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126 C. Deana et al.
3. Della Rocca G, Vetrugno L, Tripi G, et al. Liberal or restricted fluid administration: are we
ready for a proposal of a restricted intraoperative approach? BMC Anesthesiol. 2014;14:62.
https://doi.org/10.1186/1471-2253-14-62. PMID: 25104915; PMCID: PMC4124502.
4. Mundi MS, Patel JJ, Martindale R. Body composition technology: implications for the ICU.
Nutr Clin Pract. 2019;34:48–58.
5. Lopez-Ruiz A,
sarcopenia index and images studies. Curr Opin Clin Nutr Metab Care. 2020;23(5):302–11.
https://doi.org/10.1097/MCO.0000000000000673. PMID: 32657790.
6. Kyle UG, Bosaeus I, De Lorenzo AD, et al. Bioelectrical impedance analysis–part I: review of
principles and methods. Clin Nutr. 2004;23:1226–43.
7. Moonen HPFX, Van Zanten ARH. Bioelectric impedance analysis for body composition
measurement and other potential clinical applications in critical illness. Curr Opin Crit Care.
2021;27(4):344–53. https://doi.org/10.1097/MCC.0000000000000840. PMID: 33967207;
PMCID: PMC8270506.
8. Seoane F, Abtahi S, Abtahi F, et al. Mean expected error in prediction of total body water: a true
accuracy comparison between bioimpedance spectroscopy and single frequency regression
equations. Biomed Res Int. 2015;2015:656323.
9. Mulasi U, Kuchnia AJ, Cole AJ, et al. Bioimpedance at the bedside: current applications,
limitations, and opportunities. Nutr Clin Pract. 2015;30(2):180–93. https://doi.org/10.1177/
0884533614568155. Epub 2015 Jan 22. Erratum in: Nutr Clin Pract. 2015;30(4):589. PMID:
25613832.
10. Lukaski HC. Evolution of bioimpedance: a circuitous journey from estimation of physiological
function to assessment of body composition and a return to clinical research. Eur J Clin Nutr.
2013;67(suppl 1):S2–9.
11. Matthie JR. Bioimpedance measurements of human body composition: critical analysis and
outlook. Expert Rev Med Devices. 2008;5(2):239–61.
12. Khalil SF, Mohktar MS, Ibrahim F. The theory and fundamentals of bioimpedance analysis in
clinical status monitoring and diagnosis of diseases. Sensors (Basel). 2014;14(6):10895 – 928.
https://doi.org/10.3390/s140610895. PMID: 24949644; PMCID: PMC4118362.
13. Malbrain ML, Huygh J, Dabrowski W, et al. The use of bio-electrical impedance analysis (BIA)
to guide fluid management, resuscitation and deresuscitation in critically ill patients: a bench-tobedside review. Anaesthesiol Intensive Ther. 2014;46:381 –91.
14. Kumar S, Dutt A, Hemraj S, et al. Phase angle measurement in healthy human subjects through
bio-impedance analysis. Iran J Basic Med Sci. 2012;15:1180–4.
15. Norman K, Stobäus N, Pirlich M, et al. Bioelectrical phase angle and impedance vector
analysis – clinical relevance and applicability of impedance parameters. Clin Nutr. 2012;31
(6):854–61. https://doi.org/10.1016/j.clnu.2012.05.008. Epub 2012 Jun 12. PMID: 22698802.
16. Barbosa-Silva MCG, Barros AJD, Wang J, Heymsfield SB, et al. Bioelectrical impedance
analysis: population reference values for phase angle by age and sex. Am J Clin Nutr.
2005;82:49–52. https://doi.org/10.1093/ajcn.82.1.49.
17. Kyle UG, Bosaeus I, De Lorenzo AD, Deurenberg P, ESPEN, et al. Bioelectrical impedance
analysis-part II: utilization in clinical practice. Clin Nutr. 2004;23(6):1430–53. https://doi.org/
10.1016/j.clnu.2004.09.012. PMID: 15556267.
18. Lorenzo AD, Andreoli A. Segmental bioelectrical impedance analysis. Curr Opin Clin Nutr
Metab Care. 2003;6(5):551–5.
