For a critically ill surgical patient in ICU requiring nutritional support, which route is preferred when the GI tract is functioning?

• A Total parenteral nutrition (TPN) via central line for better calorie delivery
• B Peripheral parenteral nutrition for the first 72 hours followed by transition to enteral nutrition
• C Enteral nutrition (nasogastric/nasojejunal) as it preserves gut integrity, reduces bacterial translocation, and has fewer complications than TPN ✓
• D Oral supplementation with high-protein drinks; no tube feeding unless oral intake is <50% for >7 days

Explanation

Enteral nutrition (EN) is strongly preferred over parenteral nutrition when the GI tract is functioning, as it maintains mucosal integrity and tight junctions, prevents villous atrophy, preserves IgA secretion, reduces bacterial translocation and gut-derived sepsis, and is associated with lower rates of infection, hyperglycemia, and liver dysfunction compared to TPN. ESPEN and ASPEN guidelines recommend initiating EN within 24–48 hours of ICU admission if no contraindication exists. TPN is reserved for intestinal failure, high-output fistulas, or prolonged ileus. 'If the gut works, use it' is the guiding principle.

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.