Woien and Bjork developed an algorithm for starting nutritional support for a patient in the intensive care unit (ICU). The goal is to meet the nutritional targets for the patient. The authors are from Rikshospitalet-Radiumhospitalet HF National Hospital in Oslo, Norway.


Requirement: target volume of the enteric nutrition liquid in mL per hour to meet the patient's nutritional needs


The key metric is the residual gastric volume in mL. The goal is to avoid residual volumes > 200 mL. The authors aspirated the stomach to determine its volume, then reinjected it into the stomach. Ultrasonographic monitoring may be a less burdensome method.


The initial delivery is via a nasogastric tube with enteral nutrition supplied at 20 mL per hour.


Steps if the residual volume is > 200 mL per hour or if the patient does not tolerate the feeding:

(1) Slow the rate of infusion.

(2) Move the tip of the tube into the jejunum.

(3) Consider a percutaneous jejunostomy tube.

(4) Start total parenteral nutrition (TPN).


If the feedings are tolerated and the residual volume is < 200 mL, then increase the rate of administration slowly (by 20 mL per hour after a 4 hour interval) until the target delivery rate is reached.


Monitoring is done initially every 4 hours. If the feedings are tolerated then the monitoring can be gradually increased to 6, 8 and 12 hours.


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