Early versus late enteral nutrition in critically ill patients receiving vasopressor support

Published on Oct 21, 2021in Journal of Parenteral and Enteral Nutrition4.016
· DOI :10.1002/JPEN.2266
Ander Dorken Gallastegi1
Estimated H-index: 1
(Harvard University),
Anthony Gebran1
Estimated H-index: 1
(Harvard University)
+ 7 AuthorsApril E. Mendoza10
Estimated H-index: 10
(Harvard University)
Sources
Abstract
BACKGROUND Outcomes of early enteral nutrition (EEN) in critically ill patients on vasoactive medications remain unclear. We aimed to compare in-hospital outcomes for EEN vs late EN (LEN) in mechanically ventilated patients receiving vasopressor support. METHODS This was a retrospective study using the national eICU Collaborative Research Database. Adult patients requiring vasopressor support and mechanical ventilation within 24 h of admission and for ≥2 days were included. Patients with an admission diagnosis that could constitute a contraindication for EEN (eg, gastrointestinal [GI] perforation, GI surgery) and patients with an intensive care unit (ICU) length of stay (LOS) <72 h were excluded. EEN and LEN were defined as tube feeding within 48 h and between 48 h and 1 week (nothing by mouth during the first 48 h) of admission, respectively. Propensity score matching was performed to derive two cohorts receiving EEN and LEN that were comparable for baseline patient characteristics. RESULTS Among 1701 patients who met the inclusion criteria (EEN: 1001, LEN: 700), 1148 were included in propensity score-matched cohorts (EEN: 574, LEN: 574). Median time to EN was 29 vs 79 h from admission in the EEN and LEN groups, respectively. There was no significant difference in mortality or hospital LOS between the two nutrition strategies. EEN was associated with shorter ICU LOS, lower need for renal replacement therapy, and lower incidence of electrolyte abnormalities. CONCLUSION This study showed no difference in 28-day mortality between EEN and LEN in critically ill patients receiving vasopressor support.
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References35
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#1Jayshil J. Patel (MCW: Medical College of Wisconsin)H-Index: 21
#2Todd W. Rice (Vandy: Vanderbilt University)H-Index: 57
Last. Daren K. Heyland (Queen's University)H-Index: 122
view all 3 authors...
Circulatory shock is one of the most common reasons for an intensive care unit admission, has been shown to impair gut barrier and immune functions, and promotes dysbiosis. The exact timing and dose of enteral nutrition (EN) in circulatory shock remains unclear. In fact, because of fear of complications such as nonocclusive mesenteric ischemia and bowel necrosis and splanchnic steal phenomenon, clinicians may hesitate to start EN in critically ill patients with circulatory shock. In this narrati...
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#1Hiroyuki Ohbe (UTokyo: University of Tokyo)H-Index: 7
#2Taisuke Jo (UTokyo: University of Tokyo)H-Index: 17
Last. Hideo Yasunaga (UTokyo: University of Tokyo)H-Index: 55
view all 5 authors...
Despite extensive research on early enteral nutrition (EEN), it remains unclear whether EEN is effective for patients with shock requiring vasopressors. This study aimed to compare outcomes between EEN and late enteral nutrition (LEN) in ventilated patients with shock requiring low-, medium-, or high-dose noradrenaline.Using a national inpatient database in Japan, we identified ventilated patients admitted to intensive care units who had shock requiring catecholamines (noradrenaline or dobutamin...
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#1Yaseen M. Arabi (King Saud bin Abdulaziz University for Health Sciences)H-Index: 82
#2Stephen A. McClave (University of Louisville)H-Index: 57
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#1Mark Barash (MCW: Medical College of Wisconsin)H-Index: 10
#2Jayshil J. Patel (MCW: Medical College of Wisconsin)H-Index: 21
Purpose of Review Circulatory shock and subsequent gut hypoperfusion turn on the ‘gut motor,’ which impairs gut barrier function, promotes dysbiosis, and generates immune dysfunction to perpetuate inflammation. Clinicians may be reluctant to commence enteral nutrition in circulatory shock out of concern for bowel ischemia and splanchnic steal syndrome. Here, we identify contemporary studies which have evaluated the impact of enteral nutrition during circulatory shock on gut lumen functions and c...
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#1Pierre Singer (Rabin Medical Center)H-Index: 61
#2Annika Reintam Blaser (UT: University of Tartu)H-Index: 20
Last. Stephan C. Bischoff (University of Hohenheim)H-Index: 90
view all 15 authors...
Following the new ESPEN Standard Operating Procedures, the previous guidelines to provide best medical nutritional therapy to critically ill patients have been updated. These guidelines define who are the patients at risk, how to assess nutritional status of an ICU patient, how to define the amount of energy to provide, the route to choose and how to adapt according to various clinical conditions. When to start and how to progress in the administration of adequate provision of nutrients is also ...
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#2Marianne J. Chapman (Royal Adelaide Hospital)H-Index: 48
#3Sandra L. PeakeH-Index: 30
Last. Paul J YoungH-Index: 40
view all 15 authors...
BACKGROUND: The effect of delivering nutrition at different calorie levels during critical illness is uncertain, and patients typically receive less than the recommended amount. METHODS: We conducted a multicenter, double-blind, randomized trial, involving adults undergoing mechanical ventilation in 46 Australian and New Zealand intensive care units (ICUs), to evaluate energy-dense (1.5 kcal per milliliter) as compared with routine (1.0 kcal per milliliter) enteral nutrition at a dose of 1 ml pe...
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#5Roger G Mark (MIT: Massachusetts Institute of Technology)H-Index: 23
The eICU Collaborative Research Database, a freely available multi-center database for critical care research
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#1Jean Reignier (University of Nantes)H-Index: 26
Last. Yaseen M. Arabi (King Saud bin Abdulaziz University for Health Sciences)H-Index: 82
view all 3 authors...
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#1Jean Reignier (University of Nantes)H-Index: 26
#2Julie Boisramé-Helms (UDS: University of Strasbourg)H-Index: 17
Last. Frédéric BellecH-Index: 10
view all 113 authors...
Summary Background Whether the route of early feeding affects outcomes of patients with severe critical illnesses is controversial. We hypothesised that outcomes were better with early first-line enteral nutrition than with early first-line parenteral nutrition. Methods In this randomised, controlled, multicentre, open-label, parallel-group study (NUTRIREA-2 trial) done at 44 French intensive-care units (ICUs), adults (18 years or older) receiving invasive mechanical ventilation and vasopressor ...
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#1Cristian Merchan (NYU: New York University)H-Index: 10
#2Diana Altshuler (NYU: New York University)H-Index: 9
Last. David C. Schwartz (NYU: New York University)H-Index: 83
view all 5 authors...
Purpose: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...
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