Enteral nutrition in intensive care patients: a practical approach

Abstract

Severe protein-calorie malnutrition is a major problem in many intensive care (ICU) patients, due to the increased catabolic state often associated with acute severe illness and the frequent presence of prior chronic wasting conditions. Nutritional support is thus an important part of the management of these patients. Over the years, enteral nutrition (EN) has gained considerable popularity, due to its favorable effects on the digestive tract and its lower cost and rate of complications compared to parenteral nutrition. However, clinicians caring for ICU patients are often faced with contradictory data and difficult decisions when having to determine the optimal timing and modalities of EN administration, estimation of patient requirements, and choice of formulas. The purpose of this paper is to provide practical guidelines on these various aspects of enteral nutritional support, based on presently available evidence.

Comparison of complications attributable to enteral and parenteral nutrition in predicted severe acute pancreatitis: a systematic review and meta-analysis

“…Diarrhoea is a common complication of EN in the ICU (35,36) . Although it is rarely considered a life-threatening complication, diarrhoea may increase the risk of dehydration and incontinence, and thus increase the risk of wound infection as well as being burdensome to patients and nursing staff (37 -39) .…”

Insulin therapy in the intensive care unit should be targeted to maintain blood glucose between 4.4 mmol/l and 6.1 mmol/l

“…Nutritional guidelines were followed in the Leuven studies [2,11,34]. Enteral feeding was attempted as soon as possible when the patients were haemodynamically stable, but when the energy intake target could not be reached, parenteral feeding was given early to compensate for the deficit.…”

A Comparative Between the Supply and Energy Needs of Hospitalized Patients Under Enteral Nutritional Therapy

“…In another study, McClave 11 et al evaluated the supply of enteral nutrition only in ICU patients and found that they received an average of 52% of TEE, and that adequacy was approximately 78% in relation to the prescribed volume, significantly lower than the one found in the present study. Thus, according to the literature, the caloric intake offered to hospitalized patients in general is insufficient, which may be compromising the individuals' nutritional status and affecting and/or aggravating their prognosis [9][10][11]23 .…”

“…The type of diet or enteral product offered should be chosen based on the individual characteristics of each patient, and according to the needs generated by the pathologies from which they are affected 9,10 . Patients who are at risk of malnutrition are potential candidates for enteral nutritional therapy, since it allows for a more effective control of the patient's nutrition.…”

“…Several studies show that the caloric-protein needs of hospitalized patients are rarely reached in the supply of enteral nutrition, routinely reaching 70-80% of their needs. This issue may be related to the high caloric-protein malnutrition statistics pointed out by IBRANUTRI 9,12,15 . Numerous factors are identified as determinants of this inadequate nutritional supply, with the most frequent including: physiological factors of gastrointestinal intolerance, such as vomiting and diarrhea; mechanical complications; and fasting for surgeries and exams.…”