Nutritive support of patients in intensive care unit is rather difficult section of intensive treatment as it is capable to influence a disease outcome substantially. Special attention to this problem testifies to importance of food in treatment of critical patients, along with antibacterial therapy, angiotonic support, artificial ventilation of the lungs and other components of an intensive care. Food of patients is capable to carry out not only a role of providing an organism all necessary, but also directly medical function.
It is possible to provide delivery in an organism of the patient of nutritive components both enteral (through digestive tract), and parenteral (usually intravenous) in the ways. In the first case use special nutritious mixes, and in the second - drugs for parenteral food (solutions of amino acids, drugs of lipids, glucose or the combined drugs).
Rather long time in the territory of the former Soviet Union the principle of prevalence in an intensive care of parenteral food dominated over enteral. It was connected with the insufficient level of equipment of intensive care units devices for a long enteroalimentation, insufficient level of training of specialists and also the certain created approaches in treatment. However the enteroalimentation possesses the leading role in nutritive therapy and parenteral ways of delivery of nutrients has to be used only when it is impossible to provide the patient's food in the enteral way as safer and physiologic.
According to literature it is considered that nutritive therapy in the form of early has to be begun with the EDS during the first 24–48 h after arrival of the patient to the intensive care care unit if the patient cannot independently eat for some reason food and on condition of lack of contraindications for an enteroalimentation. Making decision on the beginning of an enteroalimentation does not require existence of signs of a vermicular movement of intestines (auskultativny signs of intestinal noise, existence of a chair and other signs) as the enteroalimentation in itself can be a stimulator of work of intestines, it occurs due to development at food of hormones prokinetics (gastrin, bombesin, motilin).
Serve as contraindications to an enteroalimentation: a syndrome of vascular insufficiency of intestines, mechanical intestinal impassability, perforation of a stomach and/or intestines, disturbance of digestion and absorption of food, the proceeding gastrointestinal bleeding, intolerance of components of enteral nutritious mix, a syndrome of an abdominal compartment, disturbance of a hemodynamics with angiotonic support, a heavy anoxemia (which does not manage to be eliminated by means of artificial ventilation of the lungs, the expressed disturbances of acid-base equilibrium and the first 24 h after a severe injury or extensive operation. In the presence of contraindications to an enteroalimentation it is expedient to consider a question of carrying out parenteral nutritive support.
When carrying out an enteroalimentation of an intensive care preference is, as a rule, given to liquid nutritious mixes. Dry mixes have the best organoleptic properties and are recommended at oral administration by their patients. There are different types of mixes for an enteroalimentation, their choice is carried out proceeding from the nature of pathological process and the purposes of nutritive support.
Implementation of an enteroalimentation happens by administration of nutritious mixes via the device for enteral access (for example, the probe) and also orally in the form of drink (so-called "siping"). The choice of a technique of carrying out an enteroalimentation and also a mix dose, its concentration and feed rate depends on age, the weight of the patient, type of pathological process, energy and plastic demands of an organism, a condition of digestive tract of the patient.
When carrying out probe food mix can be entered into a stomach, a duodenum or into initial departments of a small bowel, including through a gastrostomy or eyunosty. As technical means of providing probe food can gravitational systems for an enteroalimentation, Janet's syringes or peristaltic pumps for enteral probe food are used.
At most of patients of intensive care units it is recommended to begin an enteroalimentation with faltering administration of nutritious mix in a stomach.
When carrying out an enteroalimentation clinical and laboratory monitoring of a condition of the patient surely is required.