19. Ismael S, Savalle M, Trivin C, et al. The consequences of sudden fluid shifts on body
composition in critically ill patients. Crit Care. 2014;18(2):R49. https://doi.org/10.1186/
cc13794. PMID: 24666889; PMCID: PMC4057272.
20. Russell JA, Rush B, Boyd J. Pathophysiology of septic shock. Crit Care Clin. 2018;34:43–61.
https://doi.org/10.1016/j.ccc.2017.08.005.
21.
Shen Y, Huang
patients with negative fluid balance: a retrospective cohort study. Crit Care. 2017;21:104.
https://doi.org/10.1186/s13054-017-1692-3.
Kashani K. Assessment of muscle mass in critically ill patients: role of the
X, Zhang W. Association between fluid intake and mortality in critically ill
11 Bioelectrical Impedance Vector Analysis in Critically Ill Patients 127
22. Lee J, de Louw E, Niemi M, et al. Association between fluid balance and survival in critically ill
patients. J Intern Med. 2015;277(4):468–77. https://doi.org/10.1111/joim.12274. Epub 2014
Jun 27. PMID:
23. Cordemans C, De laet, I., Van Regenmortel, N., et al. Fluid management in critically
the role of extravascular lung water, abdominal hypertension, capillary leak, and fluid balance.
Ann Intensive Care. 2012;2(Suppl 1):S1. https://doi.org/10.1186/2110-5820-2-S1-S1.
24. Cihoric M, Kehlet H, Højlund J, et al. Bioimpedance spectroscopy fluid analysis in acute highrisk abdominal surgery, a prospective clinician-blinded observational feasibility study. J Clin
Monit Comput. 2023;37(2):619–27. https://doi.org/10.1007/s10877-022-00934-x. Epub 2022
Nov 4. PMID: 36333575; PMCID: PMC9638275.
25. Pinsky MR, Cecconi M, Chew MS, et al. Effective hemodynamic monitoring. Crit Care.
2022;26:294. https://doi.org/10.1186/s13054-022-04173-z.
26. Myatchin I, Abraham P, Malbrain MLNG. Bio-electrical impedance analysis in critically ill
patients: are we ready for prime time? J Clin Monit Comput. 2020;34(3):401–10. https://doi.
org/10.1007/s10877-019-00439-0. Epub 2019 Dec 5. PMID: 31808061; PMCID:
PMC7223384.
27. Jones SL, Tanaka A, Eastwood GM, et al. Bioelectrical impedance vector analysis in critically
ill patients: a prospective, clinician-blinded investigation. Crit Care. 2015;19(1):290. https://doi.
org/10.1186/s13054-015-1009-3. PMID: 26260579; PMCID: PMC4531396.
28. Samoni S, Vigo V, Reséndiz LI, et al. Impact of hyperhydration on the mortality risk in
critically ill patients admitted in intensive care units: comparison between bioelectrical impedance vector analysis and cumulative fluid balance recording. Crit Care. 2016;20:95. https://doi.
org/10.1186/s13054-016-1269-6. PMID: 27060079; PMCID: PMC4826521.
29. Chua HR, Xiang L, Chow PY, et al. Quantifying acute changes in volume and nutritional status
during haemodialysis using bioimpedance analysis. Nephrology (Carlton). 2012;17:695–702.
30. Massari F, Iacoviello M, Scicchitano P, et al. Accuracy of bioimpedance vector analysis and
brain natriuretic peptide in detection of peripheral edema in acute and chronic heart failure.
Heart Lung. 2016;45(4):319–26. https://doi.org/10.1016/j.hrtlng.2016.03.008. Epub 2016 Apr
23. PMID: 27117421.
31. Forni LG, Hasslacher J, Joannidis M. Bioelectrical impedance vector analysis in the
critically ill: cool tool or just another ‘toy’? Crit Care. 2015;19:387. https://doi.org/10.1186/
s13054-015-1110-7. PMID: 26556282; PMCID: PMC4641377.
32. Basso F, Berdin G, Virzì GM, et al. Fluid management in the intensive care unit: bioelectrical
impedance vector analysis as a tool to assess hydration status and optimal fluid balance in
critically ill patients. Blood Purif. 2013;36:192–9. http://www.karger.com?10.1159/000356366
33. Vetrugno L, Tritapepe F, Ventin M, et al. Combined echocardiography and lung ultrasound in
shocked patient. In: Robba C, Messina A, Wong A, Vieillard-Baron A, editors. Basic ultrasound
skills “head to toe” for general intensivists. Lessons from the ICU. Cham: Springer; 2023.
https://doi.org/10.1007/978-3-031-32462-8_23.
