Are there any real differences between enteral feed formulations used in the critically ill?
OBJECTIVE
We know that adequate nutritional support is essential in the treatment of critically ill patients, because it can, if applied appropriately, improve the clinical outcome. Increasing evidence seems to suggest that malnutrition itself is a predictor of poor outcome in intensive care, and significant underfeeding during intensive care stay increases the risk of bloodstream infections. The purpose of this review is to highlight recent advances in enteral nutrition in the critically ill adult patient.


RESULTS
Recent studies suggest that tight glycaemic control is associated with improved outcome. Enteral feeding should be encouraged, using simple feeding protocols, and started early if safe to do so. Gastric residual volumes do not correlate with the risk of aspiration, and therefore should be used with caution in feeding protocols. Conflicting evidence exists for supplementation with antioxidant and immunonutrition in the critically ill. Glutamine and fish oil/borage oil should be considered for burns patients and patients with adult respiratory distress syndrome, respectively.


CONCLUSIONS
This review offers information regarding the latest developments in nutritional support via the enteral route. Further research is needed to clarify the role of enteral supplements such as antioxidants and 'immune modulating substances'.
ICU Whiston Hospital and School of Clinical Science, University of Liverpool, Liverpool, UK. tbongers@liverpool.ac.uk
Thomas
T
Bongers
Richard D
RD
Griffiths
D000328:Adult; D003422:Critical Care / Q000379:methods*; D004750:Enteral Nutrition; D005526:Food, Formulated; D006801:Humans; D007362:Intensive Care Units; D012128:Respiratory Distress Syndrome / Q000628:therapy*