Table 3 Guideline recommendations for strategies to improve EN delivery [1, 2, 13, 14]
From: Nutrition therapy in critical illness: a review of the literature for clinicians
Strategy | Evidenced-based feeding protocol | GRV (minimum 500 ml cut-off) | Appropriate and timely use of prokinetics for EN intolerance | Post-pyloric tubes for EN intolerance |
|---|---|---|---|---|
ASPEN/SCCM (2016) | Use an EN protocol (designed and implemented to increase the overall percentage of goal energy delivered) (quality: moderate to high) | Do not use GRVs as part of routine care to monitor ICU patients on EN If GRVs are used, use 500ml cut-off (quality: low) | Use metoclopramide or erythromycin where indicated (quality: low) | Nil |
Canadian Clinical Practice Guidelines (2015) | Use an EN protocol (that details strategies to improve delivery of EN) (based on 2 level 2 studies and 3 cluster RCTsa) | Use GRV of 250–500 ml every 4–6 h (based on 3 level 2 studiesa) | Use metoclopramide where indicated (based on 1 level 1 study and 5 level 2 studiesa) | Use post-pyloric tubes for patients at high risk for intolerance to EN or aspiration (based on 16 level 2 studiesa) |
ESPEN (2019) | Nil | EN should only be delayed when GRV is > 500 ml/6 h (grade 0b) | Use IV erythromycin as a first line therapy (grade of recommendation Bb) or use IV metaclopramide or combination therapy (grade 0b) Alternatively, combination therapy (IV metoclopramide and erythromycin) (grade 0b) | Use post-pyloric feeding for EN intolerance not resolved with prokinetics (grade Bb) |