This is a multi-centre randomised controlled trial comparing early jejunal feeding (using a frictional nasojejunal [NJ] tube) and standard feeding in critical illness.

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)