211 Challenging a Common Myth: Is Enteral Feeding Safe in Burn Patients on Vasopressors?

Abstract

Enteral feeding in critically ill burn patients on vasopressors is controversial. The perceived risks from decreased splanchnic flow from vasopressors must be balanced against the benefits of providing consistent enteral nutritional support. We reviewed the incidence of gastrointestinal complications in patients that are receiving both vasopressors and concurrent enteral feeds. A single institution retrospective chart review was performed. All burn patients admitted to the Burn ICU between July 1, 2015 and August 2, 2017 were eligible. Abdominal complications and enteral intolerance in patients receiving vasopressors were documented. We defined full tolerance to tube feeding as meeting full caloric needs with enteral support, partial-tolerance as less than full support but more than zero, and non-tolerance as zero enteral feeds. Of 272 ICU patients, 41 received enteral feeds while on vasopressors. There were 60 episodes of drug administration, with some patients receiving repeated infusions. In 41.7% (25/60) of administration events, patients exhibited full tolerance to enteral feeding with no abdominal complications. In 36.7% (22/60) of events, patients were partially intolerant (high gastric residuals, emesis or increasing abdominal distension) of tube feeds while on vasopressors but did not go on to develop acute abdominal complications. In these patients, tube feeds were decreased but not discontinued. In 21.7% (13/60) of events, tube feeds were stopped completely. Abdominal compartment syndrome (ACS) confirmed with elevated bladder pressures and evidence of end organ dysfunction requiring laparotomy or escharotomy occurred in 18.3% (11/60) of events of drug administration which translates to 0.05 complications/day of tube feeding while on vasopressors. Most cases of ACS were attributed to a combination of high volume burn resuscitation, extensive abdominal burn distribution, sepsis, and massive hemorrhages. Evidence of bowel ischemia in 36.3% (4/11) of complications was found during surgical decompression. It can be safe to enterally feed burn patients receiving vasopressors. Individualized patient monitoring for evidence of abdominal pathology should guide clinical practice. Patients without signs of feeding intolerance can receive full enteric support without complication during vasopressor administration. However, enteral feeds should be decreased or stopped in those patients that show clinical signs of feeding intolerance. The paucity of ischemic complications may be partially explained by the low vascular resistance in critically ill burn patients even with vasopressor support. Enteral feeding can be safe in critically ill burn patients requiring vasopressor support.