A guide to enteral nutrition in intensive care units: 10 expert tips for the daily practice.

Jean-Charles Preiser, Yaseen M Arabi, Mette M Berger, Michael Casaer, Stephen McClave, Juan C Montejo-González, Sandra Peake, Annika Reintam Blaser, Greet Van den Berghe, Arthur van Zanten, Jan Wernerman, Paul Wischmeyer

Journal: Critical care (London, England) 2022;25(1):424

PMID: 34906215

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Abstract

The preferential use of the oral/enteral route in critically ill patients over gut rest is uniformly recommended and applied. This article provides practical guidance on enteral nutrition in compliance with recent American and European guidelines. Low-dose enteral nutrition can be safely started within 48 h after admission, even during treatment with small or moderate doses of vasopressor agents. A percutaneous access should be used when enteral nutrition is anticipated for ≥ 4 weeks. Energy delivery should not be calculated to match energy expenditure before day 4-7, and the use of energy-dense formulas can be restricted to cases of inability to tolerate full-volume isocaloric enteral nutrition or to patients who require fluid restriction. Low-dose protein (max 0.8 g/kg/day) can be provided during the early phase of critical illness, while a protein target of > 1.2 g/kg/day could be considered during the rehabilitation phase. The occurrence of refeeding syndrome should be assessed by daily measurement of plasma phosphate, and a phosphate drop of 30% should be managed by reduction of enteral feeding rate and high-dose thiamine. Vomiting and increased gastric residual volume may indicate gastric intolerance, while sudden abdominal pain, distension, gastrointestinal paralysis, or rising abdominal pressure may indicate lower gastrointestinal intolerance.

Address: Erasme University Hospital, Université Libre de Bruxelles, 808 Route de Lennik, 1070, Brussels, Belgium. [email protected].; Intensive Care Department, College of Medicine, King Saud Bin Abdulaziz University for Health Sciences and King Abdullah International Medical Research Center, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia.; Adult Intensive Care, Lausanne University Hospital, CHUV, 1011, Lausanne, Switzerland.; Clinical Department and Laboratory of Intensive Care Medicine, Department of Cellular and Molecular Medicine, Katholieke Universiteit Leuven, Leuven, Belgium.; Department of Medicine, University of Louisville School of Medicine, Louisville, KY, USA.; Intensive Care Medicine, Hospital Universitario, 12 de Octubre, Instituto de Investigación imas12, Madrid, Spain.; Department of Intensive Care Medicine, The Queen Elizabeth Hospital, Woodville, SA, Australia.; Department of Critical Care Research, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia.; Department of Intensive Care Medicine, Lucerne Cantonal Hospital, Lucerne, Switzerland.; Department of Anaesthesiology and Intensive Care, University of Tartu, Tartu, Estonia.; Ede and Division of Human Nutrition and Health, Gelderse Vallei Hospital, Wageningen University and Research, Wageningen, The Netherlands.; Division of Anaesthesiology and Intensive Care Medicine, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden.; Department of Anesthesiology and Surgery, Duke University School of Medicine, Durham, NC, USA.

DOI: 10.1186/s13054-021-03847-4

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MeSH Terms: Critical Illness, Enteral Nutrition, Food, Formulated, Humans, Intensive Care Units, Residual Volume