Nutritional Support: Route (Total Parenteral versus Total Enteral) (UPDATE IN PROCESS)

Published 2004

Level 1

Patients with blunt and penetrating abdominal injuries should, when feasible, be fed enterally because of the lower incidence of septic complications compared with parenterally fed patients.

Level 2

Patients with severe head injuries should preferentially receive early enteral feeding, since outcomes are similar compared with parenterally-fed patients. If early enteral feeding is not feasible or not tolerated, parenteral feedings should be instituted.

Level 3

  1. In severely injured patients, TPN should be started by day 7 if enteral feeding is not successful.
  2. Patients who fail to tolerate at least 50% of their goal rate of enteral feedings by post-injury day 7 should have TPN instituted but should be weaned when > 50% of enteral feedings are tolerated.