How to improve worldwide early enteral nutrition performance in intensive care units?

The ESICM Working Group on Gastrointestinal Function provided clinical practice guidelines on EEN and suggested to initiate it at a low rate, as beneficial effects regarding infection prevention have been demonstrated in critically ill patients, as well as in patients with severe acute pancreatitis and after gastrointestinal (GI) surgery [1]. Delaying EN was only suggested in patients with uncontrolled shock (when hemodynamic and tissue perfusion goals are not met despite fluids and vasopressors), in uncontrolled hypoxemia and acidosis, uncontrolled GI bleeding, overt bowel ischemia (occlusive or non-occlusive), bowel obstruction (mechanical ileus), abdominal compartment syndrome, gastric aspirate volume (GRV) > 500 ml/6 h or high-output fistula if reliable distal feeding access is not achievable. [...]let’s cooperate and follow the wisdom of the ancient Chinese proverb: “Talk does not cook rice”.