Enteral and Parenteral Feeding: How to Choose the Route

This chapter presents a comprehensive historical overview of artificial nutrition’s evolution, tracing its origins to ancient Egyptian practices and subsequent advancements in the twentieth century. It elucidates the transition from enteral to parenteral nutrition in the late twentieth century, driven by technological breakthroughs, particularly in lipid emulsions for intravenous administration. However, recognition of the short- and long-term complications associated with parenteral nutrition prompted a reassessment, underscoring the importance of enteral nutrition when viable. The chapter delves into the contemporary landscape of enteral versus parenteral nutrition in intensive care, emphasizing the physiological advantages of enteral nutrition when the gastrointestinal tract remains accessible. Considerations for commencing artificial nutrition, encompassing indications, therapeutic objectives, and vigilant monitoring are meticulously examined. Detailed guidelines for initiating enteral access, including nasogastric and nasojejunal tubes, are provided. Furthermore, discussions on post-pyloric nutrition and gastrostomy placement methods and indications are elucidated. Enteral nutrition is advocated as the primary choice due to its physiological compatibility, diminished complication rates, and cost-effectiveness. Parenteral nutrition is deemed the preferred therapy in scenarios where enteral routes are unfeasible. The chapter concludes by accentuating the importance of individualized and modulated nutrition strategies, harnessing both enteral and parenteral routes to address the dynamic caloric necessities of patients in the intensive care unit.