Introduction
Enteral Feeding Intolerance is a term that describes vomiting or huge gastric residual volumes connected with enteral feeding caused by late gastric emptying. Existing research reveals that enteral feeding intolerance mainly affects critically ill patients in intensive care units around the globe. However, the effect of enteral feeding intolerance on clinical results has a considerable variation between patients despite having the same clinical demonstration. Giving a unified definition to enteral feeding intolerance has proved to be a challenge because of the broad spectrum of the pathophysiological mechanisms influencing gastrointestinal tract function, which results in various clinical signs and symptoms regarded as enteral feeding intolerance manifestations. This paper’s purpose is to summarize evidence of existing descriptions and the clinical importance of enteral feeding intolerance in severely ill patients.
Evidence of Existing Descriptions
A review presented in 2014 recognized the existence of forty-three definitions of enteral feeding intolerance. This review proposed that descriptions can be divided into three groups; significant gastric residual volumes, gastrointestinal symptoms, and insufficient delivery of enteral nutrition. As an outcome of the heterogeneity of these definitions, the pervasiveness of gastrointestinal dysfunction leading to enteral feeding intolerance differs over an extensive range (Reintam Blaser et al., 2020). Various pathophysiological mechanisms have expounded that this heterogeneity is unclear because some definitions do not involve etiopathogenesis. However, gastrointestinal dysfunction is considered practical because it is primarily used in daily practice. It causes a depletion in the enteral feeding delivery irrespective of the underlying cause. Research suggests that an ideal explanation should be clinically applicable, effortless to implement and contain various pathophysiological mechanisms despite the many definitions (Reintam Blaser et al., 2020). Nevertheless, a description of enteral feeding intolerance entirely based on stomach-related symptoms like diarrhea is inadequate since it may ignore essential safety aspects.
Clinical Relevance of Enteral Feeding Intolerance in Critical Illness
Enteral feeding intolerance constitutes a physiological response that influences results through either a direct reaction on motility gastrointestinal or an indirect effect with insufficient nutrition intake. This low nutrition intake can increase the risk of non-effective outcomes or hinder recovery (Reintam Blaser et al., 2020). Alternatively, an enteral feeding intolerance can act as a protective and adaptive physiological response to a critical ailment. The ratio of this alternative physiological response is proportional and appropriate to the injury or sickness and has developed to decrease the ingestion of nutrients (Silk & Bowling). Targeting enteral feeding intolerance on gastric emptying has proved that small-bowel feeding application to gastroparesis patients is doubtlessly practical. An example of a pathway that enteral feeding intolerance has helped reduce nutrients through this physiological response is the trial of the body to maintain autophagy. Autophagy is an ever-present cellular path of reused cytoplasmic substances considered crucial to promote adaption to environmental change.
Conclusion
In conclusion, despite the lack of a unified description, enteral feeding intolerance occurs frequently and is associated with adverse outcomes. However, a more detailed definition is needed for studies to improve future knowledge. Enteral feeding intolerance due to different pathophysiological mechanisms is heterogeneous, and illustrations focusing on only one mechanism cannot cover the entire spectrum (Reintam Blaser et al., 2020). Additionally, although enteral feeding intolerance is adaptive, it may become a maladaptive process that requires intervention if it turns out severe. Consequently, it may be that this intolerance is preferably left for a short period without being treated after observation and subjected to treatment when features advance.
Reference
Reintam Blaser, A., Deane, A., Preiser, J., Arabi, Y., & Jakob, S. (2020). Enteral Feeding Intolerance: Updates in definitions and pathophysiology. Nutrition in Clinical Practice, 36(1), 40-49. Web.
Silk, D. B., & Bowling, T. (2017). Pathophysiology of enteral feeding diarrhea: The intestinal responses to enteral feeding rather than any role of FODMAPs. Journal of Parenteral and Enteral Nutrition, 41(8), 1259-1261. Web.