There is evidence to support the early initiation of enteral feedings in critically ill patients to improve outcomes. However, concern about possible ischemia of the gut and fear that the oxygen demand related to feeding could cause stress on oxygen delivery have supported hemodynamic instability as a relative contraindication to early feeding.

  • Evaluate your patient population and the current standard of practice for early enteral feeding.

  • Engage staff physicians in a discussion of factors they consider when deciding to initiate feedings.

  • Consider developing a decision tree or algorithm to help the nursing staff understand the relevant factors that affect the decision.

  • Collaborate with your colleagues in nutritional support to find support literature relevant to your patient population.

  • Invite your interdisciplinary colleagues to discuss the evidence in a journal club format.

  • Review your policies and procedures for monitoring effectiveness of feeding strategies to ensure...

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