Nutrition in ICU by Pocket ICU

Trophic feeds

  • start feeding in 48 hours
  • early initiation of enteral feeds stimulates guts, keeps it healthy, reduces infection risks
  • it's ok to not reach caloric goals for feeding in first 7 days in ICU patients
    • EDEN trial showed trickle feeds have similar outcome to aggressive feeding

Residuals

  • no benefit in monitoring residuals
  • only pause tube feeding when there is vomiting or regurgitation
  • residual up to 500 is safe in REGANE study

NG vs NJ

  • Davies trial showed NG and NJ have no major difference in VAP, energy requirements. NJ feeding has more minor bleeding
  • NG with metoclopramide has similar caloric goals

TPN

  • TPN start at day 3 has more infection, later discharge from icu, more ventilator days compared to TPN at day 8