title: Enteral nutrition in critically ill patients with severe hemodynamic failure after cardiopulmonary bypass.
abstract: OBJECTIVE
  The study was designed to investigate and quantify nutritional support, and particularly enteral nutrition (EN), in critically ill patients with severe hemodynamic failure.
  
  
  METHODS
  Prospective, descriptive study in a surgical intensive care unit (ICU) in a university teaching hospital: patients aged 67+/-13 yrs (mean+/-SD) admitted after cardiac surgery with extracorporeal circulation, staying 5 days in the ICU with acute cardiovascular failure. Severity of disease was assessed with SAPS II, and SOFA scores. Variables were energy delivery and balance, nutrition route, vasopressor doses, and infectious complications. Artificial feeding delivered according to ICU protocol. EN was considered from day 2-3. Energy target was set 25 kcal/kg/day to be reached stepwise over 5 days.
  
  
  RESULTS
  Seventy out of 1114 consecutive patients were studied, aged 67+/-17 years, and staying 10+/-7 days in the ICU. Median SAPS II was 43. Nine patients died (13%). All patients had circulatory failure: 18 patients required intra-aortic balloon-pump support (IABP). Norepinephrine was required in 58 patients (83%). Forty patients required artificial nutrition. Energy delivery was very variable. There was no abdominal complication related to EN. As a mean, 1360+/-620 kcal/kg/day could be delivered enterally during the first 2 weeks, corresponding to 70+/-35% of energy target. Enteral nutrient delivery was negatively influenced by increasing dopamine and norepinephrine doses, but not by the use of IABP.
  
  
  CONCLUSIONS
  EN is possible in the majority of patients with severe hemodynamic failure, but usually results in hypocaloric feeding. EN should be considered in patients with careful abdominal and energy monitoring.
authors.affiliation: Soins Intensifs Chirurgicaux et Centre des Brûlés, Centre Hospitalier Universitaire Vaudois (CHUV)-BH 08.660, CH-1011 Lausanne, Switzerland. mette.berger@chuv.hospvd.ch
authors.forename: Mette M
authors.initials: MM
authors.lastname: Berger
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Revelly
authors.forename: Marie-Christine
authors.initials: MC
authors.lastname: Cayeux
authors.forename: René L
authors.initials: RL
authors.lastname: Chiolero
mesh_terms: D000368:Aged; D002315:Cardiopulmonary Bypass; D003422:Critical Care / Q000379:methods*; D016638:Critical Illness / Q000628:therapy*; D002149:Energy Intake; D004734:Energy Metabolism / Q000502:physiology; D004750:Enteral Nutrition; D005260:Female; D006439:Hemodynamics; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009751:Nutritional Requirements; D011446:Prospective Studies; D012720:Severity of Illness Index; D016896:Treatment Outcome