• Jean-Charles Preiser, Yaseen M Arabi, Mette M Berger, Michael Casaer, Stephen McClave, Juan C Montejo-González, Sandra Peake, Reintam BlaserAnnikaA0000-0003-1211-7372Department of Intensive Care Medicine, Lucerne Cantonal Hospital, Lucerne, Switzerland.Department of Anaesthesiology and Intensive Care, University of Tartu, Tartu, Estonia., Greet Van den Berghe, Arthur van Zanten, Jan Wernerman, and Paul Wischmeyer.
• Erasme University Hospital, Université Libre de Bruxelles, 808 Route de Lennik, 1070, Brussels, Belgium. jean-charles.preiser@erasme.ulb.ac.be.
• Crit Care. 2021 Dec 14; 25 (1): 424.

AbstractThe preferential use of the oral/enteral route in critically ill patients over gut rest is uniformly recommended and applied. This article provides practical guidance on enteral nutrition in compliance with recent American and European guidelines. Low-dose enteral nutrition can be safely started within 48 h after admission, even during treatment with small or moderate doses of vasopressor agents. A percutaneous access should be used when enteral nutrition is anticipated for ≥ 4 weeks. Energy delivery should not be calculated to match energy expenditure before day 4-7, and the use of energy-dense formulas can be restricted to cases of inability to tolerate full-volume isocaloric enteral nutrition or to patients who require fluid restriction. Low-dose protein (max 0.8 g/kg/day) can be provided during the early phase of critical illness, while a protein target of > 1.2 g/kg/day could be considered during the rehabilitation phase. The occurrence of refeeding syndrome should be assessed by daily measurement of plasma phosphate, and a phosphate drop of 30% should be managed by reduction of enteral feeding rate and high-dose thiamine. Vomiting and increased gastric residual volume may indicate gastric intolerance, while sudden abdominal pain, distension, gastrointestinal paralysis, or rising abdominal pressure may indicate lower gastrointestinal intolerance.© 2021. The Author(s).

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