Enteral nutrition dates back to 3500 bc, when the ancient Egyptians would administer enemas of wine, milk, whey, wheat, and barley.1  Nearly 5500 years later, Dr Stanley Dudrick successfully nourished beagle puppies with total parenteral nutrition (TPN).2  The practice of nutrition has evolved greatly over the years, yet many unanswered questions regarding nutrition in critically ill patients remain. Malnutrition affects up to 78% of intensive care unit (ICU) patients, leading to increased morbidity, mortality, and hospital-related costs.3  This review explores the considerations and controversies of feeding adult patients in the ICU.

In critically ill patients, caloric intake is either limited or contraindicated due to the high rates of intubation, lack of appetite, and nothing-by-mouth status. This limitation in intake creates a dilemma because many disease states in ICU patients are extremely catabolic. Up to 1 kg of muscle mass per day is thought to be lost within...

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