Gut Feeding in Critical Care

Bharesh Dedhia
Gut Feeding in Critical CareIntragastric feeding requires adequate gastric motility and emptying; a residual of > 150 mL is a relative contraindication to gastric feeding as the risk of aspiration is high. Nutrition support with TPN or small-bowel feeding is then appropriate. Postpyloric enteral feeding is often effective even in the presence of gastric atony and/or colonic ileus. For effective small-bowel feeding, simultaneous nasogastric decompression may be required. The presence of bowel sounds and the passage of flatus or stool are not necessary to initiate postpyloric enteral feeding. Secretory diarrhea may occur and is not an absolute indication to discontinue enteral feedings unless output exceeds 1,000 mL/d. Output in this range requires an evaluation.Enteral feeding is usually started with an elemental formula with reduced fat content at low rates until tolerance is determined. Rates may be advanced toward the goal every 8 h, as tolerated, as long as the gastric residual is low, and abdominal distension and pain are absent. Multiple vitamins need to be ordered separately. Caloric requirements are calculated as for TPN.BhareshDedhia