Enteral nutrition in critically ill patients

ABSTRACT

Critical illness, stress, and surgery place increased demands on the body's nutritional requirements. These conditions promote a catabolic state and negative nitrogen balance. Nutritional problems are common in critically ill patients. Nutritional supplementation affords the opportunity of slowing down or stopping the catabolic process, restoring nitrogen balance, and preventing malnutrition. Enteral nutrition preserve the integrity of the gastrointestinal mucosa and enhance immune function. Early enteral nutrition administration to critically ill patients can decrease the number of infectious complications, length of stay and mortality. However, early enteral nutrition in the critically ill is often limited by gastroparesis, which impairs gastric emptying, thereby promoting gastroesophageal reflux and aspiration pneumonia. However, Early enteral nutrition is the treatment of choice with an A level of recommendation for some authors. A total of two hundred critically ill adult patients were enrolled in the study. Daily 18-hrs enteral nutrition via a 14F gastric tube was initiated either immediately after stabilization in group I, or later than 48hrs after admition in group II. Residual gastric volume was measured every 6hrs, and enteral nutrition was discontinued if exceed 300ml or vomiting occurred. Nutritional outcome measures included the percentage of the goal rate achieved during the study period, volume ratio, and gastrointestinal complications rate. Clinical outcomes included the incidence of ventilator associated pneumonia, multiple organ failure score, the duration of mechanical ventilation, and the length of ICU stay. Overall, the evidence suggests that early enteral feeding is beneficial to critically ill patients. In our study early intervention was associated with shorter duration of mechanical ventilation and ICU stay. Patients in the early feeding group had less sever form of MOF, and decreased infectious complications and mortality. The early institution of nutritional support and the use of enteral nutrition optimize nutritional status of the patient and reduce complications associated with bowel rest resulting in improved clinical outcomes in critically ill patients