Tolerance to enteral nutrition in the intensive care unit: A narrative literature review

Background. Nutritional deficiency is a risk factor for complications and adverse outcomes in critically ill patients. Enteral nutrition is considered the method of choice for correcting the nutritional status of patients in intensive care units. However, the implementation of enteral nutrition is associated with a number of objective and subjective problems: late initiation, non-compliance with clinical recommendations, and low gastrointestinal tolerance. Objective. Based on an analysis of scientific literature, we aim to identify risk factors for decreased enteral nutrition tolerance and propose methods for correcting these disorders. Results. The therapeutic potential of innovative enteral formulas based on the P4 protein complex (a combination of dairy and non-coagulating plant proteins) successfully overcomes gastrointestinal intolerance to nutritional support in critically ill patients. This 4-component formula effectively counteracts the limitations of standard casein-predominant polymeric feeds. The use of innovative P4-based formulas accelerates gastric emptying and minimizes gastric residual volume, thereby reducing the risk of aspiration, while also decreasing the likelihood of malabsorption and bacterial translocation. Conclusion. Upon the onset of signs of low enteral nutrition tolerance in critically ill patients, it is advisable to employ a comprehensive approach. This strategy includes the administration of prokinetics alongside enteral tube feeding formulas containing a combination of dairy and non-coagulating plant proteins (P4).