Simo Es Covello Luís Henrique, Gava-Brandolis Marcella Giovana, Castro Melina Gouveia, Dos Santos Netos Martins Fidelis, Manzanares William, Toledo Diogo Oliveira
Department of Critical Care of Barretos Cancer Hospital, Barretos, Brazil.
Department of Research of Hospital Sa˜o Luis Itaim, Sa˜o Paulo, Brazil.
Crit Care Res Pract. 2020 Feb 10;2020:1095693. doi: 10.1155/2020/1095693. eCollection 2020.
Patients with hemodynamic instability need to receive intensive treatment as fluid replacement and vasoactive drugs. In the meantime, it is supposed to initiate nutritional therapy within 24 to 48 hours after admission to the intensive care unit (ICU), as an essential part of patient's intensive care and better outcomes. However, there are many controversies tangential to the prescription of enteral nutrition (EN) concomitant to the use of vasopressor and its doses. In this way, the present study aimed to identify what the literature presents of evidence to guide the clinical practice concerning the safe dose of vasopressors for the initiation of nutritional therapy in critically ill patients.
This review was carried out in PubMed, ProQuest, Web of Science, and Medline databases. The descriptors were used to perform the search strategy: Critical Care, Intensive Care Units, Vasoconstrictor Agents, and Enteral Nutrition. Inclusion criteria were patients of both genders, over 18 years of age, using vasoactive drugs, with the possibility of receiving EN therapy, and articles written in English, Portuguese, and Spanish. In addition, exclusion criteria were case reports, non-papers, and repeated papers.
10 articles met our inclusion criteria.
It was observed that there are many controversies about the supply of EN in critically ill patients using vasopressor, especially about the safe dose, and it was not possible to identify a cutoff value for the beginning therapy. Despite the drug doses, clinical signs are still the most important parameters in the evaluation of EN tolerance.
血流动力学不稳定的患者需要接受诸如液体复苏和血管活性药物等强化治疗。与此同时，作为患者重症监护及改善预后的重要组成部分，应在入住重症监护病房（ICU）后的24至48小时内启动营养治疗。然而，在使用血管活性药物的同时给予肠内营养（EN）及其剂量方面存在诸多争议。因此，本研究旨在确定文献中关于危重症患者启动营养治疗时血管活性药物安全剂量的哪些证据可用于指导临床实践。
本综述在PubMed、ProQuest、Web of Science和Medline数据库中进行。使用描述词来执行检索策略：重症监护、重症监护病房、血管收缩剂和肠内营养。纳入标准为年龄超过18岁、使用血管活性药物、有可能接受EN治疗的男女患者，以及用英语、葡萄牙语和西班牙语撰写的文章。此外，排除标准为病例报告、非论文和重复发表的论文。
10篇文章符合我们的纳入标准。
观察到在使用血管活性药物的危重症患者中，关于EN的供应存在许多争议，尤其是关于安全剂量，并且无法确定开始治疗的临界值。尽管有药物剂量，但临床体征仍然是评估EN耐受性的最重要参数。
