The first part of this endeavor is enteral feeding. This
is greatly facilitated by getting the patient sitting up, which
aids extubation, nasogastric tube removal, the passage of
food through the stomach, and defecation. Regimens that
maintain the enforced supine position for days and weeks
on end greatly interfere with and contribute to continued
intubation, nosocomial pneumonias, and MSOF. Satisfactory enteral feeding clearly can be achieved much
sooner and in patients in whom it was not believed possible in previous times if the patient can be and is mobilized very early.' Early enteral feeding also reduces the
diarrhea problem, which is probably very much related
to mucosal atrophy and the effect of systemic antibiotics
on the commensal anaerobic bacteria. The enteral feed
should contain intact protein, all of the normal vitamins
(several of which support enterocyte replication), and
nondigestible but fermentable fiber to get nutrient to the
colonocyte commensal bacteria. It also should contain
added glutamine to support the enterocytes and perhaps
bile salts to help neutralize gut lumen bacterial toxins.