Route of nutrient delivery

Nutritional intervention early in the course of critical illness in humans and animals can have a significant impact on morbidity and mortality. Enteral delivery of nutrients is less technically demanding, more physiologic, and less expensive than parenteral nutrition. Furthermore, as complete bowel rest during critical illness can be associated with detrimental intestinal structural and functional changes ultimately resulting in bacterial translocation from the gut, direct delivery of nutrients to the gastrointestinal tract is preferred in patients with sufficient gastrointestinal function to allow digestion and absorption of nutrients. Once the decision to "feed the gut" has been established, there are several routes of enteral nutrient delivery available. A sound knowledge of gastrointestinal function, anticipated duration of enteral support, and co-moribund conditions will help the clinician tailor a plan of nutrient delivery that optimally meets each patient's needs. This article will review available routes of nutrient delivery to the gastrointestinal tract, and discuss indications and contraindications for each.