34. Puthucheary ZA, Rawal J, McPhail M, et al. Acute skeletal muscle wasting in critical illness.
JAMA. 2013;310(15):1591–600. https://doi.org/10.1001/jama.2013.278481. Erratum in:
JAMA. 2014;311(6):625. Padhke, Rahul [corrected to Phadke, Rahul]. PMID: 24108501.
35. Deana C, Gunst J, De Rosa S, et al. Bioimpedance-assessed muscle wasting and its relation to
nutritional intake during the first week of ICU: a pre-planned secondary analysis of Nutriti
Study. Ann Intensive Care. 2024;14(1):29. https://doi.org/10.1186/s13613-024-01262-w
PMID:
36. van Gassel RJJ, Baggerman MR, van de Poll MCG. Metabolic aspects of muscle wasting during
critical illness. Curr Opin Clin Nutr Metab Care. 2020;23(2):96–101. https://doi.org/10.1097/
MCO.0000000000000628. PMID: 31904602; PMCID: PMC7015189.
37. Vanhorebeek I,
2020;46(4):637–53. https://doi.org/10.1007/s00134-020-05944-4. Epub 2020 Feb 19. PMID:
32076765; PMCID: PMC7224132.
38. Herridge MS, Tansey CM, Matté A, Canadian Critical Care Trials Group, et al. Functional
disability 5 years after acute respiratory distress syndrome. N Engl J Med. 2011;364(14):
1293–304. https://doi.org/10.1056/NEJMoa1011802. PMID: 21470008.
24931482; PMCID: PMC4265574.
ill patients:
38367198; PMCID: PMC10874356.
Latronico N, Van den Berghe G. ICU-acquired weakness. Intensive Care Med.
.
128 C. Deana et al.
39. Beaudart C, Bruyère O, Geerinck A, Belgian Aging Muscle Society (BAMS), et al. Equation
models developed with bioelectric impedance analysis tools to assess muscle mass: a systematic
review. Clin Nutr ESPEN. 2020;35:47–62. https://doi.org/10.1016/j.clnesp.2019.09.012. Epub
2019 Nov 15. PMID: 31987121.
40. Kim D, Sun JS, Lee YH, et al. Comparative assessment of skeletal muscle mass using
computerized tomography and bioelectrical impedance analysis in critically ill patients. Clin
Nutr. 2019;38(6):2747–55. https://doi.org/10.1016/j.clnu.2018.12.002. Epub 2018 Dec
8. PMID: 30612851.
41. Lee SY, Ahn S, Kim YJ, et al. Comparison between dual-energy X-ray absorptiometry and
bioelectrical impedance analyses for accuracy in measuring whole body muscle mass and
appendicular skeletal muscle mass. Nutrients. 2018;10(6):738. https://doi.org/10.3390/
nu10060738. PMID: 29880741; PMCID: PMC6024648.
42. Reintam Blaser A, Rooyackers O, Bear DE. How to avoid harm with feeding critically ill
patients: a synthesis of viewpoints of a basic scientist, dietitian and intensivist. Crit Care.
2023;27(1):258. https://doi.org/10.1186/s13054-023-04543-1. PMID: 37393289; PMCID:
PMC10314407.
43. Danielis M, Mattiussi E, Piani T, Nutriti Study Group, et al. Diarrhoea and constipation during
artificial nutrition in intensive care unit: a prospective observational study. Clin Nutr ESPEN.
2023;57:375–80. https://doi.org/10.1016/j.clnesp.2023.07.007.
44. Singer P, Blaser AR, Berger MM, et al. ESPEN practical and partially revised guideline: clinical
nutrition in the intensive care unit. Clin Nutr. 2023;42(9):1671–89. https://doi.org/10.1016/j.
clnu.2023.07.011. Epub 2023 Jul 15. PMID: 37517372.
45. Hashizume N, Tanaka Y, Yoshida M, et al. Resting energy expenditure prediction using
bioelectrical impedance analysis in patients with severe motor and intellectual disabilities.
