Overview
Enteral nutrition (EN) refers to the procedure of providing nutrition directly into the gastrointestinal (GI) tract bypassing the oral cavity. It is a critical intervention in clinical nutrition, playing an indispensable role in the management of patients unable to meet their nutritional needs orally. It is imperative for maintaining nutritional status and supporting recovery in various patient populations, both in the ICU and home care settings.1
Symptoms
In acute care settings, particularly intensive care units (ICU), enteral nutrition is frequently a life-sustaining therapy. Patients who are incapacitated, unconscious, or otherwise unable to consume oral nutrition depend on EN for their nutritional sustenance. The primary objective in these scenarios is to ensure sufficient nutrient provision to facilitate recuperation, bolster the immune response, and ultimately improve patient outcomes.2,3,4
In the context of home enteral nutrition (HEN), the strategy is more personalized, addressing the specific needs and lifestyles of patients requiring long-term nutritional support in a non-hospital environment. Clinical indications for enteral nutrition encompass a range of symptoms including, but not limited to severe dysphagia (like in chronic neurological conditions such as Parkinson’s disease or amyotrophic lateral sclerosis), gastrointestinal dysmotility (e.g. gastroparesis and chronic intestinal pseudo-obstruction), and malabsorption syndromes (e.g. short bowel syndrome, chronic pancreatitis, cystic fibrosis). Patients may present with weight loss, nutrient deficiencies, or inability to maintain oral intake due to neurological or structural impairments.4,5,6
Diagnosis
Diagnosing the need for enteral nutrition involves a comprehensive assessment of the patient’s medical history, nutritional requirements, swallowing function, and gastrointestinal tract performance.4 The role of a multidisciplinary healthcare team, encompassing physicians, nurses, dietitians, and caregivers, is fundamental in both critical care and home-based settings. This collaborative approach ensures that the administration of enteral nutrition is not only effective but also attuned to the holistic needs of the patient.1
Management
Enteral nutrition management in the ICU involves meticulous monitoring of nutritional delivery, metabolic assessment, and adjustment of feeding regimens based on patient response. A wide variety of EN formulas are available: standard formulations, disease specific, peptide-based, and blenderized formulas. When administering EN, it's crucial to take into account various aspects, including timing and rate of initiation, progression protocol, feeding modality, and potential for complications.7 A thorough and meticulous evaluation of the patient is essential to guarantee the provision of EN that is both nutritionally complete and suitable for the patient's clinical needs, ensuring its safe delivery.7 Guidelines from ESPEN and ASPEN provide comprehensive recommendations on these aspects, emphasizing evidence-based practices in the provision of enteral nutrition in ICU settings.2,3 For home enteral nutrition, the ESPEN and ASPEN guidelines offer insights into best practices for HEN, focusing on patient and caregiver education, safe feeding practices, and regular follow-up with healthcare providers to ensure safety and efficacy in nutrition delivery.5,6
1. Boullata JI, Carrera AL, Harvey L, et al. ASPEN Safe Practices for Enteral Nutrition Therapy. JPEN J Parenter Enteral Nutr. 2017;41(1):15-103.
2. Compher C, Bingham AL, McCall M, et al. Guidelines for the provision of nutrition support therapy in the adult critically ill patient: The American Society for Parenteral and Enteral Nutrition [published correction appears in JPEN J Parenter Enteral Nutr. 2022 Aug;46(6):1458-1459]. JPEN J Parenter Enteral Nutr. 2022;46(1):12-41.
3. Singer P, Blaser AR, Berger MM, et al. ESPEN practical and partially revised guideline: Clinical nutrition in the intensive care unit. Clin Nutr. 2023;42(9):1671-1689.
4. Bechtold ML, Brown PM, Escuro A, et al. When is enteral nutrition indicated? JPEN J Parenter Enteral Nutr. 2022;46(7):1470-1496.
5. Durfee SM, Adams SC, Arthur E, et al. A.S.P.E.N. Standards for Nutrition Support: Home and Alternate Site Care. Nutr Clin Pract. 2014;29(4):542-555.
6. Bischoff SC, Austin P, Boeykens K, et al. ESPEN practical guideline: Home enteral nutrition. Clin Nutr. 2022;41(2):468-488.
7. Doley J. Enteral Nutrition Overview. Nutrients. 2022;14(11):2180. Published 2022 May 24.