A 60-year-old septic patient in the ICU has serum sodium of 130 mEq/L, serum albumin 22 g/L, and is on total parenteral nutrition (TPN). The decision is made to start enteral nutrition. According to ESPEN 2023 guidelines, which parameter should guide the timing of enteral nutrition in critically ill patients?

• A Passage of flatus or first bowel movement, confirming GI motility
• B Start early enteral nutrition (within 24–48 hours of ICU admission) regardless of haemodynamic instability
• C Early enteral nutrition (within 24–48 hours) should be commenced after haemodynamic stabilisation ✓
• D Enteral nutrition should be withheld for 72 hours to allow splanchnic perfusion to normalise

Explanation

ESPEN 2023 ICU nutrition guidelines recommend early enteral nutrition (within 24–48 hours of ICU admission) once haemodynamic stabilisation is achieved — defined as weaning of vasopressors or at stable, low vasopressor doses. Early EN is not recommended in haemodynamically unstable patients (high-dose or escalating vasopressors) due to risk of non-occlusive mesenteric ischaemia. Waiting for bowel sounds or flatus is not required as GI motility can be inferred from the absence of other contraindications. The gut-mucosal barrier and immune function benefits of early EN are well established.

Reference: Bailey & Love's Short Practice of Surgery, 27th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.