Brain and Development. 2019;41(4):352–8. https://doi.org/10.1016/j.braindev.2018.11.003.
Epub 2018 Nov 28. PMID: 30501961.
46. Nicoletti CF, Camelo JS Jr, dos Santos JE, et al. Bioelectrical impedance vector analysis in
obese women before and after bariatric surgery: changes in body composition. Nutrition.
2014;30(5):569–74. https://doi.org/10.1016/j.nut.2013.10.013. Epub 2013 Oct 31. PMID:
24698348.
47. Moonen HP,
Hermans AJ, Jans I, et al. Protein requirements and provision in hospitalised
COVID-19 ward and ICU patients: agreement between calculations based on body weight and
height, and measured bioimpedance lean body mass. Clin Nutr ESPEN. 2022;49:474–82.
https://doi.org/10.1016/j.clnesp.2022.03.001. Epub 2022 Mar 4. PMID: 35623854; PMCID:
PMC8895677.
Part II
Nutrition Support, Pharmaconutrition
and Special Considerations
Chapter 12
Enteral and Parenteral Feeding: How
to Choose the Route
Andrea Pezzana, Michela Zanardi, Luca De Carli, and Davide Colombo
Introduction
Artificial nutrition has undergone a remarkable evolution throughout history, with its
origins tracing back to ancient Egyptian practices documented around 3500 BC.
From these early methods of endorectal nutrition utilizing egg and milk preparations,
to advancements in the twentieth century, the landscape of artificial nutrition has
transformed significantly. In the late twentieth century, technological breakthroughs,
particularly in the development of lipid emulsions for intravenous administration,
heralded a transition from enteral to parenteral nutrition. However, the recognition of
short- and long-term complications associated with parenteral nutrition prompted a
critical reassessment, highlighting the importance of enteral nutrition when feasible.
This chapter delves into the contemporary dynamics of enteral versus parenteral
nutrition in intensive care settings, emphasizing the physiological advantages of
enteral nutrition when the gastrointestinal tract remains accessible. It meticulously
examines the considerations for commencing artificial nutrition, encompassing
indications, therapeutic objectives, and vigilant monitoring.
Supplementary Information The online version contains supplementary material available at
https://doi.org/10.1007/978-3-031-66541-7_12.
A. Pezzana · M. Zanardi · L. De Carli
Clinical Nutrition
e-mail: andrea.pezzana@aslcittaditor ino.it; michela.zanardi@aslcittaditorino.it;
luca.decarli@aslcittaditorino.it
D. Colombo (
Anesthesia and Intensive Care Department, SS Trinità Hospital – ASL Novara, Borgomanero,
Italy
Health Science Department, Eastern Piedmont University, Novara, Italy
e-mail: davide.colombo@med.uniupo.it
Author(s), under exclusive license to Springer Nature Switzerland AG 2024
© The
A. Cotoia et al. (eds.), Nutrition, Metabolism and Kidney Support,
https://doi.org/10.1007/978-3-031-66541-7_12
Department, ASL Città di Torino, Torino, Italy
✉)
131
132 A. Pezzana et al.
Furthermore, the chapter provides detailed insights into the initiation of enteral
access, including nasogastric and nasojejunal tubes, and elucidates discussions on
post-pyloric nutrition and gastrostomy placement methods and indications. Enteral
nutrition emerges as the primary choice due to its physiological compatibility,
diminished complication rates, and cost-effectiveness, while parenteral nutrition is
reserved for scenarios where enteral routes are unfeasible.
The importance of individualized and modulated nutrition strategies is accentuated, harnessing both enteral and parenteral routes to address the dynamic caloric
necessities of patients in the intensive care unit. The following sections delve into the
historical perspective of artificial nutrition, contemporary practices, and the nuanced
considerations guiding enteral and parenteral nutrition in critical care settings.
