title: Postpyloric enteral nutrition in the critically ill child with shock: a prospective observational study.
abstract: BACKGROUND
  Tolerance to enteral nutrition in the critically ill child with shock has not been studied. The purpose of the study was to analyze the characteristics of enteral nutrition and its tolerance in the critically ill child with shock and to compare this with non-shocked patients.
  
  
  METHODS
  A prospective, observational study was performed including critically ill children with shock who received postpyloric enteral nutrition (PEN). The type of nutrition used, its duration, tolerance, and gastrointestinal complications were assessed. The 65 children with shock who received PEN were compared with 461 non-shocked critically ill children who received PEN.
  
  
  RESULTS
  Sixty-five critically ill children with shock, aged between 21 days and 22 years, received PEN. 75.4% of patients with shock received PEN exclusively. The mean duration of the PEN was 25.2 days and the maximum calorie intake was 79.4 kcal/kg/day. Twenty patients with shock (30.7%) presented gastrointestinal complications, 10 (15.4%) abdominal distension and/or excessive gastric residue, 13 (20%) diarrhoea, 1 necrotising enterocolitis, and 1 duodenal perforation due to the postpyloric tube. The frequency of gastrointestinal complications was significantly higher than in the other 461 critically ill children (9.1%). PEN was suspended due to gastrointestinal complications in 6 patients with shock (9.2%). There were 18 deaths among the patients with shock and PEN (27.7%). In only one patient was the death related to complications of the nutrition.
  
  
  CONCLUSIONS
  Although most critically ill children with shock can tolerate postpyloric enteral nutrition, the incidence of gastrointestinal complications is higher in this group of patients than in other critically ill children.
authors.affiliation: Pediatric intensive care unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain. pielvi@ya.com
authors.forename: Jesús
authors.initials: J
authors.lastname: López-Herce
authors.forename: Santiago
authors.initials: S
authors.lastname: Mencía
authors.forename: César
authors.initials: C
authors.lastname: Sánchez
authors.forename: Maria J
authors.initials: MJ
authors.lastname: Santiago
authors.forename: Amaya
authors.initials: A
authors.lastname: Bustinza
authors.forename: Dolores
authors.initials: D
authors.lastname: Vigil
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D016638:Critical Illness / Q000628:therapy; D002149:Energy Intake / Q000502:physiology; D004750:Enteral Nutrition / Q000009:adverse effects* / Q000379:methods*; D005260:Female; D005767:Gastrointestinal Diseases / Q000453:epidemiology / Q000209:etiology*; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D015278:Intensive Care Units, Pediatric; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology; D011446:Prospective Studies; D011708:Pylorus; D012769:Shock / Q000628:therapy*; D013997:Time Factors; D016896:Treatment Outcome