Gut access in critically ill and injured patients: Where have we gone thus far?

Background: Nutritional support in critically ill and injured patients is crucial. It can be provided via parenteral or enteral access, each of which has advantages and disadvantages. In this article, we review enteral support, particularly gut access. Methods: We conducted a literature review. Results: A number of techniques enable access to the gastrointestinal tract in critically ill and injured patients. A temporary orogastric (OG), nasogastric (NG), or nasojejunal (NJ) feeding tube can be placed. But the prevalent technique is the more permanent percutaneous endoscopic gastrostomy (PEG), which has economic as well as safety benefits. Other techniques include open operative gastrostomy, laparoscopic or laparoscopic-as-sisted gastrostomy, and jejunostomy. Conclusions: Nutritional support should be provided enterally, via gut access whenever possible. The issue of pre- versus post-pyloric access remains controversial. PEG is safe and economical for long-term access.