Key messages

• Whenever possible, enteral nutrition should be used in preference to parenteral nutrition.

• Early enteral nutrition has been shown to improve outcomes in some groups of critically ill patients.

• Enteral feed administration sets must be incompatible with those used for intravenous infusion.

• Many patients can be fed through a transpyloric feeding tube when intragastric feeding has failed.

• The value of newer expensive feeds supplemented with glutamine, arginine, nucleotides, omega-3 fatty acids, and other nutrients has still to be proved. Introduction

The place of nutritional support, both enteral and parenteral, is controversial. In many settings there is little evidence that patient outcome is improved, and the indications for enteral nutrition are not well defined. Nevertheless, it is clear that nutrients are needed for protein synthesis, for organ function, and to sustain life. Starvation causes delayed healing, impaired immunity, impairment of gut and muscle function with generalized weakness, and eventual death.

The need for intensive care often arises after a period of illness accompanied by poor nutrition and weight loss. Most patients needing intensive care are anorexic or unable to eat. They are also metabolically stressed by the severity of their illness, injury, or major surgery. Without nutritional support there is rapid loss of body weight and muscle mass, and this is not fully reversible even with full nutritional support.

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