enteral nutrition ICU ICU management May 9, 2022

Enteral feeding

Nutrition in critical care mainly advocates for early enteral feeding. Despite general early nutrition (EEN) recommendations, malnutrition associated with induced deficiency disease is nearly ubiquitous in most ICUs worldwide. The challenges of enteral nutrition in critical care are:

  • feeding with vasopressors
  • feeding the untrained patient with neuromuscular organ blockers (NMBAs)
  • feeding in the prone position
  • essential for measuring organ process needs of a new generation Indirect Measuring Device (IC)

Vasopressor Nutrition

The gut’s central role in critical care is thought to be related to the rapid loss of the gut’s traditional microbial ecology or microbiome, known as dysbiosis, which leads to increased gut porosity and activation of the gut system and the resulting general inflammation.

These factors are thought to drive systemic inflammation that leads to gut-related downstream organ pathologies and multiple organ failure (MOF) in patients in the ICU. The priority for vasopressor nutrition is nonocclusive visceral killing or intestinal anemia due to increased demands for gut chemicals on the opposite side of delivery.

Unfortunately, there are limited reliable clinical indicators that allow early and correct diagnosis, but underutilized markers such as increased gastric residual volume (GRV) and unexplained increase at the start of feeding are helpful. Despite these concerns, most of the above information implicates possible early-onset clinical outcomes inadequately resuscitated, lactate-reducing, or traditional patients receiving stable or decreasing vasopressor doses.

Enteral nutrition stationary nutrition with neuromuscular blockers

Skeletal muscle is controlled by the action of neurotransmitters on the nicotinic acetylcholine receptors at the neuromuscular junctions, while muscle strain is controlled by the action of acetylcholine at the muscarinic receptors. Previous information indicates that NMBAs have no effect on gastric worm formation following a nut bolus.

A recent study by a similar analysis group examining NES in patients receiving vasopressors examined outcomes in NES versus LEN in ventilated patients undergoing ongoing NMBA treatment. This study evaluated 2,340 eligible patients, of whom 378 patients (16%) received ENS. No important difference in length of stay in the intensive care unit (LOS) or length of mechanical ventilation was observed between teams.

Feeding enteral nutrition in patients in the prone position: This use has become much more common as a result of SARSCoV2 infection, resulting in an increasing number of patients with severe AKI.


One of the most important reasons for the lack of stress in the provision of improved nutrition in post-ICU patients is the lack of objective information on energy requirements, which are expected to change throughout the disease. Various studies have shown that the prognostic formulas developed to calculate the technology in intensive care patients does not appear to be correct or clinically relevant.

Recently, it has become clear that critical care physicians must be objective in EN activities by indirect measurement (IQ) since any over-or undernutrition is associated with higher ICU mortality.