Enteral Feeding and Vasoactive Agents: Suggested Guidelines for Clinicians

INTRODUCTION Enteral nutrition (EN) is preferable to parenteral nutrition (PN) in critically ill patients due to a reduction in infectious complications, a decreased stress response with EN compared to PN, maintenance of enterocyte viability and growth, and the promotion of a strong gut mucosal barrier (1). However, considerable controversy exists regarding the role of EN in hypotensive, critically ill patients requiring vasopressor support. Although limited data suggest that initiation of enteral nutrients within 24 –48 hours of critical illness may offer outcome benefits (2), there is a concern that beginning EN while a patient is hemodynamically tenuous may compromise splanchnic perfusion (1). Splanchnic perfusion can be reduced during sepsis and shock and restoration of volume status does not immediately resolve the alterations in perfusion (3). The actions of vasopressor medications are complex. In some, resolution of hypotension and increased cardiac output contributes to improved splanchnic perfuNUTRITION ISSUES IN GASTROENTEROLOGY, SERIES #78