Gastric versus post-pyloric feeding: relationship to tolerance, pneumonia risk, and successful delivery of enteral nutrition.

Enteral nutrition has been shown to have clinical advantages over parenteral nutrition in critically ill patients. However, delivery of enteral nutrition can be challenging because of intolerance and potential adverse effects. Gastric feeding is more physiologic than post-pyloric feeding, but its use may be limited by intolerance due to gastric dysfunction and by inappropriately low gastric residual volumes. Post-pyloric feeding may help to overcome these disadvantages by making it possible to avoid feeding interruption and potentially reduce the risk of aspiration. Results from studies to date have not shown any advantage of post-pyloric over gastric feeding in regard to outcome. This article focuses on strategies for enteral nutrition delivery in critically ill patients. The selection of site for enteral feeding should be based on risks, patient tolerance, and availability of local expertise. Predetermined feeding protocols may help to optimize the delivery of enteral nutrition. Only sufficient and safe delivery of enteral nutrition will have a positive impact on patient outcome.