Semin Respir Crit Care Med 2019; 40(05): 580-593
DOI: 10.1055/s-0039-1697967
Review Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Reconsidering Nutritional Support in Critically Ill Patients

Amy Korwin
1   Section of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Yale University School of Medicine, New Haven, Connecticut
,
Shyoko Honiden
1   Section of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Yale University School of Medicine, New Haven, Connecticut
› Author Affiliations
Further Information

Publication History

Publication Date:
11 December 2019 (online)

Abstract

Provision of nutrition is universally considered a key element of supportive care in the intensive care unit (ICU). Despite this, there is a relative dearth of high-quality data, and where available, results are often conflicting. As we understand more about the process of recovery for critically ill patients, ICU nutrition might be better thought of as active therapy that can and should be tailored to the needs of patients in more dynamic ways. With the advent of the programmable feeding pump, continuous feeding modes have become the default manner in which patients are fed in many ICUs. In the modern ICU era, where the goal of critical care has shifted from mere survival to surviving and living well, non-continuous modes of feeding may have advantages related to fewer feeding interruptions, ICU mobilization, optimizing protein synthesis and autophagy, as well as restoring gastrointestinal physiology and the circadian rhythm. More research is desperately required to provide a framework in order to guide best nutrition practices for clinicians at the bedside.

 
  • References

  • 1 Taylor BE, McClave SA, Martindale RG. , et al; Society of Critical Care Medicine; American Society of Parenteral and Enteral Nutrition. guidelines for the provision and assessment of nutrition support therapy in the adult critically ill patient: Society of Critical Care Medicine (SCCM) and American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.). Crit Care Med 2016; 44 (02) 390-438
  • 2 Heyland DK, Dhaliwal R, Drover JW, Gramlich L, Dodek P. ; Canadian Critical Care Clinical Practice Guidelines Committee. Canadian clinical practice guidelines for nutrition support in mechanically ventilated, critically ill adult patients. JPEN J Parenter Enteral Nutr 2003; 27 (05) 355-373
  • 3 Canadian Critical Care Clinical Practice Guidelines Committee. Critical care nutrition. 2015. Available at: https://www.criticalcarenutrition.com/resources/cpgs/past-guidelines/2015 . Accessed May 31, 2019
  • 4 Arabi YM, McClave SA. Enteral nutrition should not be given to patients on vasopressor agents. Crit Care Med 2018; (e-pub ahead of print) DOI: 10.1097/CCM.0000000000003362.
  • 5 Kang W, Kudsk KA. Is there evidence that the gut contributes to mucosal immunity in humans?. JPEN J Parenter Enteral Nutr 2007; 31 (03) 246-258
  • 6 Jabbar A, Chang WK, Dryden GW, McClave SA. Gut immunology and the differential response to feeding and starvation. Nutr Clin Pract 2003; 18 (06) 461-482
  • 7 Rokyta Jr R, Matejovic M, Krouzecky A, Senft V, Trefil L, Novak I. Post-pyloric enteral nutrition in septic patients: effects on hepato-splanchnic hemodynamics and energy status. Intensive Care Med 2004; 30 (04) 714-717
  • 8 Gatt M, MacFie J, Anderson AD. , et al. Changes in superior mesenteric artery blood flow after oral, enteral, and parenteral feeding in humans. Crit Care Med 2009; 37 (01) 171-176
  • 9 Khalid I, Doshi P, DiGiovine B. Early enteral nutrition and outcomes of critically ill patients treated with vasopressors and mechanical ventilation. Am J Crit Care 2010; 19 (03) 261-268
  • 10 Ohbe H, Jo T, Matsui H, Fushimi K, Yasunaga H. Differences in effect of early enteral nutrition on mortality among ventilated adults with shock requiring low-, medium-, and high-dose noradrenaline: a propensity-matched analysis. Clin Nutr 2019; ; (e-pub ahead of print) DOI: 10.1016/j.clnu.2019.02.020.
