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There are various enteral nutrition / feeding formulas used for adults in Europe and United States of America. The popularity of ICU feeding formulas is usually based on region, hospital, medical condition and individual needs. 

Enteral Nutrition Formula Types

Standard Formulas - Complete Protein
A standard tube-feeding formula is specifically formulated for individuals, both adults and children, who have normal digestion. These formulas provide all the necessary nutrients to support overall health. Some standard formulas can be used for both enteral feeding and as an oral supplement. They may also include additional ingredients like fiber to promote digestive health and manage bowel function.

Peptide Formulas - Semi-Elemental
Similar to standard formulas, peptide formulas are nutritionally complete, containing all essential nutrients required by the body. However, they differ in that certain components, such as proteins, are broken down into smaller components for easier digestion. Peptide formulas are particularly beneficial for individuals with digestive issues, including malabsorption, short bowel syndrome, inflammatory bowel disease, cystic fibrosis, and other conditions that hinder nutrient absorption. Due to their enhanced digestibility and absorption, they are well-suited for adults and children facing such challenges.

Specialized Formulas
Specialized enteral formulas cater to the unique nutritional needs of adults and children with specific conditions such as diabetes, kidney failure, respiratory disease, or liver disorders. Selecting the appropriate enteral formula should be done in consultation with a doctor or a dietitian who possesses knowledge of the various formulas available.

Formula Selection for Enteral Nutrition

The caloric content of enteral formulas ranges from 1.0 to 2.0 kcal/mL. These formulas consist of various sources of carbohydrates, proteins, fats, and micronutrients.

Carbohydrates
Carbohydrates typically contribute the majority of energy in enteral formulas, with standard/polymeric formulas providing 30-60% of energy from carbohydrates. Carbohydrate sources may include sucrose, fructose, corn syrup solids, or sugar alcohols. Carbohydrates in enteral formulas provide 4 kcal/gm.

Protein
Protein sources in standard/polymeric enteral formulas account for 10-25% of energy and may include milk protein, whey protein, casein, caseinates, or soy protein. Protein in enteral formulas provides 4 kcal/gm.

Fats
Fats contribute 10-45% of energy in standard/polymeric enteral formulas and may come from canola oil, corn oil, soy lecithin, safflower oil, and/or medium-chain triglycerides. Fats in enteral formulas provide 9 kcal/gm.

Micronutrients
Enteral formulas are designed to meet 100% of the adult Dietary Reference Intakes (DRIs) within a specified volume indicated on the nutrition label, typically ranging from 1,000-1,500 mL of formula.

Choosing an enteral nutrition formula should be based on factors such as nutrition assessment, physical assessment, GI function, overall medical condition (including medical history and metabolic abnormalities), and patient goals/outcomes.

Whenever possible, a standard enteral formula is preferred. Specialty formulas can be more costly, may not be covered by insurance, and might lack sufficient scientific evidence to support their use.

In addition to formula selection, other considerations for tube feeding include tube access, navigating insurance coverage, and monitoring the tolerance of the enteral nutrition regimen. For a comprehensive understanding of tube feeding, please refer to the full case study to ensure you have all the necessary information.

Enteral Nutrition Calculation methods

Please note that in some regions Anesthesiologists often use different methods to calculate adult patients enteral nutrition needs. In Europe the most popular ICU feeding calculation method was provided by ESPEN (European Society of Parenteral and Enteral Nutrition). In Germany - DGEM (German Society for Nutritional Medicine). In United States of America - ASPEN ((American Society of Parenteral and Enteral Nutrition).

Conclusion

We believe that in order to get the most optimal results, Anesthesiologist should evaluate situation clinically then choose a calculation method (which is promoted in his society) and then select an enteral nutrition feeding formula type which he thinks fits the best in current situation.

Currently (2023-06-05) in ENUCA enteral nutrition calculators (Both ESPEN and DGEM) we use the following list of enteral nutrition formulas. We always update this list on demand so if you do not find ICU formula you need, just write to us those three parameters (Name, Kcal and Protein quantities) and will try to add it within 1-24h time.