Nutritional Support: Timing (Early versus Delayed Enteral Feedings) (UPDATE IN PROCESS)

Published 2004

Level 1

In severely injured blunt/penetrating trauma patients, there appears to be no outcome advantage to initiating enteral feedings within 24 hours of admission as compared to 72 hours after admission.

Level 2

  1. In burn patients, intragastric feedings should be started as soon after admission as possible, since delayed enteral feeding (>18 hours) results in a high rate of gastroparesis and need for intravenous nutrition.
  2. Patients with severe head injury who do not tolerate gastric feedings within 48 hours of injury should be switched to postpyloric feedings, ideally beyond the ligament of Treitz, if feasible and safe for the patient.
  3. Patients who are incompletely resuscitated should not have direct small bowel feedings instituted due to the risk of gastrointestinal intolerance and possible intestinal necrosis.
  4. In patients undergoing laparotomy for blunt and penetrating abdominal injuries, direct small bowel access should be obtained (via nasojejunal feeding tube, gastrojejunal feeding tube, or feeding jejunostomy) and enteral feedings begun as soon as is feasible following resuscitation from shock.

Level 3

  1. Patients who are incompletely resuscitated should not have direct small bowel feedings instituted due to the risk of gastrointestinal intolerance and possible intestinal necrosis.
  2. In patients undergoing laparotomy for blunt and penetrating abdominal injuries, direct small bowel access should be obtained (via nasojejunal feeding tube, gastrojejunal feeding tube, or feeding jejunostomy) and enteral feedings begun as soon as is feasible following resuscitation from shock.