SCCM Podcast SCCM Pod-437 Enteral Feeding Intolerance in the Mechanically Ventilated Critically Ill
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May 11, 2021 Darren Hyland, Director of the Clinical Evaluation Research Unit at Kingston General Hospital and an expert in critical care medicine, discusses enteral feeding intolerance in mechanically ventilated patients. He highlights the prevalence of this issue and its severe impact on nutrition and patient outcomes. The conversation dives into the debate over gastric residual volumes, the role of prokinetic agents, and how medications can alter gastric motility. Strategies for optimizing nutrition and the importance of tailored feeding protocols are also explored, ensuring critically ill patients receive the best care.
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Monitor For Persistence Not Single Readings
- Monitor gastric residual volumes regularly to detect persistent or recurrent intolerance rather than react to single isolated readings.
- React more aggressively when intolerance is persistent or relapsing, especially in nutritionally high-risk patients.
Gut Disuse Drives Intolerance
- Mechanisms are multifactorial but center on gut disuse, epithelial barrier breakdown, and inflammation driving dysmotility and aspiration risk.
- Early feeding may restore barrier and motility, reducing regurgitation and ventilator-associated pneumonia risk.
Feed The Distressed Gut Early
- Do not reflexively keep shocked patients NPO; consider early low-dose trophic feeds to support gut integrity.
- Early trophic feeding may reduce feeding intolerance and improve clinical outcomes in shock.