Impact of Enteral Feeding on Vasoactive Support in Septic Shock: A Retrospective Observational Study.

Abstract

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.

• Authors: Matthew Ewy, Masooma Aqeel, Michelle Kozeniecki, Kadam Patel, Anjishnu Banerjee, Daren K Heyland, Jayshil J Patel
• Journal: Nutrition in clinical practice : official publication of the American Society for Parenteral and Enteral Nutrition (Nutr Clin Pract) Vol. 35 Issue 3 Pg. 540-547 (Jun 2020) ISSN: 1941-2452 [Electronic] United States
• PMID: 32134146 (Publication Type: Journal Article, Observational Study)
• Copyright: © 2020 American Society for Parenteral and Enteral Nutrition.

Chemical References

• Vasoconstrictor Agents
• Norepinephrine

Topics

• Adult
• Aged
• Cohort Studies
• Enteral Nutrition (methods)
• Female
• Hemodynamics (physiology)
• Humans
• Male
• Middle Aged
• Norepinephrine (administration & dosage)
• Retrospective Studies
• Shock, Septic (physiopathology, therapy)
• Treatment Outcome
• Vasoconstrictor Agents (administration & dosage)