Enteral Feedings in Hospitalized Patients: Early versus Delayed Enteral Nutrition EARLY ENTERAL FEEDING

EARLY ENTERAL FEEDING T he successful administration of parenteral nutrition (PN) in the late 1960s and 1970s provided clinicians a way to feed patients with significant loss of intestinal mass or function who would otherwise starve. In the 1980s and early 1990s, laboratory and clinical data demonstrated that there were benefits gained when nutrition is delivered via the gastrointestinal tract rather than parenterally (1–5). Simultaneously, clinicians noted that most of the “ileus” that occurs in patients remains limited to the colon and the stomach (6), while the intestine remains capable of absorbing and processing those nutrients if delivered into the small intestine (7,8). As a result, the concept of “resting the bowel” or to bypass the “ileus” through the use of PN has been replaced with the concept of providing enteral nutrition (EN) whenever the gastrointestinal tract is functional (1–2,4–5). “Starving the gut” is no longer a standard of practice in the critically ill or injured patient, or even in disease states such as pancreatitis. Many studies and meta-analyses address the “PN or EN?” issue and conclude that EN results in fewer infectious complications and possibly shorter hospital stays under some conditions (1–5,9). However, the question of “How early should (and can) we feed?” in order to gain these benefits remains controversial. Many of the meta-analyses analyzing this issue have compared patients receiving PN to those on early or late delivery of EN and have failed to answer the question of how soon feeding must be started in order to benefit the patient (2–5,9). This review attempts to address those issues. NUTRITION ISSUES IN GASTROENTEROLOGY, SERIES #79