title: Safety of Enteral Feedings in Critically Ill Children Receiving Vasoactive Agents.
abstract: BACKGROUND
  The objective of this retrospective study was to evaluate the safety of enteral feeding in children receiving vasoactive agents (VAs).
  
  
  METHODS
  Patients aged 1 month to 18 years with a pediatric intensive care unit stay for ≥96 hours during 2007 and 2008 who received any VA (epinephrine, norepinephrine, vasopressin, milrinone, dopamine, and dobutamine) were included and categorized into fed and nonfed groups. Their demographics, clinical characteristics, type and dose of VA, and presence of gastrointestinal (GI) outcomes were obtained. GI outcomes were compared between the groups by the χ(2) test, Mann-Whitney test, and logistic regression.
  
  
  RESULTS
  In total, 339 patients were included. Of these, 55% were in the fed group and 45% in the nonfed group. Patients in the fed group were younger (median age, 1.05 vs 2.75 years, respectively; P < .001) and tended to have a lower Pediatric Index of Mortality 2 (PIM2) risk of mortality (ROM) than those in the nonfed group (median, 3.33% vs 3.52%, respectively; P = .106). Mortality was lower in the fed group than the nonfed group (6.9% vs 15.9%, respectively; odds ratio [OR], 0.39; 0.18-0.84; P < .01, 95% CI), while GI outcomes did not differ between the groups. The vasoactive-inotropic score (VIS) did not differ between the groups except on day 1 (P = .017). The ROM did not differ between the groups after adjusting for age, PIM2 ROM, and VIS on day 1 (OR, 0.58; 0.26-1.28; P = .18, 95% CI).
  
  
  CONCLUSIONS
  Enteral feeding in patients receiving VAs is associated with no difference in GI outcomes and a tendency towards lower mortality. Prospective studies are required to confirm the safety of enteral feedings in patients receiving VAs.
authors.affiliation: University of Kansas Medical Center, Kansas City, Kansas apurvapanchal@gmail.com.
authors.forename: Apurva K
authors.initials: AK
authors.lastname: Panchal
authors.affiliation: Pediatric Critical Care, Medical College of Wisconsin, Children's Hospital of Wisconsin, Milwaukee, Wisconsin.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Manzi
authors.affiliation: Pediatric Critical Care, Medical College of Wisconsin, Children's Hospital of Wisconsin, Milwaukee, Wisconsin.
authors.forename: Susan
authors.initials: S
authors.lastname: Connolly
authors.affiliation: Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin.
authors.forename: Melissa
authors.initials: M
authors.lastname: Christensen
authors.affiliation: Pediatric Critical Care, Medical College of Wisconsin, Children's Hospital of Wisconsin, Milwaukee, Wisconsin.
authors.forename: Martin
authors.initials: M
authors.lastname: Wakeham
authors.affiliation: Pediatric Gastroenterology and Nutrition, Medical College of Wisconsin, Milwaukee, Wisconsin.
authors.forename: Praveen S
authors.initials: PS
authors.lastname: Goday
authors.affiliation: Pediatric Critical Care, Medical College of Wisconsin, Children's Hospital of Wisconsin, Milwaukee, Wisconsin.
authors.forename: Theresa A
authors.initials: TA
authors.lastname: Mikhailov
mesh_terms: D000293:Adolescent; D002317:Cardiovascular Agents / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D016638:Critical Illness / Q000401:mortality / Q000628:therapy*; D004280:Dobutamine / Q000627:therapeutic use; D004298:Dopamine / Q000627:therapeutic use; D004750:Enteral Nutrition / Q000379:methods*; D004837:Epinephrine / Q000627:therapeutic use; D005260:Female; D041981:Gastrointestinal Tract / Q000187:drug effects / Q000378:metabolism; D006801:Humans; D007223:Infant; D015278:Intensive Care Units, Pediatric; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D020105:Milrinone / Q000627:therapeutic use; D009638:Norepinephrine / Q000627:therapeutic use; D012189:Retrospective Studies; D014667:Vasopressins / Q000627:therapeutic use
chemical_list: D002317:Cardiovascular Agents; D014667:Vasopressins; D004280:Dobutamine; D020105:Milrinone; D004298:Dopamine; D009638:Norepinephrine; D004837:Epinephrine
keywords: adverse gastrointestinal outcomes; critically ill children; enteral feeding; mortality; vasoactive agents