Should We Aim for Full Enteral Feeding in the First Week of Critical Illness?
Recent clinical trials have challenged the concept that aggressive full feeding as close to goal requirements as possible is necessary in the first week following admission to the intensive care unit. While the data suggesting that permissive underfeeding is better than full feeds are methodologically flawed, other data do indicate that in certain well-defined patient populations, outcomes may be similar. The most important issues for clinicians in determining optimal nutrition therapy for critically ill patients are to carefully determine nutrition risk and differentiate nutrition from nonnutrition benefits of early enteral feeding. Management decisions in the first week of hospitalization should be made in the context of both short- and long-term outcomes. Patients at highest nutrition risk may require advancement to goal feeds as soon as tolerated to maximize benefit from nutrition therapy.
Department of Medicine, University of Louisville, Louisville, Kentucky, USA samcclave@louisville.edu.
Stephen A
SA
McClave
Department of Surgery Medical College of Wisconsin, Milwaukee, Wisconsin, USA.
Panna
P
Codner
Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.
Jayshil
J
Patel
Department of Medicine, The Mayo Clinic, Rochester, Minnesota, USA.
Ryan T
RT
Hurt
Department of Medicine, Oklahoma University Health Sciences Center, Oklahoma City, Oklahoma, USA.
Karen
K
Allen
Department of Surgery, Oregon Health Sciences University, Portland, Oregon, USA.
Robert G
RG
Martindale
D003422:Critical Care / Q000379:methods*; D016638:Critical Illness; D002149:Energy Intake; D004750:Enteral Nutrition / Q000379:methods*; D006760:Hospitalization; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay; D009751:Nutritional Requirements; D009752:Nutritional Status; D013995:Time; D013997:Time Factors
critical care; critical illness; enteral nutrition; nutritional support; permissive underfeeding; trophic feeding; tube feeding