TABLE 11-1 Some Indications for the Use of Enteral Nutritional Support | ||||||||||||||||||||||||||||
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TABLE 11-2 Selected Enteral Nutritional Supplements | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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Enteral Nutrition
Enteral Nutrition
I. PATIENT SELECTION.
Patients with established protein-calorie malnutrition or those whose condition will result in protein-calorie undernutrition are candidates for nutritional support. The enteral route should be preferred in any patient with a functional gastrointestinal (GI) tract over the parenteral routes because of its relative simplicity, safety, and economy. Some indications for the use of enteral hyperalimentation are listed in Table 11-1. Enteral feeding is contraindicated in patients with severely compromised GI function, where access to the GI tract is not feasible, and in patients with severe vomiting, intestinal obstruction, ileus, or GI bleeding.
Nutritional support by the enteral route is not a single entity. It encompasses a wide range of techniques and products for use in the clinical spectrum of undernutrition. At one extreme, it may be the addition of a nutritional supplement to the patient’s orally consumed diet; at the other extreme, it may provide the patient with the complete nutritional requirements. In some cases, a satisfactory level of nutritional support may not be achievable by the enteral route alone, and combination of this method with parenteral intravenous alimentation may be necessary.
II. ENTERAL FORMULAS.
Three types of enteral mixtures differing in osmolality, digestibility, caloric density, lactose content, fat content, and cost (Table 11-2) are available: formulas with intact nutrients, formulas with predigested nutrients (elemental diets), and feeding modules.
A. Formulas with intact nutrients
1. Blenderized feedings
are equivalent to a meat-based meal that has been prepared in a blender. They are nutritionally complete if sufficient calories are given and generally provide 1 kcal/mL. However, they tend to be viscous and do not flow well in the newer, narrower, soft feeding tubes, and most contain lactose.
