What is the rationale for initiating enteral nutrition in ICU patients, and when should it ideally start?

• A. It should be avoided in sepsis
• B. It is unnecessary in most ICU patients
• C. It should be started within 24-48 hours if feasible
• D. Maintains gut integrity and immune function

Answer: (D)

The main concept here is that feeding the gut preserves its function and supports the body’s immune defense. Enteral nutrition provides luminal nutrients that keep the gut lining healthy, maintain tight junctions, and support gut-associated immune tissue. This helps prevent bacterial translocation and systemic infections, which is a central reason why EN is favored over delaying feeding or using parenteral nutrition when feasible. By sustaining gut integrity and immune function, patients in the ICU are more likely to have better outcomes, including fewer infections and shorter courses of critical illness.

Guidelines also emphasize starting enteral nutrition early—ideally within 24 to 48 hours after ICU admission or once the patient is hemodynamically stable and there are no contraindications—because the benefit of preserving gut function and immune defense is greatest when feeding begins promptly.