[Enteral access and intestinal function assessment in the critically ill patient]

Area of Science:

• Critical Care Medicine
• Gastroenterology
• Nutritional Support

Background:

• Gastric enteral nutrition (EN) in critically ill patients often leads to complications like increased residue and hyponutrition.
• Small bowel (jejunal) feeding may allow for greater volume administration but is influenced by access route, motility, and barrier function.
• Critically ill patients frequently exhibit gastric hypomotility, impairing nutrient delivery.

Purpose of the Study:

• To evaluate the effectiveness and impact of jejunal enteral nutrition compared to gastric feeding in critically ill patients.
• To explore factors influencing jejunal feeding, including access route selection and gastrointestinal motility.
• To discuss the role of gastrointestinal barrier function in critical illness and its potential link to multiorgan failure.

Main Methods:

• Review of access route selection criteria for EN based on duration of need (invasive vs. non-invasive techniques).
• Assessment of gastric motility using manometric techniques and acetaminophen absorption tests.
• Discussion of gastrointestinal tract barrier function and its implications in critical illness.

Main Results:

• Jejunal nutrition can increase administered nutritional requirements in mechanically ventilated patients compared to gastric feeding.
• Approximately 50% of critically ill, mechanically ventilated patients demonstrate gastric antral hypomotility.
• Impaired gastrointestinal barrier function and increased intestinal permeability are observed in various critical illness states.

Conclusions:

• Jejunal feeding should be considered in cases where gastric feeding is documented as problematic due to complications like hypomotility.
• Understanding and potentially improving gastrointestinal motility and barrier function are crucial in optimizing nutritional support for critically ill patients.
• Further research is needed to clarify the benefits of jejunal feeding on infectious complications, hospital stay, and mortality.