title: Post-pyloric enteral nutrition in septic patients: effects on hepato-splanchnic hemodynamics and energy status.
abstract: OBJECTIVE
  To evaluate the effects of post-pyloric enteral nutrition (EN) on hepato-splanchnic and systemic hemodynamics, metabolism and gastric mucosal energy balance in septic patients.
  
  
  METHODS
  Prospective clinical study.
  
  
  METHODS
  Medical intensive care unit (ICU) in a university hospital.
  
  
  METHODS
  Ten hemodynamically stable, mechanically ventilated patients with severe sepsis. Eight patients required norepinephrine.
  
  
  METHODS
  Low dose post-pyloric EN (Survimed, 40 ml bolus, 40 ml h(-1) continuously).
  
  
  RESULTS
  Three data sets: F1 = baseline fasting, EN(120) = after 120 min of EN, F2=120 min after EN cessation. In addition to global hemodynamics and gastric mucosal PCO(2), we measured hepato-splanchnic blood flow (HSBF) using continuous primed indocyanine green dye infusion with hepatic venous sampling. The mean arterial pressure remained unchanged. During EN systemic vascular resistance decreased ( p<0.05), while cardiac index increased (p<0.001). Simultaneously, HSBF increased during EN and decreased again at F2 (1.54 [0.88; 1.66] l min(-1) m(-2 )at F1; 1.72 [1.18; 1.83] l min(-1) m(-2 )at EN and 1.38 [0.91; 1.63] l min(-1) m-(2 )at F2, p<0.001). Hepatic venous acid base status, lactate/pyruvate ratio and splanchnic lactate balance remained unchanged. There was also no change in splanchnic oxygen extraction ratio or in gastric mucosal to arterial PCO(2) difference.
  
  
  CONCLUSIONS
  The initiation of low dose post-pyloric EN in medical ICU patients with severe sepsis led to the parallel increase of systemic and hepato-splanchnic blood flow. Hepato-splanchnic energy metabolism, oxygen kinetics and gastric mucosal energy balance did not deteriorate during EN, suggesting that EN during sepsis may not be harmful even in patients requiring norepinephrine.
authors.affiliation: Intensive Care Unit, Department of Internal Medicine I, School of Medicine, Charles University Hospital Pilsen, Alej svobody 80, 304 60 Pilsen, Czech Republic. rokyta@fnplzen.cz
authors.forename: Richard
authors.initials: R
authors.lastname: Rokyta
authors.forename: Martin
authors.initials: M
authors.lastname: Matejovic
authors.forename: Ales
authors.initials: A
authors.lastname: Krouzecky
authors.forename: Vaclav
authors.initials: V
authors.lastname: Senft
authors.forename: Ladislav
authors.initials: L
authors.lastname: Trefil
authors.forename: Ivan
authors.initials: I
authors.lastname: Novak
mesh_terms: D000368:Aged; D004734:Energy Metabolism; D004750:Enteral Nutrition; D006339:Heart Rate; D006439:Hemodynamics / Q000502:physiology; D006785:Hospitals, University; D006801:Humans; D007362:Intensive Care Units; D008099:Liver / Q000098:blood supply; D008875:Middle Aged; D011446:Prospective Studies; D011706:Pyloric Antrum / Q000378:metabolism / Q000503:physiopathology; D012039:Regional Blood Flow; D018805:Sepsis / Q000628:therapy*; D013154:Spleen / Q000098:blood supply; D013318:Stroke Volume