Answer to Question 1
Several years ago it would not have been a consideration to start an enteral feeding the day after or the day of surgery, absolutely not if there were no bowel sounds. Today, it has been observed that a post-op ileus is usually gastric or colonic and not in the small bowel. Feeding tubes placed in the small bowel during surgery are used to deliver modern enteral formulas the same day of surgery or the next day. Advantages over TPN include: less complications of infection or central line complication, less expensive, GI tract maintains its integrity, recovery is usually faster with GI than with TPN. Disadvantages: if the patient does have or develops a small bowel ileus, additional complications result; there is a chance of aspiration.
There are several enteral feedings that could be used in this case. Mrs. S's serum albumin is 2.8 g/dl. If it dropped acutely, I would use one of the di- and tripeptide formulas. If it dropped chronically one of the true elemental formulas may be more appropriate. If she would tolerate them, one of the special formulas like Advera, AlitraQ, or Impact could be justified. The actual feeding would depend on availability. The tube should be placed into the small bowel during surgery.
Answer to Question 2
CJ is having trouble breathing and if chewing were added to his routine it would be very difficult for him at this time. I would continue with a full liquid diet but I would supplement it with a high-protein trauma formula to the extent that he receives his needed caloric and protein needs.
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