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Recommendation 1: Start early enteral nutrition in all critically ill patients within 48 h, preferably within 24 h when there is no reason to delay enteral nutrition (see the following recommendations).
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Early enteral nutrition is associated with lower risk of infections and preserves the gut function, immunity, and absorptive capacity.
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Recommendation 2: Delay early enteral nutrition in case of enteral obstruction.
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Feeding proximal of an obstruction will lead to blow-out or perforation.
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Recommendation 3: Delay early enteral nutrition in case of compromised splanchnic circulation such as uncontrolled shock, overt bowel ischemia, abdominal compartment syndrome, and during intra-abdominal hypertension when feeding increases abdominal pressures.
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Absorption of nutrients demands energy and oxygen. In states of low flow or ischemia, forcing feeding into the ischemic gut may aggravate ischemia and lead to necrosis or perforation.
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Recommendation 4: Delay early enteral nutrition in case of high-output fistula that cannot be bypassed.
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Enteral feeding will be spilled into the peritoneal space or increase the fistula production.
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Recommendation 5: Delay early enteral nutrition in case of active gastrointestinal bleeding.
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Enteral feeding will limit the visualization of the upper gastrointestinal tract during endoscopy.
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Recommendation 6: Delay early enteral nutrition in case of high gastrointestinal residual volume (> 500 mL per 6 h).
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This threshold is associated with poor gastric emptying and may increase the risk of aspiration. Prokinetics and postpyloric feeding can circumvent this problem.
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