Patient selection

In general, if the gut can be used safely in a patient who cannot meet nutritional requirements by oral intake, then EN is the preferred route. If the gut functions, EN is usually preferred over PN. The timing of SNS (either EN or PN) is controversial, but definitive guidelines for these therapies state that SNS should be started when intake has been inadequate for 7 to 14 days or if inadequate oral intake is anticipated to last at least 7 to 14 days.1 Prior nutritional status of the patient should be considered. Previously well-nourished patients can better afford not being fed for longer periods of time than those who are previously poorly nourished. Patients in the intensive care unit (ICU) setting probably benefit from early EN started within 24 to 48 hours of

admission to the ICU. ' Methods for assessing nutritional status and designing SNS regimens are covered in Chapter 100. In general, non-obese hospitalized patients require 20 to 35 total kcal/kg of body weight/day and 1 to 2 g protein/kg of body weight/ day.

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