Preliminary Evidence for a Medical Nutrition Therapy Protocol: Enteral Feedings for Critically Ill Patients

Metabolic and Nutrition Support in the Chronic Critical Illness Syndrome

“…15,81 EN is associated with a relatively low cost and complication rate, and provides a trophic stimulus to enterocytes, possibly reducing bacterial translocation. 82 Providing EN early can favorably modulate the immune and catabolic responses, preserve gastrointestinal integrity, and support wound healing.…”

Evidence-Based Practice Habits: Putting More Sacred Cows Out to Pasture

“…64 Published reports vary in providing guidance for what constitutes a high gastric residual, ranging from 150 mL to 500 mL of aspirate. 64,65,66,68,71,72 Best evidence suggests that a single high GRV should be monitored for the following hour, but enteral feeding should not be ceased or withheld for an isolated GRV greater than 250 mL. 65,68 Serial hourly elevated GRVs greater than 250 mL may require withholding enteral feeding for an hour in conjunction with evaluation for prokinetic agents to promote gastric motility and assessment of possible causes for decreased gastric tolerance, including a change in the patient's acuity.…”

“…No reliable clinical marker has been found for risk of aspiration, including GRV assessment. 65,68,72,76 Risk for aspiration is increased with hemodynamic instability, increased acuity or critical illness (eg, sepsis), altered level of consciousness, neurological compromise, sedation, and mechanical ventilation. Interventions to minimize aspiration include elevating the head of bed more than 30º, initiating continuous enteral feedings, using medications to promote gastric motility, and consideration of postpyloric feeding.…”

An Enteral Nutrition Protocol to Improve Efficiency in Achieving Nutritional Goals

“…1,4 • Protocols, algorithms, and clinical practice guidelines have been developed to standardize enteral feeding practice, and many have resulted in an improvement in the delivery of enteral feedings to patients. 1,6 Based on the findings of the literature review, the ICU clinical coordinator designed an enteral nutrition protocol order set to address and correct the challenges we faced with the traditional initiation and delivery of enteral feedings (see Figure-available online only at www.ccnonline.org).…”