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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

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.
  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.