Table 3 Summary of the main recommendations from the ESPEN guidelines for enteral nutrition of critically ill patients. Adapted from: [76].
From: Metabolic changes after polytrauma: an imperative for early nutritional support
| Recommendations | |
|---|---|
| Indications and application of enteral nutrition (EN) | All patients who are not expected to be on a full oral diet within three days. |
| The expert committee recommends that haemodynamically stable critically ill patients who have a functioning gastrointestinal tract should be fed early (<24 h) using an appropriate amount of nutrition. | |
| Exogenous energy supply (kcal): | |
| • 20–25 kcal/kg body weight/day during the acute and initial phase of critical illness. | |
| • 25–30 kcal/kg body weight/day during the anabolic recovery phase, | |
| Consider parenteral administration of metoclopramide or erythromycin in patients with intolerance to enteral feeding (e.g. with high gastric residuals). | |
| Route of administration | Use EN in all patients who can be fed via the enteral route. |
| There is no significant difference in the efficacy of jejunal versus gastric feeding in critically ill patients. | |
| Avoid additional parenteral nutrition in patients who tolerate EN and can be fed to the target values. | |
| Consider careful parenteral nutrition in patients intolerant to EN. | |
| Type of formula | Whole protein formulae are appropriate in most patients, since peptide-based formulae have not shown clinical advantages. |
| "Immunonutrition": | |
| Glutamine should be added to standard enteral formula in all trauma patients and burn patients. | |
| Formulae enriched with nucleotides and fatty acids are superior to standard enteral formulae in trauma patients, patients with ARDS, and patients with mild, but not severe, sepsis (APACHE II score < 15) | |
| Patients with very severe illness who do not tolerate more than 700 ml enteral formulae per day should not receive an immune-modulating formula. |
