GASTROINTESTINAL SYSTEM: Edited by Jan J. De WaeleOvercoming challenges to enteral nutrition delivery in critical careWischmeyer, Paul E. Author Information Department of Anesthesiology, Duke University School of Medicine, Durham, North Carolina, USA Correspondence to Paul E. Wischmeyer, MD, EDIC, FASPEN, FCCM, Professor of Anesthesiology and Surgery, Duke University School of Medicine DUMC, Box 3094 Mail # 41; 2301 Erwin Road, 5692 HAFS, Durham, NC 27710, USA. Tel: +1 919 681 6646; e-mail: [email protected] Current Opinion in Critical Care: April 2021 - Volume 27 - Issue 2 - p 169-176 doi: 10.1097/MCC.0000000000000801 Buy Metrics Abstract Purpose of review Existing data and all ICU nutrition guidelines emphasize enteral nutrition (EN) represents a primary therapy leading to both nutritional and non-nutritional benefits. Unfortunately, iatrogenic malnutrition and underfeeding is virtually ubiquitous in ICUs worldwide for prolonged periods post-ICU admission. Overcoming essential challenges to EN delivery requires addressing a range of real, and frequently propagated myths regarding EN delivery. Recent findings Key recent data addresses perceived challenges to EN including: Adequately resuscitated patients on vasopressors can and likely should receive trophic early EN and this was recently associated with reduced mortality; Patients paralyzed with neuromuscular blocking agents can and should receive early EN as this was recently associated with reduced mortality/hospital length of stay; Proned patients can safely receive EN; All ICU nutrition delivery, including EN, should be objectively guided by indirect calorimetry (IC) measures. This is now possible with the new availability of a next-generation IC device. Summary It is the essential implementation of this new evidence occurs to overcome real and perceived EN challenges. This data should lead to increased standardization/protocolization of ICU nutrition therapy to ensure personalized nutrition care delivering the right nutrition dose, in the right patient, at the right time to optimize clinical outcome. Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.