feeding (gastric vs intestinal)

A note on Pros and Cons of gastric feeding in ICU

It should be understood that gastric feeding is more physiologic. It buffers gastric acid better. The gastropancreatic reflexes and gastrin release are more balanced. It enhances the pancreatic responses prior to food reaching the upper small bowel. In long term, it is easier to place and convenient to use. Moreover, the stomach can relatively tolerate a larger volume and higher osmotic load. 

Post-pyloric feeding should be utilized in situations where there is a chance of delayed gastric emptying, severe gastroesophageal reflux disease (GERD) and/or esophagitis causing nausea, vomiting, or aspiration pneumonia. Paralytic agents affect gastric motility more and post-pyloric feeding may be required if gastric intolerance may become an issue. 

#GI

References:

1. Tamion F, Hamelin K, Duflo A, Girault C, Richard JC, Bonmarchand G. Gastric emptying in mechanically ventilated critically ill patients: effect of neuromuscular blocking agent. Intensive Care Med. 2003 Oct;29(10):1717-22. doi: 10.1007/s00134-003-1898-5. Epub 2003 Jul 30. PMID: 12897996. 

2. Weledji EP. Perspectives on paralytic ileus. Acute Med Surg. 2020;7(1):e573. Published 2020 Oct 4. doi:10.1002/ams2.573 

3. Murray MJ, DeBlock H, Erstad B, Gray A, Jacobi J, Jordan C, McGee W, McManus C, Meade M, Nix S, Patterson A, Sands MK, Pino R, Tescher A, Arbour R, Rochwerg B, Murray CF, Mehta S. Clinical Practice Guidelines for Sustained Neuromuscular Blockade in the Adult Critically Ill Patient. Crit Care Med. 2016 Nov;44(11):2079-2103. doi: 10.1097/CCM.0000000000002027. PMID: 27755068.