Enteral nutrition in critically ill patients under vasoactive drug therapy: The NUTRIVAD study.

Autor: Flordelís Lasierra JL; Intensive Care Medicine Service, Research Institute Hospital 12 de Octubre (i+12), Hospital Universitario 12 de Octubre, Madrid, Spain., Montejo González JC; Intensive Care Medicine Service, Research Institute Hospital 12 de Octubre (i+12), Hospital Universitario 12 de Octubre, Madrid, Spain., López Delgado JC; Intensive Care Medicine Department, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain., Zárate Chug P; Intensive Care Medicine Service, Hospital Universitario Miguel Servet, Zaragoza, Spain., Martínez Lozano-Aranaga F; Intensive Care Medicine Service, Hospital General Universitario Reina Sofía de Murcia, Murcia, Spain., Lorencio Cárdenas C; Intensive Care Medicine Service, Hospital Universitario de Girona Josep Trueta, Gerona, Spain., Bordejé Laguna ML; Intensive Care Medicine Service, Hospital Universitario Germans Trias i Pujol, Barcelona, Spain., Maichle S; Intensive Care Medicine Service, Hospital Universitario Clínico San Carlos, Madrid, Spain., Terceros Almanza LJ; Intensive Care Medicine Service, Hospital Universitario 12 de Octubre, Madrid, Spain., Trasmonte Martínez MV; Intensive Care Medicine Service, Hospital Universitario 12 de Octubre, Madrid, Spain., Mateu Campos L; Intensive Care Medicine Service, Hospital General Universitario de Castellón, Comunidad Valenciana, Spain., Servià Goixart L; Intensive Care Medicine Service, Hospital Universitario Arnau de Villanova, Lérida, Spain., Vaquerizo Alonso C; Intensive Care Medicine Service, Hospital Universitario de Fuenlabrada, Madrid, Spain., Vila García B; Intensive Care Medicine Service, Hospital Universitario Infanta Cristina, Parla, Madrid, Spain.
Jazyk: angličtina
Zdroj: JPEN. Journal of parenteral and enteral nutrition [JPEN J Parenter Enteral Nutr] 2022 Aug; Vol. 46 (6), pp. 1420-1430. Date of Electronic Publication: 2022 Apr 13.
DOI: 10.1002/jpen.2371
Abstrakt: Background: Enteral nutrition (EN) in critically ill patients requiring vasoactive drug (VAD) support is controversial. This study assesses the tolerability and safety of EN in such patients.
Methods: This prospective observational study was conducted in 23 intensive care units (ICUs) over 30 months. Inclusion criteria were a need for VADs and/or mechanic circulatory support (MCS) over a minimum of 48 h, a need for ≥48 h of mechanical ventilation, an estimated life expectancy >72 h, and ≥72 h of ICU stay. Patients with refractory shock were excluded. EN was performed according to established protocols during which descriptive, daily hemodynamic and efficacy, and safety data were collected. An independent research group conducted the statistical analysis.
Results: Of 200 patients included, 30 (15%) required MCS and 145 (73%) met early multiorgan dysfunction criteria. Mortality was 24%. Patients needed a mean dose of norepinephrine in the first 48 h of 0.71 mcg/kg/min (95% CI, 0.63-0.8) targeting a mean arterial pressure of 68 mm Hg (95% CI, 67-70) during the first 48 h. EN was started 34 h (95% CI, 31-37) after ICU admission. Mean energy and protein delivered by EN/patient/day were 1159 kcal (95% CI, 1098-1220) and 55.6 g (95% CI, 52.4-58.7), respectively. Daily energy balance during EN/patient/day was -432 (95% CI, -496 to -368). One hundred and fifty-four (77%) patients experienced EN-related complications. However, severe complications, such as mesenteric ischemia, were recorded in only one (0.5%) patient.
Conclusion: EN in these patients seems feasible, safe, and unrelated to serious complications. Reaching the energy target only through EN is difficult.
(© 2022 American Society for Parenteral and Enteral Nutrition.)
Databáze: MEDLINE
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