Review Med Principles Pract 1999;8:77–84 Enteral Versus Parenteral Feeding: The Avoidance of Systemic Infection in the Critically Ill Christine M. Finck Giovanni F. Torelli Michael M. Meguid Madhu Varma Rebecca Evangelista Surgical Metabolism and Nutrition Laboratory, Department of Surgery, University Hospital, SUNY Health Science Center, Syracuse, N.Y., USA Received: June 8, 1998 Revised: July 20, 1998 Dr. Michael M. Meguid, MD, PhD, FACS, Department of Surgery University Hospital, SUNY Health Science Center 750 East Adams Street, Syracuse, NY 13210 (USA) Tel. +1 315 464 6277, Fax +1 315 464 6237 E-Mail meguidm@mailbox.hscsyr.edu ABC Fax + 41 61 306 12 34 E-Mail karger@karger.ch www.karger.com © 1999 S. Karger AG, Basel 1011–7571/99/0082–0077$17.50/0 Accessible online at: http://BioMedNet.com/karger Key Words Enteral nutrition W Parenteral nutrition W Sepsis W Infectious diseases Abstract The critically ill patient very often presents with systemic evidence of infection including tachypnea, tachycardia and hypo-hyperther- mia; this may lead to sepsis syndrome and subsequent multisystem organ failure. In or- der to manage this clinical condition, nutri- tional supportive therapy is very often re- quired. The choice between enteral and par- enteral nutrition is not always straightfor- ward. Early enteral nutrition seems to exert beneficial effects, although parenteral nutri- tion is often easier to administer, and thus is the treatment of choice. There are only few prospective, randomized, controlled trials comparing the two methods of intervention therapy. Parenteral nutrition seems to be as- sociated with mechanical, metabolic and septic complications, while enteral nutrition, which is associated with similar compli- cations, prevents gastrointestinal mucosal atrophy, attenuates the injury stress re- sponse, maintains immunocompetence, and preserves normal gut flora. This literature review focuses on the role played by these two methods of nutritional support therapy in the development of systemic infections. This review will also analyze possible mecha- nisms of action and future therapeutic strate- gies.