ventilated, critically ill patient and review EN versus PN compo-
sitions of nutritional support. Several measures have been shown
to decrease the risk of aspiration pneumonia in critically ill patients
on EN.
54–57
Gastrointestinal promorbidity agents in the ICU have
been systematically reviewed recently;
58
although no study dem-
onstrated a positive effect on clinical outcomes, promorbidity
agents as a class appear to increase indexes of gastrointestinal
transit and “tolerance” of feeding. Small bowel feeding, beyond
the pylorus, may also be associated with a decrease in gastroesoph-
ageal regurgitation, an increase in nutrient delivery, and a lower
rate of ventilator-associated pneumonia.
59
The use of an EN feed-
ing protocol with a gastric residual threshold volume of 250 mL
may also positively affect tolerance of tube feeds and achievement
of goal rates