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Nutrition in Clinical Practice
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Reviews

Approach to Enteral Feeding in the PICU

Nilesh M. Mehta, MD, DCH

From the Division of Critical Care Medicine, Children's Hospital, Boston, Massachusetts.

Correspondence: Address correspondence to Nilesh M. Mehta, MD, DCH, Division of Critical Care Medicine, Children's Hospital, Boston, MA 02115; e-mail: nilesh.mehta{at}childrens.harvard.edu.

The pediatric intensive care unit (PICU) environment poses unique challenges to achieving enteral nutrition (EN) goals for the critically ill child. Nutrition support in the PICU is often in conflict with the complexity of care provided to acutely ill children. A significant proportion of eligible patients do not receive optimal enteral nutrition for avoidable reasons. Early institution of EN is recommended and the gastric route is preferred because of ease of administration and reduced costs compared with the transpyloric route. In patients with poor gastric emptying or in cases where a trial of gastric feeding has failed, transpyloric or postpyloric feeding may be used to decrease the risk of aspiration and to improve enteral feed tolerance. However, there is no evidence of benefit for routine use of small bowel feeding in all patients admitted to the PICU. The placement of blind nasoenteric feeding tubes can be technically challenging, is not without complications, and requires local expertise and experience for successful placement and maintenance. A protocolized approach to selecting the optimal route and advancing enteral feedings may optimize EN delivery. Institutional practice guidelines based on consensus, available evidence, and national guidelines may decrease time to reaching caloric goal, improve protein balance, and potentially affect clinical outcomes. The rationale and challenges to the delivery and maintenance of optimal EN, and strategies to achieve optimal EN during critical illness, are discussed.

Key Words: enteral nutrition • child • critical care • intensive care • intensive care units, pediatric

Nutrition in Clinical Practice, Vol. 24, No. 3, 377-387 (2009)
DOI: 10.1177/0884533609335175
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