Medical College of Wisconsin, Milwaukee, Wisconsin, USA.
Section of Pulmonary and Critical Care Medicine, Department of Medicine, Aga Khan University, Karachi, Sindh, Pakistan.
Nutr Clin Pract. 2020 Jun;35(3):540-547. doi: 10.1002/ncp.10480. Epub 2020 Mar 5.
Introducing enteral nutrition (EN) during hemodynamic instability may induce the splanchnic steal phenomenon, which may worsen systemic oxygen delivery and increase vasopressor dose. We aimed to determine the change in vasopressor dose in septic shock patients who received concomitant EN. We hypothesize that EN delivery is not associated with worsening hemodynamic instability, as defined by an increase in vasopressor dose ≥50% at 24 hours.
This is a retrospective observational cohort study of adult patients with septic shock who were admitted to the intensive care unit from January 2015 to June 2015 and received EN. Vasopressor and EN parameters were collected at 6-hour intervals for the first 24 hours.
Data were available for 28 consecutive patients. The mean age was 60 years (SD = 18), and 54% were females. Norepinephrine (NE) was used in 100%. EN and vasopressor overlap totaled 36 hours (interquartile range [IQR], 27-69). Median NE dose when starting EN was 5.9 μg/min (IQR, 3.88). Median change in dose from 0 to 6 hours was 0.85 μg/min (95% CI, 0.681.06; P = 0.136), corresponding to a median increase of 14.5%. Total NE duration was 60.5 hours (IQR, 47.5-75.5). No serious complications occurred.
The median vasopressor dose did not increase by ≥50% during the first 24 hours of EN. This suggests early EN delivered during septic shock is not associated with worsening hemodynamic instability. Limitations include a small sample size and residual confounding. Prospective data are needed.
在血流动力学不稳定时引入肠内营养（EN）可能会引发内脏盗血现象，从而导致全身氧输送恶化并增加血管加压药剂量。我们旨在确定接受同时 EN 治疗的脓毒性休克患者血管加压药剂量的变化。我们假设，EN 给予与 24 小时内血管加压药剂量增加≥50%定义的血流动力学不稳定恶化无关。
这是一项回顾性观察性队列研究，纳入 2015 年 1 月至 6 月期间入住重症监护病房的脓毒性休克成年患者，并接受 EN。在最初 24 小时内，每 6 小时收集一次血管加压药和 EN 参数。
共纳入 28 例连续患者。平均年龄为 60 岁（标准差=18），54%为女性。100%使用去甲肾上腺素（NE）。EN 和血管加压药重叠共 36 小时（四分位距 [IQR]，27-69）。开始 EN 时 NE 剂量中位数为 5.9 μg/min（IQR，3.88）。0-6 小时剂量变化的中位数为 0.85 μg/min（95%置信区间，0.681.06；P=0.136），对应于 14.5%的中位数增加。NE 总持续时间为 60.5 小时（IQR，47.5-75.5）。未发生严重并发症。
在 EN 的最初 24 小时内，中位血管加压药剂量未增加≥50%。这表明脓毒性休克期间早期给予 EN 与血流动力学不稳定恶化无关。局限性包括样本量小和残留混杂因素。需要前瞻性数据。
