[Artificial enteral nutrition. Overview of the technics and their applications]

In intensive care it is usual to give from between 3000 and 4500 calories. It seems that an intake of 1 gram of nitrogen for 150 to 200 calories from a non-protein source allows the optimal utilization of nitrogen. The advances made in the manufacture of nutritional mixtures and the techniques of administration often allow high calorie/protein intakes by the oral route alone. Small calibre silicone tubes which are perfectly tolerated are now available. They avoid naso-pharyngeal, oesophageal and pulmonary complications, and there is no reflux. Continuous oral feeding usually given by a pump improves gastric tolerance, reduces the digestive secretions, and slows down the intestinal transit. Digestion and absorption are improved. This technique, as well as the new tubes, allows comatose patients to be fed without any risk. The use of refrigerated nutripompes avoids bacterial proliferation in the nutritional liquid, which can affect digestion. Furthermore these pumps reduce the work of the nurse. Various nutritional mixtures allow a high calorie intake despite the abnormal digestion in the patient. Complications of oral feeding are rare. Reactions of intolerance and the respiratory risks have been considerably reduced. Metabolic disorders can be easily avoided. Diarrhoea is the result either of bacterial proliferation or an error in administration. These complications are definitely less frequent and less serious than those of feeding by the intravenous route, and the precautions to be taken are much simpler. The method is also cheaper.