Timing of Target Enteral Feeding in the Mechanically Ventilated Patient

Inclusion Criteria

• •Mechanical ventilation expected to last at least 72 hours.
• •Presence of, or primary physician's intent to place, an enteral feeding tube and begin enteral feeds.
• •Patient, legal representative, or physician refuses consent or is unavailable to provide consent.
• •Patient, legal representative, or physician not committed to full support (Exception: A patient will not be excluded if he/she would receive all supportive care except for attempts at resuscitation from cardiac arrest).
• •Presence of malignant or irreversible condition and estimated 28 day mortality greater than 50%.
• •Severe or refractory shock.
• •Moribund patients not expected to survive 24 hours from start of enteral feeding (as determined by primary medical team).
• •Child-Pugh score greater than 10.
• •Presence of partial or complete mechanical bowel obstruction, or ischemia, or infarction.
• •Current TPN use or intent to use TPN within 7 days.
• •Severe malnutrition with BMI less than 18.5 and/or loss of more than 30% total body weight in the previous 6 months.
• •Neuromuscular disease impairing the ability to ventilate spontaneously.
• •Laparotomy expected within 7 days.
• •Unable to raise head of bed 45°.
• •greater than 30% total body surface area burns.
• •Absence of GI tract/short bowel syndrome - defined as entire length of small bowel totaling 4 feet or less.
• •Presence of high-output (\> 500 cc/day) enterocutaneous fistula.
• •Age less than 13 years
• •Allergy to enteral formula