The Early Nasojejunal Tube to Meet Energy Requirements in Intensive Care (ENTERIC) Study (ENTERIC)

Inclusion Criteria: ICU patients are eligible for enrolment if they meet all of the following: Age > 18 years old In ICU for < 48 hours prior to enrolment Receiving invasive mechanical ventilation (through an endotracheal tube or tracheostomy, but NOT a facemask) with an anticipated need for > 48 hours of mechanical ventilation Receiving a continuous infusion of any one of: morphine > 2 mg/hour, fentanyl > 20 mcg/hour, or pethidine > 20 mg/hour Either a single GRV > 150 mls (whilst receiving EN via a NG tube) or nasogastric drainage > 500 mls over 12 hours (whether receiving EN or not) Exclusion Criteria: Patients will be ineligible for enrolment if they meet any of the following: Previous or recent surgery which has altered the anatomy of the upper gastrointestinal tract (eg. oesophagectomy, gastrectomy, any gastric anastomosis surgery, gastroplasty, pyloroplasty, pancreaticoduodenectomy [Whipple's procedure]) Known gastric malignancy Known oesophageal varices Current admission for peptic ulceration Current mechanical bowel obstruction Current gastrostomy, jejunostomy, or surgically-placed enteral tube in situ Contraindication to the use of the nose and mouth for enteral tube insertion (eg. recent facial trauma or surgery) Receiving nutritional support prior to ICU admission Severe coagulopathy (defined by platelet count < 20 and/or international normalized ratio [INR] > 4.0)