ABSTRACT
Adequate nutrition is essential in patients who cannot eat and is particularly important for the critically ill patient. Adequate nutrition improves patient outcomes, frequently getting them through a stay in the intensive care units. Nutrition can be provided to a patient either intravenously (parenteral nutrition) or delivered by feeding tubes into the gastrointestinal tract (enteral nutrition). When the gastrointestinal tract is able to function, enteral nutrition (EN) is preferred over parenteral nutrition (PN) because there is less risk of sepsis and metabolic derangements.1 EN also promotes a healthier gut barrier, an important defense against ingested bacteria.2 There
10.1 Introduction .................................................................................................. 159 10.2 Indications for Enteral Feeding .................................................................... 160 10.3 Prophylactic Antibiotics for Enteral Access Procedures .............................. 160 10.4 Types of Endoscopic Enteral Access ............................................................ 160
10.4.1 Endoscopic Nasoenteric Access ....................................................... 160 10.4.2 Endoscopic Percutaneous Enteral Access ........................................ 162
10.4.2.1 Percutaneous Endoscopic Gastrostomy (PEG) .................. 162 10.4.3 Percutaneous Endoscopic Gastrostomy/Jejunostomy ....................... 162 10.4.4 Direct Percutaneous Jejunostomy ..................................................... 164
10.4.4.1 The Technique .................................................................... 165 10.5 Enteral Feeding following Feeding Tube Placement .................................... 166
10.5.1 The Decision for Tube Feeding ........................................................ 166 10.5.2 Nutrition Assessment ........................................................................ 167
10.6 Administration of Enteral Feedings ............................................................. 168 10.6.1 Advancing Feedings ......................................................................... 168 10.6.2 Interval versus Continuous Feedings ................................................ 168 10.6.3 Minimizing Aspiration Risk ............................................................. 170 10.6.4 So Now, What Do I Put In This Tube? ............................................. 170
10.6.4.1 Protein Modications ......................................................... 171 10.6.4.2 Immune Enhancing Nutrients ............................................ 171 10.6.4.3 Disease Specic Formulas ................................................. 171
10.7 Conclusions ................................................................................................... 172 References .............................................................................................................. 172
is growing evidence that EN should be used whenever possible and used early as in severe acute pancreatitis where, until recently, PN or prolonged fasting was commonly recommended. Increasingly a feeding tube or other enteral route is sought when a patient cannot eat in the setting of normal absorptive capability of the digestive tract.
