Hemodynamic and skin perfusion is associated with successful enteral nutrition therapy in septic shock patients.

Abstract

Enteral nutrition is controversial in hemodynamically unstable patients. This study aimed to evaluate the association between hemodynamic and skin perfusion parameters and enteral nutrition therapy (NT) outcomes in septic shock patients. Ventilated adults with septic shock were evaluated at bedside upon admission (H0), and at 12h (H1), 24h (H2) and 48h (H3) for mean arterial pressure (MAP), heart rate, urine output, lactate levels, mottling score, capillary refill time (CRT), central-to-toe temperature gradient and norepinephrine dose. Two groups were stratified: NT success (NTS) (≥20kcal/kg or 11kcal/kg for obese in the first ICU week) or NT failure (NTF). A generalized linear model and generalized estimating equations were performed. Over a 19-month period, 2167 admissions were assessed and 141 patients were analyzed (63.5±15.0 years, SAPS-3 75±12, 102 [72%] in the NTS vs. 39 [28%] in NTF). At 12h, the failure group showed more severe mottling scores, higher lactate levels, norepinephrine dose and central-to-toe temperature gradient. Mottling score at 12h was a predictor of NT failure (RR 1.28 95%CI [1.09-1.50], p=.003). Over 48h, higher mottling scores, lactate levels and norepinephrine dosage, % of patients with central-to-toe temperature gradient and CRT ≥3s were observed in the failure group and higher urine output and MAP values were observed in the success group. Early improvement in hemodynamic and skin perfusion parameters was associated with success in nutrition therapy, and mottling score at 12h was a risk factor for nutrition therapy failure. This data could support the recommendation to start NT after hemodynamic and perfusion goals are achieved and to proactively evaluate bedside parameters while implementing NT in critical care setting.