Procedures Routine interruption of

Procedures
Routine interruption of enteral nutrition before procedures and surgeries is common. Feedings are withheld in an attempt to prevent aspiration of stomach contents during extended periods of positioning with a head-ofbed (HOB) position less than 30º or during placement of an artificial airway. If anesthetics or sedatives are administered, reinitiation of enteral feeding may be delayed during recovery from the procedure. The most frequently cited reason for interruption of enteral feeding is for procedures and operations.22,32 Enteral feedings may also be withheld in anticipation of extubation or in anticipation of future reintubation. According to O’Leary-Kelly et al,33 more than 50% of interruptions in enteral nutrition were due to planned procedures or extubations. Scheduling of procedures and operations has also been cited as a reason for interruptions in and delay in resumption of enteral feedings. Scheduling influenced the delivery of enteral nutrition because the variability in the surgical schedule led to increased fasting times.34 No clear guidelines exist to guide the withholding of enteral nutrition before procedures in critically ill patients.32 Because of the increased risk of aspiration pneumonia and its complications in critically ill patients, the current practice of withholding feedings before procedures in critically ill patients who require enteral nutrition is recommended.35,36