Impact of Enteral Feeding on Vasoactive Support in Septic Shock: A Retrospective Observational Study. Nutr Clin Pract 2020 Jun;35(3):540-547
Date
03/07/2020Pubmed ID
32134146DOI
10.1002/ncp.10480Scopus ID
2-s2.0-85080855826 (requires institutional sign-in at Scopus site) 5 CitationsAbstract
BACKGROUND: Introducing enteral nutrition (EN) during hemodynamic instability may induce the splanchnic steal phenomenon, which may worsen systemic oxygen delivery and increase vasopressor dose. We aimed to determine the change in vasopressor dose in septic shock patients who received concomitant EN. We hypothesize that EN delivery is not associated with worsening hemodynamic instability, as defined by an increase in vasopressor dose ≥50% at 24 hours.
METHODS: This is a retrospective observational cohort study of adult patients with septic shock who were admitted to the intensive care unit from January 2015 to June 2015 and received EN. Vasopressor and EN parameters were collected at 6-hour intervals for the first 24 hours.
RESULTS: Data were available for 28 consecutive patients. The mean age was 60 years (SD = 18), and 54% were females. Norepinephrine (NE) was used in 100%. EN and vasopressor overlap totaled 36 hours (interquartile range [IQR], 27-69). Median NE dose when starting EN was 5.9 μg/min (IQR, 3.88). Median change in dose from 0 to 6 hours was 0.85 μg/min (95% CI, 0.681.06; P = 0.136), corresponding to a median increase of 14.5%. Total NE duration was 60.5 hours (IQR, 47.5-75.5). No serious complications occurred.
CONCLUSION: The median vasopressor dose did not increase by ≥50% during the first 24 hours of EN. This suggests early EN delivered during septic shock is not associated with worsening hemodynamic instability. Limitations include a small sample size and residual confounding. Prospective data are needed.
Author List
Ewy M, Aqeel M, Kozeniecki M, Patel K, Banerjee A, Heyland DK, Patel JJAuthor
Anjishnu Banerjee PhD Associate Professor in the Data Science Institute department at Medical College of WisconsinMESH terms used to index this publication - Major topics in bold
AdultAged
Cohort Studies
Enteral Nutrition
Female
Hemodynamics
Humans
Male
Middle Aged
Norepinephrine
Retrospective Studies
Shock, Septic
Treatment Outcome
Vasoconstrictor Agents
