22/02/2026
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For many years, fibre in the ICU has been approached with caution. The concern has often been around feeding intolerance or the rare risk of non occlusive mesenteric ischaemia. However, emerging evidence is challenging this fear.
Critical illness disrupts the gut microbiome, leading to dysbiosis and a reduction in short chain fatty acids, particularly butyrate. Butyrate plays a key role in fuelling colonocytes, maintaining the gut barrier, and supporting the protective mucus layer. Without it, gut integrity weakens, inflammation increases, and recovery may be delayed.
Providing soluble and insoluble fibre through enteral nutrition can help restore short chain fatty acid production. This supports immune modulation, promotes gut defence, and improves gastrointestinal tolerance. Studies have shown reduced feeding intolerance, lower incidence of C. difficile infection, and shorter hospital stays in patients receiving fibre containing formulas compared to fibre free feeds.
Importantly, the risk of bowel ischaemia remains very low in appropriately selected patients. When used thoughtfully and monitored closely, fibre can offer significant clinical benefit.
In critical care, nutrition is not just supportive care. It is therapeutic. Fibre provision, when clinically appropriate, may be one of the simplest ways to protect the gut and improve outcomes in ICU patients.
Dietetics PatientOutcomes
