title: Tolerability of Enteral Nutrition in Mechanically Ventilated Patients With Septic Shock Who Require Vasopressors.
abstract: OBJECTIVE
  Enteral nutrition (EN) is often held in patients receiving vasopressor support for septic shock. The rationale for this practice is to avoid mesenteric ischemia. The objective of this study is to evaluate the tolerability of EN in patients with septic shock who require vasopressor support and determine factors associated with tolerance of EN.
  
  
  METHODS
  This was a single-center retrospective review of adult patients admitted to the intensive care unit with a diagnosis of septic shock and an order for EN. The primary outcome was EN tolerance. Secondary outcomes included time to initiation of EN from the start of vasopressor(s), length of stay, and mortality.
  
  
  RESULTS
  A total of 120 patients were included. Sixty-two percent of patients tolerated EN. The most common reason for intolerance of EN was gastric residuals > 250 mL (74%). No reports of mesenteric ischemia were observed. A multivariate analysis demonstrated that patients with septic shock initiating EN within 48 hours and receiving norepinephrine-equivalent doses of 0.14 μg/kg/min or less were more likely to tolerate EN.
  
  
  CONCLUSIONS
  Based on our observation, early EN may be tolerated and safely administered in patients with septic shock who are adequately fluid resuscitated and receive doses of < 0.14 μg/kg/min of norepinephrine equivalents.
authors.affiliation: 1 Department of Pharmacy, New York University Langone Medical Center, New York, NY, USA.
authors.forename: Cristian
authors.initials: C
authors.lastname: Merchan
authors.affiliation: 1 Department of Pharmacy, New York University Langone Medical Center, New York, NY, USA.
authors.forename: Diana
authors.initials: D
authors.lastname: Altshuler
authors.affiliation: 1 Department of Pharmacy, New York University Langone Medical Center, New York, NY, USA.
authors.forename: Caitlin
authors.initials: C
authors.lastname: Aberle
authors.affiliation: 1 Department of Pharmacy, New York University Langone Medical Center, New York, NY, USA.|2 Department of Medicine, New York University School of Medicine, New York, NY, USA.
authors.forename: John
authors.initials: J
authors.lastname: Papadopoulos
authors.affiliation: 2 Department of Medicine, New York University School of Medicine, New York, NY, USA.
authors.forename: David
authors.initials: D
authors.lastname: Schwartz
mesh_terms: D018806:APACHE; D000368:Aged; D003131:Combined Modality Therapy; D004750:Enteral Nutrition / Q000379:methods / Q000401:mortality*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012121:Respiration, Artificial / Q000379:methods*; D012189:Retrospective Studies; D012772:Shock, Septic / Q000401:mortality / Q000628:therapy*; D013997:Time Factors; D016896:Treatment Outcome; D014662:Vasoconstrictor Agents / Q000008:administration & dosage*
chemical_list: D014662:Vasoconstrictor Agents
keywords: enteral nutrition; mesenteric ischemia; septic shock; tolerance; vasopressors