Gold Standard Rule: “If the gut works, use it.” Always prefer enteral nutrition (EN) over parenteral nutrition (PN)/total parenteral nutrition (TPN).
Physiologic Benefits:
Preserves gut mucosal integrity and tight junctions.
Prevents bacterial translocation from the gut lumen into systemic circulation.
Reduces infectious complications (e.g., avoids CLABSI associated with TPN).
Maintains local immune function (GALT/IgA production).
Indications:
Critically ill patients on mechanical ventilation who cannot eat orally.
Severe dysphagia (e.g., acute ischemic stroke, head/neck cancer, neuromuscular disorders).
Hypermetabolic states (e.g., severe burns, major trauma) with inadequate oral intake for >3–5 days. c
Contraindication to PEG: Advanced dementia with dysphagia. Hand-feeding is preferred; PEG tubes do not prolong life, improve nutritional status, or prevent aspiration pneumonia in this population.
Routes of Administration
Short-Term Access (<4 weeks):
Nasogastric (NG) tube: Easiest to place. Standard initial route. Requires normal gastric emptying.
Nasoduodenal (ND) / Nasojejunal (NJ) tube: “Post-pyloric” tubes. Indicated if there is high aspiration risk, severe GERD, or gastroparesis.
Long-Term Access (>4 weeks):
Percutaneous Endoscopic Gastrostomy (PEG): Tube placed directly into the stomach.
Jejunostomy (J-tube): Placed into the jejunum. Preferred if gastric pathology exists (e.g., prior gastrectomy, severe gastroparesis).