When is the seriously ill patient ready to be fed?
BACKGROUND
After assessing the critically ill patient for risk of aspiration, the clinician still must decide if the patient is ready to be fed. The goal is to identify critically ill patients who are likely to tolerate enteral nutrition and attempt to minimize complications.


METHODS
A synthesis of the both clinical and animal studies to identify factors related to patient readiness for enteral nutrition.


RESULTS
The key issue to be resolved is adequacy of resuscitation and restoration of mesenteric perfusion. Currently, there is no reliable clinical tool to measure gut perfusion. The best indicators currently are stabilization of vital signs, decreasing fluid and blood requirements, normalization of the base deficit, and lactate and removal of inotropic or vasopressor support.


CONCLUSIONS
Most critically ill patients should be ready for enteral nutrition within 24 to 48 hours of intensive care unit admission. Critically ill patients who need catecholamine support, heavy sedation, or therapeutic neuromuscular blockade should probably not receive enteral nutrition until they have been stabilized.
Spain
David A
DA
Department of Trauma, Stanford University Medical Center, California 94305-5655, USA. dspain@stanford.edu
D016638:Critical Illness / Q000628:therapy*; D004750:Enteral Nutrition; D006801:Humans; D013997:Time Factors