Feeding intolerance syndrome (FI)
FI is a general term indicating intolerance of enteral feeding for whatever clinical reason (vomiting, high gastric residuals, diarrhoea, GI bleeding, presence of entero-cutaneous fistulas, etc.).
Rationale Diagnosis is based on complex clinical evaluation. There is no single clear-cut symptom or value that defines FI [
31]. Several symptoms are commonly present.
FI should be considered present if at least 20 kcal/kg BW/day via enteral route cannot be reached within 72 h of feeding attempt or if enteral feeding has to be stopped for whatever clinical reason. FI should not be considered as present if enteral feeding is electively not prescribed or is withheld/interrupted due to procedures.
FI in special conditions: in a patient with postpyloric feeding, FI is defined similarly to gastric feeding. If a patient is not fed enterally due to the presence of entero-atmospheric fistulas, FI should be considered present. If the patient undergoes a surgical intervention for ACS or for changing of surgical dressings of an open abdomen, FI should be considered present immediately after surgery unless enteral feeding can be administered.
Management FI requires efforts to maintain/restore GI function: limiting the use of drugs impairing motility, application of prokinetics and/or laxatives [
32‐
34] (grade 1C), and controlling IAP. Challenges with small amounts of EN should be regularly considered. In patients not tolerating enteral feeding, supplemental parenteral nutrition should be considered [
35,
36] (grade 2D). Recent data suggest that delay for 1 week with parenteral nutrition enhances recovery when compared to early intravenous feeding [
27] (grade 2B).