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Approach to enteral feeding in the PICU

Nilesh M Mehta1

  • 1Division of Critical Care Medicine, Children's Hospital, Boston, MA 02115, USA. nilesh.mehta@childrens.harvard.edu

Nutrition in Clinical Practice : Official Publication of the American Society for Parenteral and Enteral Nutrition
|June 2, 2009
PubMed

Insights

Optimizing enteral nutrition (EN) in the pediatric intensive care unit (PICU) is crucial for critically ill children. Protocolized feeding strategies and institutional guidelines can improve EN delivery and patient outcomes.

Area of Science:

  • Pediatric Critical Care Medicine
  • Clinical Nutrition
  • Intensive Care Unit Management

Background:

  • Critically ill children in the pediatric intensive care unit (PICU) face challenges in receiving optimal enteral nutrition (EN).
  • Current practices often result in suboptimal EN delivery due to complexities in care and avoidable reasons.
  • Effective nutrition support is vital for improving clinical outcomes in this vulnerable population.

Purpose of the Study:

  • To discuss the challenges and strategies for optimizing enteral nutrition delivery in the PICU.
  • To review the evidence and rationale for selecting appropriate enteral feeding routes.
  • To highlight the importance of protocolized approaches and institutional guidelines for EN.

Main Methods:

  • Review of current literature on enteral nutrition in critically ill children.
  • Analysis of different feeding routes (gastric, transpyloric, postpyloric) and their indications.
  • Discussion of factors influencing EN tolerance and delivery.
  • Examination of the role of institutional guidelines and protocols.

Main Results:

  • Gastric EN is preferred for ease and cost, but transpyloric/postpyloric routes may be necessary for specific cases like poor gastric emptying.
  • Routine small bowel feeding in all PICU patients is not supported by current evidence.
  • Blind nasoenteric tube placement presents technical challenges and potential complications.
  • Protocolized EN delivery and institutional guidelines show potential to improve caloric intake and clinical outcomes.

Conclusions:

  • Optimizing EN in the PICU requires careful consideration of feeding routes and patient-specific factors.
  • Protocolized feeding strategies and adherence to institutional guidelines are essential for maximizing EN delivery.
  • Further research and implementation of best practices can enhance nutrition support and outcomes for critically ill children.

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