Can it all be done by enteral nutrition?

Purpose of review During recent years techniques and metabolic considerations have been discussed intensively. One contributing reason is that results have not always been easy to interpret and introduce into clinical practice. Nutrition through the enteral and parenteral route has classically been compared, and this is the topic of this review. Recent findings During the past 2 years a growing number of studies have focused on the amount and type of nutrition that is possible to give by enteral nutrition to intensive care unit patients. How to handle the clinical problem with paralysis and gastroparesis has also been studied. Basic research has shown a link between the gastrointestinal tract, immunocompetence and nutritional status. More evidence now exists that this is also clinically valid. Summary Recent research has shown that enteral nutrition alone does not cover the total nutritional needs of intensive care unit patients. Enteral nutrition given early in a high dose is associated with a higher risk of complications. Metabolism in intensive care unit patients is different from the perioperative condition, which has been highlighted in recent studies with important clinical implications. The final solution has not been found yet, if it exists at all, and research in this field will continue. As the situation in biology and in real intensive care unit life is neither black nor white, it would be most beneficial for the intensive care unit patient if enteral nutrition and parenteral nutrition joined together in a good balance in order to avoid underload and overload.