Early enteral nutrition in critically ill patients with hemodynamic instability: an evidence-based review and practical advice.
Early enteral nutrition (EEN) in critically ill patients is associated with significant benefit as well as elevated risk of complications. Concomitant use of EEN with vasopressors has been associated with nonocclusive bowel necrosis in critically ill patients with hemodynamic instability. The decision when to initiate enteral nutrition in hemodynamically unstable patients that require vasoactive substances remains a clinical dilemma. This review summarizes the effect of EEN and vasoactive agents on gastrointestinal blood flow and perfusion in critically ill patients, based on current evidence. Animal and clinical data involving simultaneous administration of EEN and vasoactive agents for hemodynamic instability are reviewed, and the factors related to the safety and effectiveness of EEN support in this patient population are analyzed. Moreover, practical recommendations are provided. Additional randomized clinical trials are warranted to provide cutting-edge evidence-based guidance about this issue for practitioners of critical care.
Wenkui Yu, Research Institute of General Surgery, Jinling Hospital, Medical School of Nanjing University, No. 305 East Zhongshan Road, Nanjing 210002, Jiangsu Province, People's Republic of China, Nanjing, 210002, China. Email: degs35@sohu.com.
Shuofei
S
Yang
Xingjiang
X
Wu
Wenkui
W
Yu
Jieshou
J
Li
D000818:Animals; D003422:Critical Care / Q000379:methods; D016638:Critical Illness / Q000628:therapy*; D004750:Enteral Nutrition / Q000379:methods*; D019317:Evidence-Based Medicine; D006439:Hemodynamics / Q000187:drug effects*; D006801:Humans; D064887:Observational Studies as Topic; D016032:Randomized Controlled Trials as Topic; D016896:Treatment Outcome; D014662:Vasoconstrictor Agents / Q000627:therapeutic use
D014662:Vasoconstrictor Agents
critical illness; enteral nutrition; hemodynamics; vasoconstrictor agents