Enteral and parenteral feedings. Guidelines and recommendations.

The clinician is confronted with many options in choosing appropriate nutritional support for a patient. Several major issues emerge. 1. Supplemental nutritional support is appropriate in patients who will not be able to take oral calories for more than 7 days. Individuals with preexisting deficits due to lifestyle or disease should have support started more promptly. 2. The use of TPN as a preoperative adjunct in surgical patients appears to be beneficial only to those with severe malnutrition. 3. In the vast majority of patients, the enteral route is preferred. Total parenteral nutrition appears to be beneficial in those with inadequate absorptive capacity, fistula, acute hepatic/renal failure, inflammatory bowel disease, and as an adjunct to cancer therapy. 4. Complications associated with enteral and parenteral nutrition delivery can be minimized by careful attention to detail and adequate monitoring of responses. 5. An exciting area beyond the scope of this monograph is the emergence of the field of "Nutritional Pharmacology" where one manipulates the patient's diet to achieve a desired physiologic result, just as one will change antibiotics or pressors. This will provide an additional tool to the clinician in the treatment of critically ill patients.