness. My assessment involves understanding their nutritional history, weight changes, malnutrition risk, muscle status, blood results, organ function and the treatments they are receiving.
Nutrition in ICU is complex. Energy can come not only from enteral feeds but also from medications such as propofol and intravenous fluids containing glucose. We calculate individual nutritional requirements using predictive equations or, where appropriate, indirect calorimetry. At St George’s, dietitians lead on the use of indirect calorimetry, a short measurement that involves connecting a device to the patient's ventilator to measure the patient’s resting energy expenditure. This helps us provide personalised nutrition and requires close collaboration with ICU nursing colleagues to ensure it's completed safely and appropriately.
Communication with patients and families
Communication is at the heart of everything we do. Where possible, we involve patients, families and relatives in discussions about nutritional care, considering personal preferences, allergies, intolerances, cultural and religious requirements. For patients who are unable to communicate, we document in ICU diaries, helping them later understand the care they received during a time when they may not have been awake or aware.
We work closely with nurses, doctors, physiotherapists, speech and language therapists and many others. Physiotherapists help us obtain accurate weights to guide our prescriptions, speech and language therapists support decisions around eating and drinking, and nursing colleagues help deliver and monitor nutrition plans at the bedside.
Beyond the bedside
Beyond direct patient care, ICU dietitians contribute to improving services through audit, education and research. I also have a wider role with the British Dietetic Association Critical Care Specialist Group, contributing to national projects and as one of the Dietetic representatives on the Intensive Care Society’s AHP Professional Advisory Group.
One team, one shared aim
Being an ICU dietitian means being part of a team where every professional brings a different perspective. Together, we combine our expertise with one shared aim: helping critically ill patients survive, recover and return to the things that matter most to them.
James Jackson
ICU Dietitian, St George's Hospital
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