Unit
- Enteral Nutrition Definition: Enteral nutrition (EN) involves delivering liquid formula directly into the gastrointestinal tract via a tube when oral intake is inadequate or impossible. It preserves gut function and supports metabolic needs across acute and chronic care settings.
- Primary Indications: EN is indicated for patients with functional gastrointestinal tracts who cannot meet energy requirements orally. Common scenarios include dysphagia after stroke, critical illness, head and neck cancer, neurological conditions, and severe malnutrition.
- Contribution to Recovery: Early EN reduces infection rates, length of stay, and mortality in intensive care. It maintains gut barrier integrity, supports immune function, and prevents muscle wasting compared to parenteral nutrition.
- Patient Selection Criteria: Candidates must have a viable gut, no bowel obstruction, and ability to tolerate at least partial enteral feeding. Contraindications include diffuse peritonitis, intestinal ischemia, and severe short bowel syndrome.
- Timing of Initiation: In critically ill patients, EN should start within 24-48 hours of admission if hemodynamically stable. For non-critically ill patients, EN begins when oral intake is insufficient for more than 5-7 days.
- Types of Feeding Tubes: Short-term access uses nasogastric or nasoenteric tubes; long-term access requires gastrostomy or jejunostomy tubes. Selection depends on expected duration, gastric function, and aspiration risk.
- Route Considerations: Gastric feeding allows bolus delivery and uses stomach's reservoir capacity. Small bowel feeding (post-pyloric) is preferred for high aspiration risk, gastroparesis, or pancreatitis.
- Outcome Goals: EN aims to meet 60-80% of energy needs within 48 hours, achieve nitrogen balance, prevent weight loss/5% per month, and maintain functional status. Regular reassessment adjusts goals to changing clinical status.
- Monitoring and Complication Prevention: Regular monitoring includes gastric residual volumes, abdominal distension, bowel sounds, and signs of intolerance such as nausea or diarrhea. Tube placement should be confirmed before each use. Complications like aspiration, tube dislodgement, and clogging require prompt intervention to maintain therapy safety.
- Formula Selection Factors: Choice of formula depends on patient age, renal function, fluid status, and digestive capacity. Standard polymeric formulas suit most patients; semi-elemental or elemental formulas benefit those with malabsorption. Disease-specific formulas are available for diabetes, renal failure, or pulmonary conditions.
- Administration Methods: Feedings can be delivered continuously via pump, intermittently over 20 to 60 minutes, or as bolus using a syringe. Continuous infusion is preferred for small bowel feeding and critically ill patients to reduce intolerance. Intermittent and bolus methods mimic normal feeding patterns for stable patients.
- Transition to Oral Feeding: When oral intake improves, enteral feeding is gradually reduced while monitoring calorie and protein intake. Swallowing assessments and diet modifications support safe transition. Patients may require long-term nocturnal tube feeding to supplement daytime oral nutrition.
Terminology
- Enteral Nutrition
- Nutrition delivered through the gastrointestinal tract via a tube.
- Dysphagia
- Difficulty swallowing, a common indication for enteral feeding.
- Post-pyloric feeding
- Delivery of formula into the duodenum or jejunum, bypassing the stomach.
- Gastrostomy
- Surgical or percutaneous creation of a stoma into the stomach for tube placement.
Quick Revision
- Enteral nutrition is indicated when oral intake is insufficient but the gut is functional.
- Early initiation improves clinical outcomes in critical illness.
- Tube selection depends on therapy duration, gastric function, and aspiration risk.
- Outcome goals include meeting energy targets and preventing significant weight loss.