Enteral feeding, even when the gut does not feel very good?

Abstract

Purpose of reviewTo summarize knowledge on the gut function in relation to enteral nutrition. Recent findingsThe gut is certainly suffering during critical illness but our understanding of the exact mechanisms involved is limited. Physicians at bedside are lacking tools to identify how well or bad the gut is doing and whether the gut is responding adequately to critical illness. Sensing nutrition as a signal is important for the gut and microbiome. Enteral nutrition has beneficial effects for the gut perfusion and function. However, early full enteral nutrition in patients with shock was associated with an increased number of rare but serious complications.

Gastrointestinal failure, big data and intensive care

“…In a large, multicenter, data analysis study (more than 15 000 ICU patients) [16 ▪ ] comparing patients who experienced gastrointestinal intolerance to those who did not, gastrointestinal intolerance occurred mainly in the first week after admission, was associated with lower energy and protein intake, and mainly with increased length of ventilation, length of stay and mortality. So, it seems that gastrointestinal intolerance is very frequent in critical illness [17] and requires a careful analysis to define its characteristics. Therefore, any gastrointestinal intolerance needs to be diagnosed and should be managed to address the medical nutritional support needs.…”

The need for biomarkers to determine response to enteral nutrition during and after critical illness: an update

“…altered neurohumoral feedback and pancreatic response with the more continuous, low rate flow of nutrients arriving in the small bowel [8]…”

Gastrointestinal function in critically ill patients

“…The relationship between the gastrointestinal tract and critical illness is bidirectional. An acute and severe illness or injury can cause gastrointestinal dysfunction [1], with any physiological process that the gastrointestinal tract performs, including motility, secretory, endocrine, metabolic, digestive and absorptive processes may be impacted [2,3]. These disturbed physiological processes occur anywhere from the esophagus to the distal large intestine [2][3][4].…”

“…An acute and severe illness or injury can cause gastrointestinal dysfunction [1], with any physiological process that the gastrointestinal tract performs, including motility, secretory, endocrine, metabolic, digestive and absorptive processes may be impacted [2,3]. These disturbed physiological processes occur anywhere from the esophagus to the distal large intestine [2][3][4]. In parallel, gastrointestinal dysfunction during critical illness is independently associated with poorer outcomes from the illness or injury itself [5].…”

“…To assist with diagnosis and monitoring of severity and response to treatment there is considerable interest in developing sophisticated monitoring systems that provide real time assessment of gastrointestinal motility [14]. However, until continuous gastrointestinal function monitoring systems are validated and commercially available, monitoring for gastrointestinal dysfunction in the intensive care unit, outside of the research setting, relies on clinical signs [3,[16][17][18].…”