A 55-year-old patient with a head injury (GCS 9) is intubated and mechanically ventilated. The ICU team initiates nutritional support. According to ESPEN 2019 ICU nutrition guidelines, enteral nutrition should be initiated:

• A After 72 hours once bowel sounds return
• B Within 24-48 hours of ICU admission once hemodynamically stable ✓
• C Only after measurement of gastric residual volume confirms adequate gastric emptying
• D Parenteral nutrition should be started first as enteral nutrition is contraindicated with head injury

Explanation

ESPEN 2019 ICU nutrition guidelines recommend initiating early enteral nutrition (EN) within 24-48 hours in critically ill patients who cannot maintain voluntary oral intake, provided there is no absolute contraindication (intestinal obstruction, severe ileus, abdominal compartment syndrome, uncontrolled shock). Early EN in head-injured patients is associated with reduced infectious complications, improved gut mucosal integrity, and better outcomes. Gastric residual volume (GRV) monitoring alone should not delay EN initiation — ESPEN recommends tolerating GRV up to 500 mL before considering prokinetics. Parenteral nutrition is reserved for patients in whom EN is contraindicated or targets cannot be met after 3-7 days.

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.