  • 11 Arabi YM, Aldawood AS, Haddad SH. , et al; PermiT Trial Group. Permissive underfeeding or standard enteral feeding in critically ill adults. N Engl J Med 2015; 372 (25) 2398-2408
  • 12 Rice TW, Wheeler AP, Thompson BT. , et al; National Heart, Lung, and Blood Institute Acute Respiratory Distress Syndrome (ARDS) Clinical Trials Network. Initial trophic vs full enteral feeding in patients with acute lung injury: the EDEN randomized trial. JAMA 2012; 307 (08) 795-803
  • 13 Allingstrup MJ, Kondrup J, Wiis J. , et al. Early goal-directed nutrition versus standard of care in adult intensive care patients: the single-centre, randomised, outcome assessor-blinded EAT-ICU trial. Intensive Care Med 2017; 43 (11) 1637-1647
  • 14 Chapman M, Peake SL, Bellomo R. , et al; TARGET Investigators, for the ANZICS Clinical Trials Group. Energy-dense versus routine enteral nutrition in the critically ill. N Engl J Med 2018; 379 (19) 1823-1834
  • 15 Reignier J, Boisramé-Helms J, Brisard L. , et al; NUTRIREA-2 Trial Investigators; Clinical Research in Intensive Care and Sepsis (CRICS) group. Enteral versus parenteral early nutrition in ventilated adults with shock: a randomised, controlled, multicentre, open-label, parallel-group study (NUTRIREA-2). Lancet 2018; 391 (10116): 133-143
  • 16 Kondrup J, Rasmussen HH, Hamberg O, Stanga Z. ,; Ad Hoc ESPEN Working Group. Nutritional risk screening (NRS 2002): a new method based on an analysis of controlled clinical trials. Clin Nutr 2003; 22 (03) 321-336
  • 17 Heyland DK, Dhaliwal R, Jiang X, Day AG. Identifying critically ill patients who benefit the most from nutrition therapy: the development and initial validation of a novel risk assessment tool. Crit Care 2011; 15 (06) R268
  • 18 Jeong DH, Hong SB, Lim CM. , et al. Comparison of accuracy of NUTRIC and modified NUTRIC scores in predicting 28-day mortality in patients with sepsis: a single center retrospective study. Nutrients 2018; 10 (07) 10
  • 19 Chourdakis M, Grammatikopoulou MG, Poulia KA. , et al. Translation of the modified NUTRIC score and adaptation to the Greek ICU setting. Clin Nutr ESPEN 2019; 29: 72-76
  • 20 Jung YT, Park JY, Jeon J, Kim MJ, Lee SH, Lee JG. Association of inadequate caloric supplementation with 30-day mortality in critically ill postoperative patients with high modified nutric Score. Nutrients 2018; 10 (11) 10
  • 21 de Vries MC, Koekkoek WK, Opdam MH, van Blokland D, van Zanten AR. Nutritional assessment of critically ill patients: validation of the modified NUTRIC score. Eur J Clin Nutr 2018; 72 (03) 428-435
  • 22 Mendes R, Policarpo S, Fortuna P, Alves M, Virella D, Heyland DK. ; Portuguese NUTRIC Study Group. Nutritional risk assessment and cultural validation of the modified NUTRIC score in critically ill patients-A multicenter prospective cohort study. J Crit Care 2017; 37: 45-49
  • 23 Mukhopadhyay A, Henry J, Ong V. , et al. Association of modified NUTRIC score with 28-day mortality in critically ill patients. Clin Nutr 2017; 36 (04) 1143-1148
  • 24 Rahman A, Hasan RM, Agarwala R, Martin C, Day AG, Heyland DK. Identifying critically-ill patients who will benefit most from nutritional therapy: further validation of the “modified NUTRIC” nutritional risk assessment tool. Clin Nutr 2016; 35 (01) 158-162
  • 25 Lee ZY, Heyland DK. Determination of nutrition risk and status in critically ill patients: what are our considerations?. Nutr Clin Pract 2019; 34 (01) 96-111
  • 26 Schlein KM, Coulter SP. Best practices for determining resting energy expenditure in critically ill adults. Nutr Clin Pract 2014; 29 (01) 44-55
  • 27 Dickerson RN, Patel JJ, McClain CJ. Protein and calorie requirements associated with the presence of obesity. Nutr Clin Pract 2017; 32 (1_suppl): 86S-93S
