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Abstract
Dr. Mehta and colleagues 1 have provided an excellent opportunity for those of us who treat critically ill infants and children to examine and improve enteral nutrition (EN) delivery to our patients. Future research aimed at elucidating effective nutrition strategies to improve patient outcomes depends on early initiation and subsequent maintenance of optimal EN. If we are unable to reliably reach and sustain target intakes of EN, we will be unable to determine effects of specific EN therapies on patient outcomes. Many basic research questions in need of answers revolve around enteral feeding in the pediatric intensive care unit (PICU). When should we start EN? How should we administer EN? Are there advantages or disadvantages to specialized enteral formulas? Should initiation of EN be delayed until medical paralytic and vasoactive agents have been discontinued? What is the optimal amount of EN needed for trophic gastrointestinal effects? How is EN tolerance defined, and how can it be improved? When is the transpyloric route indicated? How do we define appropriate enteral intake targets? When should the goal rate be achieved? Which strategies will reduce intake deficits and ensure patients meet calorie and protein goals? How can we minimize the risks associated with enteral feeding? What nutrition and outcome benefits can be pursued through provision of optimal EN? Once we provide EN as an imperative therapy and use it to its fullest potential in the PICU, we can begin to examine the associated outcome benefits. 2 Other groups have reported their experiences with the inadvertent inadequate nourishment of PICU patients. 3-8 This publication is unique in that it focuses on a PICU population with a wide variation of ages and diagnoses (as is commonly encountered in a moderate- to large-sized PICU), exclusively looking at preventable obstacles to optimal EN during a 4-week period. What can you do to improve EN delivery in your PICU? Many of us who read the article by Mehta et al 1
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