title: Gastrointestinal tract access for enteral nutrition in critically ill and trauma patients: indications, techniques, and complications.
abstract: BACKGROUND
  Enteral nutrition (EN) is a widely used, standard-of-care technique for nutrition support in critically ill and trauma patients.
  
  
  OBJECTIVE
  To review the current techniques of gastrointestinal tract access for EN.
  
  
  METHODS
  For this traditional narrative review, we accessed English-language articles and abstracts published from January 1988 through October 2012, using three research engines (MEDLINE, Scopus, and EMBASE) and the following key terms: "enteral nutrition," "critically ill," and "gut access." We excluded outdated abstracts.
  
  
  RESULTS
  For our nearly 25-year search period, 44 articles matched all three terms. The most common gut access techniques included nasoenteric tube placement (nasogastric, nasoduodenal, or nasojejunal), as well as a percutaneous endoscopic gastrostomy (PEG). Other open or laparoscopic techniques, such as a jejunostomy or a gastrojejunostomy, were also used. Early EN continues to be preferred whenever feasible. In addition, evidence is mounting that EN during the early phase of critical illness or trauma trophic feeding has an outcome comparable to that of full-strength formulas. Most patients tolerate EN through the stomach, so postpyloric tube feeding is not needed initially.
  
  
  CONCLUSIONS
  In critically ill and trauma patients, early EN through the stomach should be instituted whenever feasible. Other approaches can be used according to patient needs, available expertise, and institutional guidelines. More research is needed in order to ensure the safe use of surgical tubes in the open abdomen.
authors.affiliation: Department of Surgery, Trauma Surgery Section, Hamad General Hospital (HGH), Hamad Medical Corporation, Doha, Qatar.
authors.forename: M
authors.initials: M
authors.lastname: Tuna
authors.affiliation: Department of Surgery, Trauma Surgery Section, Hamad General Hospital (HGH), Hamad Medical Corporation, Doha, Qatar. rlatifi@email.arizona.edu.|Department of Surgery, University of Arizona, Tucson, AZ, USA. rlatifi@email.arizona.edu.|Weill Cornell Medical School, Doha, Qatar. rlatifi@email.arizona.edu.
authors.forename: R
authors.initials: R
authors.lastname: Latifi
authors.affiliation: Department of Surgery, Trauma Surgery Section, Hamad General Hospital (HGH), Hamad Medical Corporation, Doha, Qatar.|Weill Cornell Medical School, Doha, Qatar.
authors.forename: A
authors.initials: A
authors.lastname: El-Menyar
authors.affiliation: Department of Surgery, Trauma Surgery Section, Hamad General Hospital (HGH), Hamad Medical Corporation, Doha, Qatar.
authors.forename: H
authors.initials: H
authors.lastname: Al Thani
keywords: Enteral nutrition; Feeding tube; Gastrojejunostomy; Gastrostomy; Nasojejunostomy; Percutaneous endoscopic gastrostomy
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