Enteral Nutrition or Parenteral Nutrition?

Enteral nutrition has been agreed by most people as the preferred route for nutrition in patients that are critically ill (Harvey et al., 2014). Enteral routes of medication administration usually involve the esophagus, the stomach, the large and small intestines and rely on oral, nasogastric, and rectal administration. In contrast, parenteral administration includes non-oral methods that consist of injecting medication directly into a patient by going through the skin and mucous membranes. The main controversy stems from the fact that although enteral nutrition is very effective for the majority of the population there are certain individual in which parenteral nutrition is better mainly due to problems GI tract organs. There is not a good method in place for switching care from enteral to parenteral nutrition before serious adverse effects begin to show (Heighes, Doig, & Simpson, 2016).

Enteral nutrition is theoretically seen as the better option when selecting a route of medical administration because it can improve gut mucosal health, systemic immune function, and efficiency of nutrient use (Harvey et al., 2014). Some evidence also shows that it is both more convenient and safer than parenteral nutrition, because it does not rely on a central line and is much cheaper than parenteral nutrition (Harvey et al., 2014).

It is important for the physicians of the future to run preliminary check-ups and tests to see whether it is better to implement an enteral or parenteral route. Although the vast majority of physicians prefer to use the enteral route, it is important to implement the parenteral route of administration for patients with certain complications such as esophageal traumas or fistulas. It is important to for physicians to consider both beneficence and nonmalfeasance before picking a certain route of administration in order to do the best for the patient and to make sure no harm comes to them.  Although the enteral route is preferred it is important to note that there is no mortality difference between enteral and parenteral nutrition (Heighes et al., 2016). There are also several complications that can arise from enteral nutrition including aspiration risk of medication and complications with the insertion of the nasogastric tube.

In general the nutrition of the critically ill does not have a one size shoe fits all solution, and must be approached carefully in the interest of saving lives.

Harvey, S. E., Parrott, F., Harrison, D. A., Bear, D. E., Segaran, E., Beale, R., … Rowan, K. M. (2014). Trial of the Route of Early Nutritional Support in Critically Ill Adults. New England Journal of Medicine, 371(18), 1673–1684. https://doi.org/10.1056/NEJMoa1409860

Heighes, P. T., Doig, G. S., & Simpson, F. (2016). Timing and Indications for Enteral Nutrition in the Critically Ill. In Nutrition Support for the Critically Ill (pp. 55–62). Cham: Springer International Publishing. https://doi.org/10.1007/978-3-319-21831-1_4