Nutrition

The prevalence of malnutrition is increasing in hospitalized patients due to the increasing age of the population treated in hospital and the development of advanced medical and surgical treatments for chronic debilitating diseases.

The positive consequences of enteral feeding however go beyond nutrition and extend to immune modulation, and possibly reduced bacterial translocation through the gut.

Enteric feeding is the preferred mode of nutritional support and should be considered in all patients as soon as possible.

Reference

Jolliet P et al.  Enteral nutrition in intensive care patients:  a practical approach.  Working group on nutrition and metabolism, European Society of Intensive Care.  Intensive Care Medicine 1998-24(8): 848-59.

Advantages

  • In some patient subgroups (trauma) early enteral feeding improves patient outcome

  • Enteral feeding helps retain gut integrity and reduce atrophic changes

  • May reduce the incidence of gastric erosions and stress ulceration

  • Cost effective:  cheaper than TPN!

  • Complications of enteral access for TPN are reduced (invasive procedures, infective risk).

 

Disadvantages

  • Regurgitation / aspiration (no difference gastric versus distal feeding)

  • Diarrhoea:  diarrhoea may be a result of osmotic load to the gut, however it is not the most likely reason for diarrhoea in critically ill patients, and other causes should be sought and excluded.

 

Indications

  • All intensive care patients with a secure airway and functioning gut should receive enteral feeding.

  • Patients admitted post surgical intervention should have the intention to feed discussed with the surgeon.

Page last reviewed: 14 May 2014
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