Enteral nutrition in critically ill patients under vasoactive drug therapy: The NUTRIVAD study
Por:
Lasierra, JLF, Gonzalez, JCM, Delgado, JCL, Chug, PZ, Lozano-Aranaga, FM, Cardenas, CL, Laguna, MLB, Maichle, S, Almanza, LJT, Martinez, MVT, Campos, LM, Goixart, LS, Alonso, CV and Garcia, BV
Publicada:
1 ago 2022
Ahead of Print:
1 abr 2022
Resumen:
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.
Filiaciones:
Lasierra, JLF:
Hosp Univ 12 Octubre, Res Inst Hosp 12 Octubre I 12, Intens Care Med Serv, Ave Cordoba S-N, Madrid 28041, Spain
Gonzalez, JCM:
Hosp Univ 12 Octubre, Res Inst Hosp 12 Octubre I 12, Intens Care Med Serv, Ave Cordoba S-N, Madrid 28041, Spain
Delgado, JCL:
Hosp Univ Bellvitge, Intens Care Med Dept, Barcelona, Spain
Chug, PZ:
Hosp Univ Miguel Servet, Intens Care Med Serv, Zaragoza, Spain
Lozano-Aranaga, FM:
Hosp Gen Univ Reina Sofia Murcia, Intens Care Med Serv, Murcia, Spain
Cardenas, CL:
Hosp Univ Girona Josep Trueta, Intens Care Med Serv, Girona, Spain
:
Hosp Badalona Germans Trias & Pujol, Intens Care Med Serv, Barcelona, Spain
Maichle, S:
Hosp Univ Clin San Carlos, Intens Care Med Serv, Madrid, Spain
Almanza, LJT:
Hosp Univ 12 Octubre, Intens Care Med Serv, Madrid, Spain
Martinez, MVT:
Hosp Univ 12 Octubre, Intens Care Med Serv, Madrid, Spain
Campos, LM:
Hosp Gen Univ Castellon, Intens Care Med Serv, Comunidad Valenciana, Spain
Goixart, LS:
Hosp Univ Arnau Villanova, Intens Care Med Serv, Lerida, Spain
Alonso, CV:
Hosp Univ Fuenlabrada, Intens Care Med Serv, Madrid, Spain
Garcia, BV:
Hosp Univ Infanta Cristina, Intens Care Med Serv, Madrid, Spain
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