Early initiation of enteral feeding has been suggested to benefit ICU patients by reducing infectious complications, length of hospital stay and possibly reducing mortality. Which group of patients might be at significant risk from early enteral feeding?

• A. Cancer patients who underwent surgery of the gastrointestinal tract
• B. Patients with increasing vasopressor support
• C. Traumatic brain injury patients with intracranial pressure controlled by hypertonic saline
• D. Patients admitted to the hospital with acute on chronic pancreatitis

Answer: (B)

In critical illness, starting enteral feeding hinges on gut perfusion. When a patient requires increasing vasopressor support, vasoconstriction and reduced splanchnic blood flow can make the gut vulnerable. Providing nutrition to a gut with compromised perfusion raises the risk of nonocclusive mesenteric ischemia and bowel injury, so early feeding in this setting is particularly risky. That’s why the group at significant risk from early enteral feeding is patients on escalating vasopressor support.

The other scenarios involve situations where hemodynamics may be more stable or where early feeding is commonly pursued with monitoring—for example, many patients after GI surgery who are stable, brain-injured patients who can tolerate early feeding with careful oversight, or pancreatitis patients where early feeding can be beneficial once pain and ileus are controlled.