Historical Perspective
The genesis of artificial nutrition can be traced back to practices documented in
ancient Egyptian papyri around 3500 BC, which detailed endorectal nutrition techniques utilizing preparations derived from eggs and milk. Similar therapeutic strategies were described in Indian and Chinese texts centuries later. The elucidation of
blood circulation by William Harvey in 1628 marked a pivotal step toward the
discovery of parenteral nutrition. However, the majority of advancements in enteral
and parenteral feeding, including physio-pathological insights, techniques, solutions, and formulas, occurred in the twentieth century with the introduction of
innovative procedures. The first documentation of post-pyloric tube placement
dates to 1910, while 1916 marks the true commencement of enteral nutrition,
evidenced by early administrations akin to contemporary continuous enteral nutrition practices. The exigencies of emergency surgery during the Second World War
precipitated the widespread adoption of surgical techniques for creating enteral
accesses such as gastrostomy and jejunostomy. The evolut ion of artificial nutrition
saw significant improvements in device design, particularly with the introduction of
polyurethane and silicone materials. Research initiatives driven by the necessity to
develop high-caloric, low-residue meals for astronauts culminated in the formulation
of elementary and semi-elementary enteral nutrition formulas, which swiftly found
clinical applications. The recognition of the importance of micronutrients, including
trace elements and vitamins, dates to the 1940s. The availability of innovative highconcentration products for parenteral nutrition, administered via venous catheters in
large veins, led to a shift towards parenteral nutrition from the late 1970s onwards
[
approach in artificial nutrition practice, particularly with the advent of lipid emulsions for intravenous use. However, growing awareness of the potential short- and
long-term complications associated with parenteral nutrition prompted a
reevaluation. Understanding the intestinal physiology during fasting, along with its
anatomical and functional vulnerabilities and loss of immunomodulatory barrier
function, renewed interest in enteral nutrition as the primary choice whenever the
Initially met with skepticism, parenteral nutrition became the preferred
1, 2].
12 Enteral and Parenteral Feeding: How to Choose the Route 133
gastrointestinal system remained functional. In agreement with most scientific societies, BAPEN (The British Association for Parenteral and Enteral Nutrition) asserts
that enteral nutrition is generally preferred over parenteral nutrition due to its
physiological compatibility, simplicity, cost-effectiveness, and reduced complexity.
The subsequent cultural and scientific transition was driven by a gradual accumulation of knowledge regarding the possib
with increasing recognition of its potential short- and long-term complications
3]. Most significantly, advancements in understanding the physiology of the intes-
[
tine during fasting, its anatomical and functional challenges, and the compromise of
its immuno-modulating barrier function underscored the clinical and scientific
preference for enteral nutrition as the primary choice whenever the gastrointestinal
system remained partially practicable and usable [4]. As affirmed by numerous
scientific societies, including BAPEN (The British Association for Parenteral and
Enteral Nutrition), enteral nutrition is generally favored over parent eral nutrition due
to its superior physiological compatibility, simplicity, cost-effectiveness, and
reduced complexity [
5].
ilities and limitations of parenteral nutri tion,
Enteral Versus Parenteral Nutrition Nowadays
As discussed in previous sections, the significance of nutrition in critically ill
patients is underscored by increasingly robust evidence. This aspect becomes particularly critical in patients experiencing prolonged hospitalization and severe catabolic states. Only about 40% of patients can orally ingest sufficient nutrients during
their stay in the intensive care unit (ICU), and even in these cases, the intake often
needs supplementation to cover estimated calor ie and protein requirements. In such
scenarios, the initiation of medical nutri tion therapy (MNT), especially through
enteral nutrition (EN) and parenteral nutrition (PN), must be considered among the
therapeutic options. Both are medical interventions that necessitate three prerequisites before initiation: (1) a relevant indication, (2) a defined therapeutic goal, and
(3) continuous monitoring. Artificial nutrition in the ICU is warranted when there’s
an anticipation that the patient cannot orally ingest sufficient nutrients to meet at least
70% of their requirements from day 3 to day 7. In such cases, artificial nutrition
should commence prom ptly, within 48 h of admission. Enteral nutrition is the
preferred choice when the gastrointestinal tract is accessible and functional. It is
more physiological, associated with fewer complications (metabolic, septic, electrolytic, thrombotic), and more cost-effective. The gastrointestinal tract serves crucial
roles beyond digestion and absorption; it performs complex secretory, metabolic,
and barrier functions. Additionally, it plays a significant role in immune system
development and defense. Extended absence of food leads to intestinal atrophy,
which may contribute to bacterial translocation, systemic inflammatory responses,
and compromised immunity. Intestinal rest, once advocated, is no longer
recommended today except in rare conditions. Stimulation of the gastrointestinal
tract through enteral nutrition may help preserve intestinal function.
