Is early feeding beneficial? How early is early?

Nutritional support is a vital part of the therapy of most hospitalized patients. Early initiation, particularly via the enteral route, has a significant effect on septic complications in a wide variety of patients. Early enteral feeding may also attenuate the hypercatabolic response that follows burn injury, although the evidence is somewhat conflicting. The mechanisms for the benefit of early nutrition have not been fully elucidated. However, preservation of gut mass, prevention of increased gut permeability to bacteria and other toxins, and maintenance of the gut-associated lymphoid tissue all probably play a role. The question "How early is early?" is important, since maintenance of early feeding requires time, patience, and dedication. It appears that starting nutrition within 24 hrs of major surgery, injury, or burn is ideal, but within 48 hours is acceptable. However, hemodynamic stability is a prerequisite to initiation of enteral feeding. Although labor intensive, the provision of early feeding, particularly via the enteral route, is a worthwhile goal for all clinicians.