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Review
. 2025 Jan;16(1):100345.
doi: 10.1016/j.advnut.2024.100345. Epub 2024 Nov 17.

Nine Myths about Enteral Feeding in Critically Ill Adults: An Expert Perspective

Tara Ramaswamy  1 , Michael P DeWane  2 , Hassan S Dashti  3 , Meghan Lau  3 , Paul E Wischmeyer  4 , Alexander Nagrebetsky  3 , Jamie Sparling  3
Affiliations
Review

Nine Myths about Enteral Feeding in Critically Ill Adults: An Expert Perspective

Tara Ramaswamy et al. Adv Nutr. 2025 Jan.

Abstract

Malnutrition is a well-studied and significant prognostic risk factor for morbidity and mortality in critically ill perioperative patients. Common nutrition myths in the critically ill may prevent early, consistent, and adequate delivery of enteral nutrition. We outlined 9 common intensive care unit (ICU) nutrition misconceptions and our recommendations to optimize enteral nutrition in critically ill patients based on the review of available literature. Our approach is to treat every patient admitted to the ICU as at risk for malnutrition and to initiate enteral nutrition upon admission in the absence of contraindications. Early enteral nutrition via the gastric route is more beneficial than delaying feeding while awaiting small bowel access and daytime-intermittent nutrition support can safely be initiated over continuous feeding. Gastric residual volumes to assess feeding tolerance should no longer be routinely measured. For perioperative nutrition, we recommend continuing enteral nutrition for most patients with secure airways undergoing anesthesia and resuming nutrition within 24 h of abdominal surgery; even patients with open abdomens can be safely fed in the absence of bowel injury. Critically ill patients who are proned, paralyzed, and on vasopressors can usually continue enteral nutrition. Finally, continuing enteral nutrition before extubation may optimize nutrition without compromising extubation success. In this review, we highlight several common misconceptions regarding ICU nutrition that may prevent achieving nutrition goals and subsequently lead to increased malnutrition, morbidity, and mortality. This knowledge may contribute to increased implementation of early and consistent enteral nutrition strategies to improve outcomes in critically ill adult patients.

Keywords: clinical nutrition; evidence-based practice; intensive care unit; malnutrition; nutrition support; perioperative nutrition.

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Conflict of interest statement

Conflict of interest HSD is an Editor for Advances in Nutrition and played no role in the journal’s evaluation of the manuscript. The other authors declared no potential conflicts of interest with respect to the research, authorship, or publication of this article.

Figures

FIGURE 1
FIGURE 1
Summary of 9 common intensive care unit (ICU) nutrition misconceptions.
See this image and copyright information in PMC

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