title: Tolerability and safety of enteral nutrition in critically ill patients receiving intravenous vasopressor therapy.
abstract: BACKGROUND
  Enteral nutrition (EN) is recommended within the first 24-48 hours following admission to an intensive care unit (ICU) once resuscitation and hemodynamic stability have been achieved; however, hemodynamic stability is not well defined.
  
  
  OBJECTIVE
  To evaluate the tolerability and safety of EN in critically ill patients receiving intravenous (IV) vasopressor therapy.
  
  
  METHODS
  A retrospective medical record review was conducted in an urban academic medical center and included adult ICU patients from 2011 who received concomitant EN and IV vasopressor therapy for ≥1 hour. EN tolerance was defined as an absence of gastric residuals ≥300 mL, emesis, positive finding on abdominal imaging, and evidence of bowel ischemia/perforation.
  
  
  RESULTS
  Two hundred fifty-nine patients received 346 episodes of concomitant EN and IV vasopressor therapy. Overall EN tolerability was 74.9%. Adverse events included rising serum lactate (30.6%), elevated gastric residuals (14.5%), emesis (9.0%), positive finding on kidney/ureter/bladder radiograph (4.3%), and bowel ischemia/perforation (0.9%). An inverse relationship was found between maximum norepinephrine equivalent dose and EN tolerability (12.5 mcg/min for patients who tolerated EN vs 19.4 mcg/min, P = .0009). This relationship remained statistically significant after controlling for other variables (P = .019). Patients who tolerated EN were less likely to have received dopamine (63.8% vs 77.6%, P = .018) or vasopressin (58.9% vs 77.9%, P = .0027). These patients received concomitant therapy for less time and received more nutrition.
  
  
  CONCLUSIONS
  Most patients receiving IV vasopressor therapy tolerate EN. Tolerability was related to the maximum cumulative vasopressor dose and may be related to the specific vasopressor administered.
authors.affiliation: Department of Pharmacy Services, Virginia Commonwealth University Health System, Richmond, Virginia 23298-0042, USA.
authors.forename: Erin E
authors.initials: EE
authors.lastname: Mancl
authors.forename: Katie M
authors.initials: KM
authors.lastname: Muzevich
mesh_terms: D061605:Administration, Intravenous; D000328:Adult; D000368:Aged; D016638:Critical Illness / Q000628:therapy*; D004305:Dose-Response Relationship, Drug; D004750:Enteral Nutrition / Q000009:adverse effects; D005260:Female; D018530:Gastric Stump; D006801:Humans; D007362:Intensive Care Units; D019344:Lactic Acid / Q000097:blood; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009638:Norepinephrine / Q000008:administration & dosage*; D012189:Retrospective Studies; D016896:Treatment Outcome; D014662:Vasoconstrictor Agents / Q000008:administration & dosage*; D014839:Vomiting / Q000209:etiology / Q000517:prevention & control
chemical_list: D014662:Vasoconstrictor Agents; D019344:Lactic Acid; D009638:Norepinephrine