Decisions for enteral access in the intensive care unit

When making decisions regarding nutrition support, many factors must be considered before committing a patient to receive parenteral or enteral nutrition. Parenteral nutrition (PN) is more expensive and technically more difficult to administer than enteral nutrition (EN). The charge for PN can range from US $200 to $1000 per day, where a standard hospital diet or enteral tube feedings might cost less than US $25/d. PN is also associated with a much higher incidence of biochemical complications such as hyperglycemia and other electrolyte abnormalities and catheter-related complications such as infection, thrombosis, or pneumothorax. For many years PN was preferred to EN because it was believed to be unwise to feed a critically ill patient into the gut. It has now been shown in multiple studies that it is not only feasible to feed critically ill patients early, but also it may be immunologically advantageous to feed enterally. The cost effectiveness of the nutrition support team approach to monitoring PN and EN should not be underestimated by hospital administrators. If enteral therapy can be instituted, significant patient-care cost savings may be realized. This presentation will discuss decisions that must be addressed in the intensive care unit. With more physician education, protocols can be designed to provide the most advantageous use of nutrition support for the benefit of the hospitalized patient.