Guidelines for the Provision and Assessment of Nutritio Support Therapy in the Adult Critically Ill Patient

This section gives a description of the most commonly used monitors for tolerance to the entral nutrition. It likewise discusses the pertinent data that are important to the practice. The tolerance for EN of all patients must be monitored and all inappropriate cessation of the EN must be avoided at all cost. However, there are a number of factors that may affect the delivery of EN.

There is a tendency for health care providers who prescribe the formulation to under-order calories and as such, there are patients who only receive approximately 80% of what they deserve. The combination of under-ordering and inadequate delivery that results in the patients receiving only half of the target goal calories.

It is a fact that the intolerance accounts for approximately one-third of the time of cessation. There are also other reasons for cessation like the remaining NPO after midnight for the diagnostic tests and the procedures in another third of the patients.

Using enteral feeding protocols increases all percentage of goal calories provided and must be implemented. In the same way, all the patients that are placed on EN must be checked for risk of any aspiration. Aspiration is the most leading feared complications that EN can give to a patient.

All people who are at risk for aspiration may be detected by several factors which includes the use of nasoentric and endotracheal tube and the mechanical ventilation. There are many complications that may arise due to the use of enteral tube feedings and one of the effects is diarrhea. The diarrhea that being suffered by the ICU patient who is receiving EN must be investigated immediately.

E. Selection of Appropriate Enteral Formulation

When it comes to selecting the proper enteral formulation for the critically ill patient, the one in charge must first ascertain if the patient is one of the candidates for the specialty immune-modulating formulation. Patients more likely to display a more favorable outcome who would be a proper candidate for the use of ummune-modulating formulations include all people that are undergoing G1 surgery and trauma, and those that have head and neck cancer.

Numerous data suggest that adding amounts of pharmaconutrients to the enteral formulations gives many further benefits on the outcome of the patients rather than using the standard formula alone.  It is unfortunate though that there are a few studies that have discussed the effects of individual pharmaconutrients and their dosage. This literature was criticized greatly for the heterogeneity of the studies that are performed in a great range of ICU patient populations.

The multiple enteral formulations are said to be immune-modulating, but they considerable cange in their characteristics and the dosage of the individual components. There is no certainty as to whether or not the date from the studies that were published as well as their recommendations can be extracted in order to use the formulations that have not been evaluated in a formal way.

In order to receive the maximum therapeutic benefit from the immune-modulating formulations at about 50% to 60% of the goal energy requirements must be delivered. According to the studies, the benefit of EN as well as the added value of immune-modulating agents have an effect which is dose-dependent.

Patients who have the worst cases of diarrhea may gain some benefit from the use of the soluble fiber-containing formula and a small portion of peptide semi-elemental formulation. The laboratory data, the theoretical concepts as well as the expert opinions that support the use of the peptide enteral formulations however, large protective trials are not available to make this one a strong recommendation.


McClave, S., Martindale, R., Vanek, V., et., al. (2009). Guidelines for the Provision and            Assessment of Nutrition Support Therapy in the Adult Critically Ill Patient. Journal        of Parental and Enteral Nutrition (JPEN): Sage Publications, 33:277