Which method of enteral nutrition delivery is preferred for critically ill patients?

• A. Bolus feeding
• B. Cyclic feeding
• C. Intermittent feeding
• D. Continuous infusion

Answer: (D)

In critically ill patients, delivering nutrition in a steady, controlled manner is crucial to tolerance and safety. Continuous infusion via a feeding pump provides a constant rate of delivery, spreading the caloric load evenly over time. This minimizes gastric overload, reduces fluctuations in gastric residuals, and lowers the risk of aspiration and intolerance that can accompany larger, intermittent boluses or meals. It also allows careful titration of the rate based on tolerance and clinical status, which is particularly important when GI motility is impaired or when patients are sedated or on mechanical ventilation.

Bolus feeding delivers a large volume quickly, which can provoke cramps, diarrhea, vomiting, or aspiration in patients with reduced protective reflexes. Intermittent feeding is closer to meals but can still lead to intolerance and aspiration if gastric emptying is delayed. Cyclic feeding, typically overnight, improves mobility and may be used in some patients, but it does not provide the continuous, stable support that severely ill patients often need to maintain gut integrity and metabolic stability.

So, the preferred method for critically ill patients is continuous infusion.