  • 28 Wei X, Day AG, Ouellette-Kuntz H, Heyland DK. The association between nutritional adequacy and long-term outcomes in critically ill patients requiring prolonged mechanical ventilation: a multicenter cohort study. Crit Care Med 2015; 43 (08) 1569-1579
  • 29 Perman MI, Ciapponi A, Franco JV. , et al. Prescribed hypocaloric nutrition support for critically-ill adults. Cochrane Database Syst Rev 2018; 6: CD007867
  • 30 Allingstrup MJ, Esmailzadeh N, Wilkens Knudsen A. , et al. Provision of protein and energy in relation to measured requirements in intensive care patients. Clin Nutr 2012; 31 (04) 462-468
  • 31 Weijs PJ, Looijaard WG, Beishuizen A, Girbes AR, Oudemans-van Straaten HM. Early high protein intake is associated with low mortality and energy overfeeding with high mortality in non-septic mechanically ventilated critically ill patients. Crit Care 2014; 18 (06) 701
  • 32 Thiessen SE, Derde S, Derese I. , et al. Role of glucagon in catabolism and muscle wasting of critical illness and modulation by nutrition. Am J Respir Crit Care Med 2017; 196 (09) 1131-1143
  • 33 José IB, Leandro-Merhi VA, Aquino JLB. Target, prescription and infusion of enteral nutritional therapy of critical patients in intensive care unit. Arq Gastroenterol 2018; 55 (03) 283-289
  • 34 Heyland DK, Schroter-Noppe D, Drover JW. , et al. Nutrition support in the critical care setting: current practice in canadian ICUs--opportunities for improvement?. JPEN J Parenter Enteral Nutr 2003; 27 (01) 74-83
  • 35 Bendavid I, Singer P, Theilla M. , et al. NutritionDay ICU: A 7 year worldwide prevalence study of nutrition practice in intensive care. Clin Nutr 2017; 36 (04) 1122-1129
  • 36 Cahill NE, Dhaliwal R, Day AG, Jiang X, Heyland DK. Nutrition therapy in the critical care setting: what is “best achievable” practice? An international multicenter observational study. Crit Care Med 2010; 38 (02) 395-401
  • 37 McClave SA, Saad MA, Esterle M. , et al. Volume-based feeding in the critically ill patient. JPEN J Parenter Enteral Nutr 2015; 39 (06) 707-712
  • 38 Wischmeyer PE. Tailoring nutrition therapy to illness and recovery. Crit Care 2017; 21 (Suppl. 03) 316
  • 39 Al-Dorzi HM, Al-Humaid W, Tamim HM. , et al. Anemia and blood transfusion in patients with isolated traumatic brain injury. Crit Care Res Pract 2015; 2015: 672639
  • 40 Uehara M, Plank LD, Hill GL. Components of energy expenditure in patients with severe sepsis and major trauma: a basis for clinical care. Crit Care Med 1999; 27 (07) 1295-1302
  • 41 Bear DE, Hart N, Puthucheary Z. Continuous or intermittent feeding: pros and cons. Curr Opin Crit Care 2018; 24 (04) 256-261
  • 42 Bonten MJ, Gaillard CA, van der Hulst R. , et al. Intermittent enteral feeding: the influence on respiratory and digestive tract colonization in mechanically ventilated intensive-care-unit patients. Am J Respir Crit Care Med 1996; 154 (2 Pt 1): 394-399
  • 43 Serpa LF, Kimura M, Faintuch J, Ceconello I. Effects of continuous versus bolus infusion of enteral nutrition in critical patients. Rev Hosp Clin Fac Med Sao Paulo 2003; 58 (01) 9-14
  • 44 Ibrahim EH, Mehringer L, Prentice D. , et al. Early versus late enteral feeding of mechanically ventilated patients: results of a clinical trial. JPEN J Parenter Enteral Nutr 2002; 26 (03) 174-181
  • 45 MacLeod JB, Lefton J, Houghton D. , et al. Prospective randomized control trial of intermittent versus continuous gastric feeds for critically ill trauma patients. J Trauma 2007; 63 (01) 57-61
  • 46 Evans DC, Forbes R, Jones C. , et al. Continuous versus bolus tube feeds: Does the modality affect glycemic variability, tube feeding volume, caloric intake, or insulin utilization?. Int J Crit Illn Inj Sci 2016; 6 (01) 9-15
  • 47 Hiebert JM, Brown A, Anderson RG, Halfacre S, Rodeheaver GT, Edlich RF. Comparison of continuous vs intermittent tube feedings in adult burn patients. JPEN J Parenter Enteral Nutr 1981; 5 (01) 73-75
