title: Gastric feeding as an extension of an established enteral nutrition protocol.
abstract: BACKGROUND
  Indiscriminate gastric feeding in ICU patients imposes unacceptable risks of aspiration. Believing that a subset of ICU patients can be fed safely via the stomach, we have developed a protocol to identify appropriate patients and guide the bedside clinician in how to safely and effectively feed via the stomach.
  
  
  METHODS
  A literature search was done to identify appropriate medical literature. High grade evidence along with local expert opinions were used to develop a protocol. This protocol has been refined and implemented.
  
  
  RESULTS
  Based on perceived risk of aspiration, patients are assigned enteral access (ie, stomach vs. distal post-pyloric). Enteral formula is selected based on patient characteristics. It is then advanced by a standard protocol with specific precautions while monitoring for symptoms of intolerance. Management of intolerance is dictated by the type and severity of intolerance.
  
  
  CONCLUSIONS
  We have implemented a gastric feeding into a subset of our ICU patients. Gastric feeding requires certain precautions but appears to be safe. With more experience and better understanding of the pathogenesis gastroparesis, we believe that most ICU patients should be able to safely feed into the stomach. This is logistically easier than post-pyloric feeding and offers physiologic advantages.
authors.affiliation: Department of Surgery, Louisiana State University Health Sciences Center, New Orleans, USA.
authors.forename: Alan B
authors.initials: AB
authors.lastname: Marr
authors.forename: Margaret M
authors.initials: MM
authors.lastname: McQuiggan
authors.forename: Rosemary
authors.initials: R
authors.lastname: Kozar
authors.forename: Frederick A
authors.initials: FA
authors.lastname: Moore