Abstract

Background: Enteral nutrition (EN) is recommended within the first 24–48 h for patients with hemodynamic stability, following admission to an intensive care unit (ICU). However, for patients with approximate stable hemodynamics requiring mechanical circulatory support and vasoactive drugs, the application of early EN remains controversial. We sought to evaluate the tolerance of early EN in patients with cardiogenic shock who required vasoactive drugs and mechanical circulatory support after cardiac surgery.Methods: This single-center, prospective observational study included patients with cardiogenic shock, requiring vasoactive drugs and mechanical circulatory support after cardiac surgery, undergoing EN. The primary endpoint was EN tolerance and secondary endpoints were mortality, length of mechanical ventilation, and length of ICU stay.Results: From February 2019 to December 2020, 59 patients were enrolled, of which 25 (42.37%) developed intolerance within 3 days of starting EN. Patients in the EN intolerant group had a longer median length of mechanical ventilation (380 vs. 128 h, p = 0.006), a longer median ICU stay (20 vs. 11.5 days, p = 0.03), and a higher proportion of bloodstream infections (44 vs. 14.71%, p = 0.018). The median EN calorie levels for all patients in the first 3 days of EN were 4.00, 4.13, and 4.28 kcal/kg/day, respectively. Median protein intake levels of EN in the first 3 days were 0.18, 0.17, and 0.17 g/kg/day, respectively. No significant difference was observed in the median dose of vasoactive drugs between the groups (0.035 vs. 0.05 μg/kg/min, p = 0.306).Conclusions: Patients with cardiogenic shock after cardiac surgery had a high proportion of early EN intolerance, and patients with EN intolerance had a worse prognosis, but no significant correlation was identified between EN tolerance and the dose of vasoactive drugs.

Highlights

  • According to the guidelines from the Society of Critical Care Medicine (SCCM) and the American Society for Parenteral and Enteral Nutrition (ASPEN), enteral nutrition (EN) is recommended for patients admitted to an intensive care unit (ICU) once hemodynamics are stable [1]

  • We investigated the tolerance of early EN in patients taking vasoactive drugs and undergoing mechanical circulatory support after cardiac surgery to determine the effects of different vasoactive drug doses on the safety of early EN administration

  • 170 adult patients were diagnosed with cardiogenic shock with an ICU stay >72 h

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Summary

Introduction

According to the guidelines from the Society of Critical Care Medicine (SCCM) and the American Society for Parenteral and Enteral Nutrition (ASPEN), enteral nutrition (EN) is recommended for patients admitted to an intensive care unit (ICU) once hemodynamics are stable [1]. The European Society for Parenteral and Enteral Nutrition (ESPEN) guidelines recommend that if oral intake is not possible, early EN (within 48 h) in critically ill adult patients should be performed/initiated rather than delaying it [2]. Early EN is recommended for most critically ill patients, the European Society of Intensive Care Medicine (ESICM) guidelines advocate seven scenarios that require delayed EN, including uncontrolled shock and failure to achieve hemodynamic and tissue perfusion targets [14]. For patients with approximate stable hemodynamics requiring mechanical circulatory support and vasoactive drugs, the application of early EN remains controversial. We sought to evaluate the tolerance of early EN in patients with cardiogenic shock who required vasoactive drugs and mechanical circulatory support after cardiac surgery

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