  • 48 Kadamani I, Itani M, Zahran E, Taha N. Incidence of aspiration and gastrointestinal complications in critically ill patients using continuous versus bolus infusion of enteral nutrition: a pseudo-randomised controlled trial. Aust Crit Care 2014; 27 (04) 188-193
  • 49 Montejo JC, Miñambres E, Bordejé L. , et al. Gastric residual volume during enteral nutrition in ICU patients: the REGANE study. Intensive Care Med 2010; 36 (08) 1386-1393
  • 50 McClave SA, Lukan JK, Stefater JA. , et al. Poor validity of residual volumes as a marker for risk of aspiration in critically ill patients. Crit Care Med 2005; 33 (02) 324-330
  • 51 Poulard F, Dimet J, Martin-Lefevre L. , et al. Impact of not measuring residual gastric volume in mechanically ventilated patients receiving early enteral feeding: a prospective before-after study. JPEN J Parenter Enteral Nutr 2010; 34 (02) 125-130
  • 52 Ozen N, Tosun N, Yamanel L, Altintas ND, Kilciler G, Ozen V. Evaluation of the effect on patient parameters of not monitoring gastric residual volume in intensive care patients on a mechanical ventilator receiving enteral feeding: A randomized clinical trial. J Crit Care 2016; 33: 137-144
  • 53 Reignier J, Mercier E, Le Gouge A. , et al; Clinical Research in Intensive Care and Sepsis (CRICS) Group. Effect of not monitoring residual gastric volume on risk of ventilator-associated pneumonia in adults receiving mechanical ventilation and early enteral feeding: a randomized controlled trial. JAMA 2013; 309 (03) 249-256
  • 54 Ciocon JO, Galindo-Ciocon DJ, Tiessen C, Galindo D. Continuous compared with intermittent tube feeding in the elderly. JPEN J Parenter Enteral Nutr 1992; 16 (06) 525-528
  • 55 Nasiri M, Farsi Z, Ahangari M, Dadgari F. Comparison of intermittent and bolus enteral feeding methods on enteral feeding intolerance of patients with sepsis: a triple-blind controlled trial in intensive care units. Middle East J Dig Dis 2017; 9 (04) 218-227
  • 56 Deloose E, Janssen P, Depoortere I, Tack J. The migrating motor complex: control mechanisms and its role in health and disease. Nat Rev Gastroenterol Hepatol 2012; 9 (05) 271-285
  • 57 Sanger GJ, Wang Y, Hobson A, Broad J. Motilin: towards a new understanding of the gastrointestinal neuropharmacology and therapeutic use of motilin receptor agonists. Br J Pharmacol 2013; 170 (07) 1323-1332
  • 58 Ledeboer M, Masclee AA, Coenraad M, Vecht J, Biemond I, Lamers CB. Antroduodenal motility and small bowel transit during continuous intraduodenal or intragastric administration of enteral nutrition. Eur J Clin Invest 1999; 29 (07) 615-623
  • 59 Lloyd DA, Powell-Tuck J. Artificial nutrition: principles and practice of enteral feeding. Clin Colon Rectal Surg 2004; 17 (02) 107-118
  • 60 Jawaheer G, Shaw NJ, Pierro A. Continuous enteral feeding impairs gallbladder emptying in infants. J Pediatr 2001; 138 (06) 822-825
  • 61 Dimitriadis G, Mitrou P, Lambadiari V, Maratou E, Raptis SA. Insulin effects in muscle and adipose tissue. Diabetes Res Clin Pract 2011; 93 (Suppl. 01) S52-S59
  • 62 Chowdhury AH, Murray K, Hoad CL. , et al. Effects of bolus and continuous nasogastric feeding on gastric emptying, small bowel water content, superior mesenteric artery blood flow, and plasma hormone concentrations in healthy adults: a randomized crossover study. Ann Surg 2016; 263 (03) 450-457
  • 63 Liebau F, Norberg Å, Rooyackers O. Does feeding induce maximal stimulation of protein balance?. Curr Opin Clin Nutr Metab Care 2016; 19 (02) 120-124
  • 64 Compher C, Chittams J, Sammarco T, Nicolo M, Heyland DK. Greater protein and energy intake may be associated with improved mortality in higher risk critically ill patients: a multicenter, multinational observational study. Crit Care Med 2017; 45 (02) 156-163
  • 65 Puthucheary ZA, Rawal J, McPhail M. , et al. Acute skeletal muscle wasting in critical illness. JAMA 2013; 310 (15) 1591-1600
