Since enteral feeding promotes more efficient utilization of nutrients and better preservation of intestinal integrity than does parenteral feeding, the gut is the preferred route for nutritional support.  Enteral feeding is also safer and more economical.  Adequate intestinal function must be present.  Sufficient gastrointestinal function is frequently available in the surgical patient at least to allow some enteral feeding, which helps minimize gut mucosal atrophy.  The appropriate enteral dietary regimen depends upon the patient’s diagnosis, nutritional status, nutrient and fluid requirements, and alimentary tract function.  Enteral feedings provide many physiologic, metabolic, safety, and cost benefits over parenteral feedings.  Oral consumption of nutrients is the easiest approach and sufficient nutrients should be provided once gastrointestinal function has been restored.

If gastrointestinal function is impaired, correctable causes should be sought and eliminated.  Among the common correctable causes of ileus are hypoalbuminemia (less than 2.5 g per deciliter), narcotic use, electrolyte abnormalities, and increased fat in the diet.

 If gastrointestinal function is impaired, correctable causes should be sought and eliminated.  Among the common correctable causes of ileus are hypoalbuminemia (less than 2.5 g per deciliter), narcotic use, electrolyte abnormalities, and increased fat in the diet.

The voluntary intake of food alone may be insufficient for the increased energy and protein demands of the major surgery, trauma or septic population.  Numerous studies demonstrate the need for increased energy and protein intake during both he catabolic and recovery phase after injury.  The increased protein demands, especially if restoration of depleted body lean mass is required; often exceed that which a severe stressed patient can achieve with intake of food alone.  This concept is particularly well documented in the management of the patients with a wound when the addition of protein supplements to maintain intake at 1.5-2.0 g/kg/day significantly increased healing rate.

As described, the protein intake correlates best with healing rate.  Nutrient supplements should be selected based on the following criteria.

Highly concentrated hyperosmolar solution of calories, carbohydrates, protein and fat (2 calories per ml).

Isosmolar solution of calories, carbohydrates, protein and fat. (1 calorie per ml)