NUTRITION AND THE INTENSIVE CARE UNIT: Edited by Michael P. Casaer and Adam M. DeaneEnteral feeding, even when the gut does not feel very good?Reintam Blaser, Annikaa,b; Hiesmayr, Michaelc,d Author Information aDepartment of Anaesthesiology and Intensive Care, University of Tartu, Puusepa 8, Tartu, Estonia bDepartment of Intensive Care Medicine, Lucerne Cantonal Hospital, Lucerne, Switzerland cDivision of Cardiac Thoracic and Vascular Anaesthesia and Intensive Care dCenter for Medical Statistics Informatics And Intelligent Systems, Medical University Vienna, Vienna, Austria Correspondence to Annika Reintam Blaser, Department of Anaesthesiology and Intensive Care, University of Tartu, Puusepa 8, Tartu 50406, Estonia. E-mail: [email protected] Current Opinion in Clinical Nutrition and Metabolic Care: March 2022 - Volume 25 - Issue 2 - p 122-128 doi: 10.1097/MCO.0000000000000817 Buy Metrics Abstract Purpose of review To summarize knowledge on the gut function in relation to enteral nutrition. Recent findings The gut is certainly suffering during critical illness but our understanding of the exact mechanisms involved is limited. Physicians at bedside are lacking tools to identify how well or bad the gut is doing and whether the gut is responding adequately to critical illness. Sensing nutrition as a signal is important for the gut and microbiome. Enteral nutrition has beneficial effects for the gut perfusion and function. However, early full enteral nutrition in patients with shock was associated with an increased number of rare but serious complications. Summary Whenever synthesizing knowledge in physiology and available evidence in critically ill, we suggest that enteral nutrition has beneficial effects but may turn harmful if provided too aggressively. Contraindications to enteral nutrition are listed in recent guidelines. For patients with gastrointestinal dysfunction but without these contraindications, we suggest considering early enteral nutrition as a signal to the gut and to the body rather than an energy and protein provision. With this rationale, we think that low dose of enteral nutrition could and probably should be provided also when the gut does not feel very good. Understanding the feedback from the gut in response to enteral nutrition would be important, however, monitoring tools are currently limited to clinical assessment only. Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.