A 'gutsy move': tackling enteral feeding intolerance in critically ill patients.

摘要

There exists little dispute that in critically ill patients, enteral feeding is associated with improving clinical outcomes, minimizing infection-related complications, preserving gut epithelial cell mass and the function of gut-associated lymphoid tissue, and offering cost-saving benefits over parenteral feeding alone. Therefore, unless it is contraindicated, enteral nutrition (EN) is preferred over parenteral nutrition (PN) in critically ill patients. Nevertheless, it is rare that the implementation process for EN in these patients goes smoothly and uneventfully with caloric goals being met without setbacks or obstacles. Numerous prospective and retrospective clinical studies have shown that most intensive care unit (ICU) patients receiving EN never actually received target calories.Although interventional procedures and medication administration may interrupt the infusion of EN, the most common cause of EN infusion interruption is gastrointestinal (GI) intolerance. Up to 60% of ICU patients experience GI intolerance or motility disturbances, necessitating the transient cessation of EN infusion.8 The common symptoms of EN intolerance include elevated gastric residual volume (GRV), bloating, nausea, vomiting, abdominal distention, and diarrhea.