Abstract
Multiple guides recommend early enteral nutritional support in critically ill patients, while enteral nutrition is contraindicated in hemodynamically unstable patients. The main risk attributed to enteral nutrition in this kind of patients is non-occlusive mesenteric ischemia, which shows a high mortality rate. Giventhe lack of concrete evidence in this area, this paper proposes the integral assessment of the patient considering clinical history, vasopressors (doses and tendencies), vital signs, clinical condition, and lactate levels, in order to begin with mainly early enteral support. Afterwards, close monitoring of signs of enteral intolerance and clinical deterioration, with the ability to start the diagnosis process and immediately approach an eventual case of mesenteric ischemia. Topics in this paper include enteral feeding access route, support modality, which formulas to use, and basic concepts of shock and its management, and proposed pathophysiological mechanisms for non-occlusive mesenteric ischemia.
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