134 A. Pezzana et al.
Table 12.1 Situation that might contraindicate or limit the beginning
Inability to gain access
Hemodynamically unstable shock with tissue hypoperfusion (despite hydration and vasopressor
amine therapy)
Intractable vomiting or diarrhea
Uncontrolled, life-threatening hypoxemia, hypercapnia, or acidosis
Bowel occlusion of mechanic origin
Active gastrointestinal bleeding
Bowel ischemia
High-flow intestinal fistula (if reliable access to the feed distal to the fistula cannot be obtained)
Abdominal compartment
Gastric aspirate v
syndrome
olume >500 ml/6 h
of EN [6–11]
Contraindications for initiating EN in the ICU include hemodynamically unstable
shock, uncontrolled hypoxemia, intestinal obstruction, active gastrointestinal bleeding, intestinal ischemia, abdominal compartment syndrome, and high-flow intestinal
fistulas. When EN is not tolerated due to complications like diarrhea and vomiting, it
may compromise the patient’s nutritional status. Guidelines recommend using
gastric access as the standard approach for ini
tiating EN. Nasogastric tubes (NGT)
are commonly used, with polyurethane and silicone materials recommended for their
flexibility and resistance to stomach acid. Proper positioning of NGTs is crucial and
often confirmed radiologically. Postpyloric nutrition, particularly duodenal nutrition,
is recommended for patient’s intolerant to gastric nutrition despite optimization of
prokinetic therapy and those at high risk of aspiration. Nasojejunal tubes (NJT) come
in various types, each with its advantages and limitations (Table 12.1).
In cases where long-term enteral nutrition (EN) of 30 days or
more is planned,
gastric or jejunal access of long duration is indicated. Early placement of percutaneous gastrostomies lowers the risk of aspiration compared to NGTs and allows for
better nutritional support. Contraindications to gastrostomy placement include
severe coagulopathy, previous gastrectomy, severe ascites, and others. Percutaneous
endoscopic gastrostomy (PEG) is the primary technique for gastrostomy placement,
offering various approaches based on patient needs [
12, 13].
Parenteral nutrition
(PN) is preferred in patients for whom the enteral route is impractical or insufficient
to meet nutritional requirements. EN and PN are considered equivalent regarding
risk and outcome benefits. Low-dose enteral nutrition may also be effective in
maintaining enterocyte trophism. Contraindications to PN include severe hyperglycemia, electrolyte abnormalities, and volume overload. PN can be administered via
central or peripheral venous access, with central venous catheters (CVCs) typically
used for prolonged administration. In ICU patients, PN via peripheral access is not
recommended due to insufficient caloric and protein delivery and the risk of phlebitis. Instead, central venous access is preferred for PN administration [
14, 15, 16].
12 Enteral and Parenteral Feeding: How to Choose the Route 135
Conclusions
In summary, EN and PN are not viewed as distinct routes anymore but rather
complementary methods to meet patient caloric needs. They can be administered
independently or concurrently based on patient requirements, providing a versatile
and adaptable therapeutic approach in critical care settings.
References
1. Harkness L. The history of enteral nutrition therapy: from raw eggs and nasal tubes to purified
amino acids and early postoperative jejunal delivery. J Am Diet Assoc. 2002;102:399–404.
2. Vassilyadi F, Panteliadou A-K, Panteliadis C. Hallmarks in the history of enteral and parenteral
nutrition: from antiquity to the 20th century. Nutr Clin Pract. 2013;28:209–17.
3. Domínguez-Cherit G, Borunda D, Rivero-Sigarroa E. Total parenteral nutrition. Curr Opin Crit
Care. 2002;8:285–9.
4. Kreymann KG, Berger MM, Deutz NEP, et al. ESPEN guidelines on enteral nutrition: intensive
care. Clin Nutr. 2006;25:210–23.
5. The British Association for Parenteral and Enteral Nutrition (BAPEN). Enteral and parenteral
nutrition. The British Association for Parenteral and Enteral Nutrition; 2004. https://www.
bapen.org.uk. Accessed 19 Feb 2024.
