Department of Medicine, Division of Pulmonary & Critical Care Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.
Intensive Care Unit, Royal Adelaide Hospital; Clinical Professor, School of Medicine, University of Adelaide, Adelaide, Australia.
Curr Opin Clin Nutr Metab Care. 2021 Mar 1;24(2):159-164. doi: 10.1097/MCO.0000000000000731.
Circulatory shock is associated with reduced splanchnic blood flow and impaired gut epithelial barrier function (EBF). Early enteral nutrition (EN) has been shown in animal models to preserve EBF. There are limited human data informing early EN in circulatory shock and critical care nutrition guidelines provide disparate recommendations regarding the optimal timing and dose. The purpose of this review is to describe the harms and benefits of early EN in circulatory shock by identifying and appraising recent human data.
The cumulative risk of nonocclusive bowel ischemia and necrosis in patients with circulatory shock is no higher than 0.3% across observational and randomized controlled trial-level data, and whether the risk is increased by EN delivery remains uncertain. Observational data suggest that early EN in circulatory shock is associated with improved clinical outcomes but data from robust randomized controlled trials remain equivocal, so the optimal timing and dose remain unknown.
Based on the best available data, initiating restrictive dose EN into the stomach after initial resuscitation in patients with circulatory shock does not appear to be harmful. In fact, early EN may preserve EBF and improve clinical outcomes.
循环休克与内脏血流减少和肠道上皮屏障功能（EBF）受损有关。动物模型研究表明，早期肠内营养（EN）可维持 EBF。关于循环休克和重症监护营养指南中早期 EN 的最佳时机和剂量，目前仅有有限的人体数据提供了不一致的建议。本综述旨在通过识别和评估最近的人体数据，描述循环休克中早期 EN 的危害和益处。
在观察性和随机对照试验水平的数据中，循环休克患者非闭塞性肠缺血和坏死的累积风险不高于 0.3%，EN 治疗是否会增加风险仍不确定。观察性数据表明，循环休克中早期 EN 与改善临床结局相关，但来自稳健随机对照试验的数据仍存在争议，因此最佳时机和剂量仍不清楚。
根据现有最佳数据，在循环休克患者初始复苏后，将限制剂量的 EN 经胃内给予，似乎没有危害。实际上，早期 EN 可能维持 EBF 并改善临床结局。