  • 66 Parry SM, Puthucheary ZA. The impact of extended bed rest on the musculoskeletal system in the critical care environment. Extrem Physiol Med 2015; 4: 16
  • 67 Atherton PJ, Etheridge T, Watt PW. , et al. Muscle full effect after oral protein: time-dependent concordance and discordance between human muscle protein synthesis and mTORC1 signaling. Am J Clin Nutr 2010; 92 (05) 1080-1088
  • 68 Bohé J, Low JF, Wolfe RR, Rennie MJ. Latency and duration of stimulation of human muscle protein synthesis during continuous infusion of amino acids. J Physiol 2001; 532 (Pt 2): 575-579
  • 69 Gazzaneo MC, Suryawan A, Orellana RA. , et al. Intermittent bolus feeding has a greater stimulatory effect on protein synthesis in skeletal muscle than continuous feeding in neonatal pigs. J Nutr 2011; 141 (12) 2152-2158
  • 70 El-Kadi SW, Suryawan A, Gazzaneo MC. , et al. Anabolic signaling and protein deposition are enhanced by intermittent compared with continuous feeding in skeletal muscle of neonates. Am J Physiol Endocrinol Metab 2012; 302 (06) E674-E686
  • 71 El-Kadi SW, Gazzaneo MC, Suryawan A. , et al. Viscera and muscle protein synthesis in neonatal pigs is increased more by intermittent bolus than by continuous feeding. Pediatr Res 2013; 74 (02) 154-162
  • 72 El-Kadi SW, Boutry C, Suryawan A. , et al. Intermittent bolus feeding promotes greater lean growth than continuous feeding in a neonatal piglet model. Am J Clin Nutr 2018; 108 (04) 830-841
  • 73 Campbell IT, Morton RP, Cole JA, Raine CH, Shapiro LM, Stell PM. A comparison of the effects of intermittent and continuous nasogastric feeding on the oxygen consumption and nitrogen balance of patients after major head and neck surgery. Am J Clin Nutr 1983; 38 (06) 870-878
  • 74 Mazaherpur S, Khatony A, Abdi A, Pasdar Y, Najafi F. The effect of continuous enteral nutrition on nutrition indices, compared to the intermittent and combination enteral nutrition in traumatic brain injury patients. J Clin Diagn Res 2016; 10 (10) JC01-JC05
  • 75 Sanz París A, Lázaro J, Guallar A, Gracia P, Caverni A, Albero R. [Continuous enteral nutrition versus single bolus: effects on urine C peptide and nitrogen balance]. Med Clin (Barc) 2005; 124 (16) 613-615
  • 76 Dickerson RN. Nitrogen balance and protein requirements for critically ill older patients. Nutrients 2016; 8 (04) 226
  • 77 Liebau F, Wernerman J, van Loon LJ, Rooyackers O. Effect of initiating enteral protein feeding on whole-body protein turnover in critically ill patients. Am J Clin Nutr 2015; 101 (03) 549-557
  • 78 Aragon AA, Schoenfeld BJ. Nutrient timing revisited: is there a post-exercise anabolic window?. J Int Soc Sports Nutr 2013; 10 (01) 5
  • 79 Yang Y, Breen L, Burd NA. , et al. Resistance exercise enhances myofibrillar protein synthesis with graded intakes of whey protein in older men. Br J Nutr 2012; 108 (10) 1780-1788
  • 80 Gerhart-Hines Z, Lazar MA. Circadian metabolism in the light of evolution. Endocr Rev 2015; 36 (03) 289-304
  • 81 Albrecht U. Timing to perfection: the biology of central and peripheral circadian clocks. Neuron 2012; 74 (02) 246-260
  • 82 Zarrinpar A, Chaix A, Panda S. Daily eating patterns and their impact on health and disease. Trends Endocrinol Metab 2016; 27 (02) 69-83
  • 83 Zhou B, Zhang Y, Zhang F. , et al. CLOCK/BMAL1 regulates circadian change of mouse hepatic insulin sensitivity by SIRT1. Hepatology 2014; 59 (06) 2196-2206
  • 84 Vollmers C, Gill S, DiTacchio L, Pulivarthy SR, Le HD, Panda S. Time of feeding and the intrinsic circadian clock drive rhythms in hepatic gene expression. Proc Natl Acad Sci U S A 2009; 106 (50) 21453-21458
  • 85 de Goede P, Sen S, Su Y. , et al. An ultradian feeding schedule in rats affects metabolic gene expression in liver, brown adipose tissue and skeletal muscle with only mild effects on circadian clocks. Int J Mol Sci 2018; 19 (10) 19
  • 86 Kalsbeek A, la Fleur S, Fliers E. Circadian control of glucose metabolism. Mol Metab 2014; 3 (04) 372-383
