Iatrogenic causes

Failure to initiate feeding

Before initiating nutritional support, the patient must be hemodynamically stable and adequately oxygenated. However, even after the patient has been stabilized, feeding may be delayed for a further 12 to 48 h for three common reasons:

1. feed not prescribed;

2. poor understanding of the urgency of nutritional support;

3. late prescription of total parenteral nutrition when enteral nutrition is poorly tolerated.

Failure to feed patients in the first few days in the ICU will be most harmful to the already malnourished patient whose nutrition is of paramount importance. The consequences may be much less marked in the well-nourished septic patient.

Insufficient daily delivery of enteral nutrients

If fluid must be restricted, the first source of fluid input to be decreased or stopped is often the feed. Furthermore, enteral feed is often prescribed by volume (or calories), and regular cessation for drug delivery or routine tube aspiration, for example, results in underdelivery that is rarely corrected.

Drug-related causes

Opiates and sedatives cause gastric stasis by decreasing smooth muscle contraction and may further decrease absorption by causing both biliary spasm and reduced gastric secretions.

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