Volume 35, Issue 3 p. 540-547
Clinical Research

Impact of Enteral Feeding on Vasoactive Support in Septic Shock: A Retrospective Observational Study

Matthew Ewy RD, CNSC

Corresponding Author

Matthew Ewy RD, CNSC

Medical College of Wisconsin, Milwaukee, Wisconsin, USA

Corresponding Author:

Matthew Ewy, RD, CNSC, Medical College of Wisconsin, Milwaukee, WI, USA.

Email: [email protected]

Search for more papers by this author
Masooma Aqeel MD

Masooma Aqeel MD

Section of Pulmonary and Critical Care Medicine, Department of Medicine, Aga Khan University, Karachi, Sindh, Pakistan

Search for more papers by this author
Michelle Kozeniecki MS, RD, CNSC

Michelle Kozeniecki MS, RD, CNSC

Nutrition Services Department, Froedtert Hospital, Milwaukee, Wisconsin, USA

Search for more papers by this author
Kadam Patel MBBS, MPH

Kadam Patel MBBS, MPH

Institute for Health & Equity, Division of Biostatistics, Medical College of Wisconsin, Milwaukee, Wisconsin, USA

Search for more papers by this author
Anjishnu Banerjee PhD

Anjishnu Banerjee PhD

Institute for Health & Equity, Division of Biostatistics, Medical College of Wisconsin, Milwaukee, Wisconsin, USA

Search for more papers by this author
Daren K. Heyland MD

Daren K. Heyland MD

Department of Medicine, Queen's University, Kingston, Ontario, Canada

Search for more papers by this author
Jayshil J. Patel MD

Jayshil J. Patel MD

Department of Medicine, Division of Pulmonary and Critical Care Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA

Search for more papers by this author
First published: 05 March 2020
Citations: 6

Financial disclosure: None declared.

Conflicts of interest: D. K. Heyland is a principal investigator and consultant in academic-industry partnered trials sponsored by GlaxoSmithKline, Lyric Pharmaceuticals, and E-motion Medical, as well as a speaker for Abbott, Nestlé Health Sciences, and Cardinal Health.

Abstract

Background

Introducing enteral nutrition (EN) during hemodynamic instability may induce the splanchnic steal phenomenon, which may worsen systemic oxygen delivery and increase vasopressor dose. We aimed to determine the change in vasopressor dose in septic shock patients who received concomitant EN. We hypothesize that EN delivery is not associated with worsening hemodynamic instability, as defined by an increase in vasopressor dose ≥50% at 24 hours.

Methods

This is a retrospective observational cohort study of adult patients with septic shock who were admitted to the intensive care unit from January 2015 to June 2015 and received EN. Vasopressor and EN parameters were collected at 6-hour intervals for the first 24 hours.

Results

Data were available for 28 consecutive patients. The mean age was 60 years (SD = 18), and 54% were females. Norepinephrine (NE) was used in 100%. EN and vasopressor overlap totaled 36 hours (interquartile range [IQR], 27–69). Median NE dose when starting EN was 5.9 μg/min (IQR, 3.88). Median change in dose from 0 to 6 hours was 0.85 μg/min (95% CI, 0.681.06; P = 0.136), corresponding to a median increase of 14.5%. Total NE duration was 60.5 hours (IQR, 47.5–75.5). No serious complications occurred.

Conclusion

The median vasopressor dose did not increase by ≥50% during the first 24 hours of EN. This suggests early EN delivered during septic shock is not associated with worsening hemodynamic instability. Limitations include a small sample size and residual confounding. Prospective data are needed.