6. Singer P, Blaser AR, Berger MM, et al. ESPEN guideline on clinical nutrition in the intensive
care unit. Clin Nutr. 2019;38:48–79.
7. Berger MM. Critical care nutrition therapy for non-nutritionists. Cham: Springer; 2018.
8. Singer P. Nutrition in intensive care medicine: beyond physiology. Basel: Karger Medical and
Scientific Publishers; 2013.
9. Wischmeyer PE. Overcoming challenges to enteral nutrition delivery in critical care. Curr Opin
Crit Care. 2021;27:169–76.
10. Thibault R, Bear DE, Fischer A, Montejo-González JC, Hiesmayr M, Tamási P, Uyar M, de
Waele E, Weber-Carstens S, Singer P. Implementation of the ESPEN guideline on clinical
nutrition in the intensive care unit (ICU): it is time to move forward!: a position paper from the
“nutrition in the ICU” ESPEN special interest group. Clin Nutr ESPEN. 2023;57:318–30.
11. Reintam Blaser A, Starkopf J, Alhazzani W, et al. Early enteral nutrition in critically ill patients:
ESICM clinical practice guidelines. Intensive Care Med. 2017;43:380–98.
12. Wei M, Ho E, Hegde P. An overview of percutaneous endoscopic gastrostomy tube placement
in the intensive care unit. J Thorac Dis. 2021;13:5277–96.
13. Rahnemai-Azar AA, Rahnemaiazar AA, Naghshizadian R, Kurtz A, Farkas DT. Percutaneous
endoscopic gastrostomy: indications, technique, complications and management. World J
Gastroenterol. 2014;20:7739–51.
14. Cotogni P. Management of parenteral nutrition in critically ill patients. Pediatr Crit Care Med.
2017;6:13–20.
15. Pittiruti M, Hamilton H, Biffi R, MacFie J, Pertkiewicz M, ESPEN. ESPEN guidelines on
parenteral nutrition: central venous catheters (access, care, diagnosis and therapy of complications). Clin Nutr. 2009;28:365–77.
16.
Ziegler TR.
Parenteral nutrition in the critically ill patient. N Engl J Med. 2009;361:1088–97.
Chapter 13
Enteral Nutrition Overview and Formula
Selection Considerations
Cinzia di Venos a
Enteral Nutrition
The critically ill patient, afflicted by a multitude of severe pathologies such as sepsis,
trauma, burns, and conditions like multiple organ failure (MOF) and acute respiratory distress syndrome (ARDS), faces a profound insufficiency in one or more vital
functions. This challenging clinical scenario triggers a cascade of metabolic and
hormonal imbalances, creating a pronounced state of hypercatabolism. This heightened metabolic activity results in significant deficiencies of both macro and
micronutrients. The complexity of these interrelated pathophysiological processes
underscores the critical nature of nutritional support in the comprehensive care and
management of critically ill patients, aiming to address the unique challenges posed
by their intricate health conditions [1]. Patients who require a stay in the intensive
care
unit (ICU) of more than 48 h, with prolonged life support, are at greatest risk of
malnutrition. The supply of exogenous nutrients through the early onset of EN can
attenuate or even reverse some of these pathophysiological cascades, helping to limit
the catabolic state, preventing intestinal villous atrophy, enterocyte apoptosis,
inflammatory infiltration, dysbiosis, and impairment of intestinal immune
functions [2].
The preferential and early use of the enteral route in critically ill patients compared to intestinal rest is now recommended by all the most recent guidelines [3–
5]. Enteral nutrition (EN) must be started at a low dose within 24–48 h of admission
intensive care, reaching the energy/protein goal progressively and not before the
to
first 48–72 h to avoid overnutrition.
Supplementary Information The online version contains supplementary material available at
https://doi.org/10.1007/978-3-031-66541-7_13.
C. di Venosa (
Department of Anesthesia and Intensive Care, UO Anestesia e Rianimazione II, Policlinico di
Bari, Bari, Italy
© The
A. Cotoia et al. (eds.), Nutrition, Metabolism and Kidney Support,
https://doi.org/10.1007/978-3-031-66541-7_13
✉)
Author(s), under exclusive license to Springer Nature Switzerland AG 2024
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