  • 87 Yasumoto Y, Hashimoto C, Nakao R. , et al. Short-term feeding at the wrong time is sufficient to desynchronize peripheral clocks and induce obesity with hyperphagia, physical inactivity and metabolic disorders in mice. Metabolism 2016; 65 (05) 714-727
  • 88 Damiola F, Le Minh N, Preitner N, Kornmann B, Fleury-Olela F, Schibler U. Restricted feeding uncouples circadian oscillators in peripheral tissues from the central pacemaker in the suprachiasmatic nucleus. Genes Dev 2000; 14 (23) 2950-2961
  • 89 Van Cauter E, Polonsky KS, Scheen AJ. Roles of circadian rhythmicity and sleep in human glucose regulation. Endocr Rev 1997; 18 (05) 716-738
  • 90 Scott EM, Carter AM, Grant PJ. Association between polymorphisms in the Clock gene, obesity and the metabolic syndrome in man. Int J Obes 2008; 32 (04) 658-662
  • 91 Canuto R, Garcez AS, Olinto MT. Metabolic syndrome and shift work: a systematic review. Sleep Med Rev 2013; 17 (06) 425-431
  • 92 Scheer FA, Hilton MF, Mantzoros CS, Shea SA. Adverse metabolic and cardiovascular consequences of circadian misalignment. Proc Natl Acad Sci U S A 2009; 106 (11) 4453-4458
  • 93 Ely EW, Shintani A, Truman B. , et al. Delirium as a predictor of mortality in mechanically ventilated patients in the intensive care unit. JAMA 2004; 291 (14) 1753-1762
  • 94 Ouimet S, Kavanagh BP, Gottfried SB, Skrobik Y. Incidence, risk factors and consequences of ICU delirium. Intensive Care Med 2007; 33 (01) 66-73
  • 95 Roybal K, Theobold D, Graham A. , et al. Mania-like behavior induced by disruption of CLOCK. Proc Natl Acad Sci U S A 2007; 104 (15) 6406-6411
  • 96 Vanhorebeek I, Gunst J, Derde S. , et al. Insufficient activation of autophagy allows cellular damage to accumulate in critically ill patients. J Clin Endocrinol Metab 2011; 96 (04) E633-E645
  • 97 Brealey D, Brand M, Hargreaves I. , et al. Association between mitochondrial dysfunction and severity and outcome of septic shock. Lancet 2002; 360 (9328): 219-223
  • 98 Van Dyck L, Casaer MP. Intermittent or continuous feeding: any difference during the first week?. Curr Opin Crit Care 2019; 25 (04) 356-362
  • 99 Kompan L, Kremzar B, Gadzijev E, Prosek M. Effects of early enteral nutrition on intestinal permeability and the development of multiple organ failure after multiple injury. Intensive Care Med 1999; 25 (02) 157-161
  • 100 Chiarelli A, Enzi G, Casadei A, Baggio B, Valerio A, Mazzoleni F. Very early nutrition supplementation in burned patients. Am J Clin Nutr 1990; 51 (06) 1035-1039
  • 101 Chuntrasakul C, Siltharm S, Chinswangwatanakul V, Pongprasobchai T, Chockvivatanavanit S, Bunnak A. Early nutritional support in severe traumatic patients. J Med Assoc Thai 1996; 79 (01) 21-26
  • 102 Eyer SD, Micon LT, Konstantinides FN. , et al. Early enteral feeding does not attenuate metabolic response after blunt trauma. J Trauma 1993; 34 (05) 639-643 , discussion 643–644
  • 103 Singh G, Ram RP, Khanna SK. Early postoperative enteral feeding in patients with nontraumatic intestinal perforation and peritonitis. J Am Coll Surg 1998; 187 (02) 142-146
  • 104 Minard G, Kudsk KA, Melton S, Patton JH, Tolley EA. Early versus delayed feeding with an immune-enhancing diet in patients with severe head injuries. JPEN J Parenter Enteral Nutr 2000; 24 (03) 145-149
  • 105 Pupelis G, Selga G, Austrums E, Kaminski A. Jejunal feeding, even when instituted late, improves outcomes in patients with severe pancreatitis and peritonitis. Nutrition 2001; 17 (02) 91-94
  • 106 Moore EE, Jones TN. Benefits of immediate jejunostomy feeding after major abdominal trauma--a prospective, randomized study. J Trauma 1986; 26 (10) 874-881
  • 107 Haac B, Henry S, Diaz J, Scalea T, Stein D. Early enteral nutrition is associated with reduced morbidity in critically ill soft tissue patients. Am Surg 2018; 84 (06) 1003-1009