Enteral nutrition can often be started early in a patient in the intensive care unit (ICU). Blaser et al listed indications for delaying enteral nutrition until clinical problems have resolved. The authors are from the European Society of Intensive Care Medicine (ESICM).
Indications for a delay in the initiation of enteral nutrition:
(1) uncontrolled shock
(2) uncontrolled hypoxemia, hypercapnia and/or acidosis
(3) uncontrolled gastrointestinal bleeding
(4) high gastric residual volume (gastric aspirate > 500 mL in 6 hours)
(5) bowel ischemia
(6) bowel obstruction
(7) abdominal compartment syndrome
(8) high-output intestinal fistula without reliable distal feeding access
where:
• Using a naso-jejunal tube may negate the impact of high gastric residuals.
• Enteral nutrition is feasible in a patient receiving ECMO.
Additional issues:
(1) Enteral nutrition should not be started after abdominal trauma until the continuity of the intestines is confirmed.
Enteral nutrition can be attempted in most patients in the ICU; however, it may be started at reduced volumes. The goal should not be to meet total energy expenditure needs. Delivering more than energy needs may be harmful and should be avoided.
