Nutrición enteral en el paciente crítico con inestabilidad hemodinámica

Lasierra, J.L. Flordelís; Pérez-Vela, J.L.; García-Arriaza, Juan

doi:10.1016/j.medin.2014.04.002

Cited by 14 publications

(10 citation statements)

References 39 publications

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“…Daily and careful monitoring of the possible alarm signs of intestinal ischemia in these high-risk patients is of crucial importance. Clinical signs such as increased gastric residue, a rise in intra-abdominal pressure to over 15 mmHg (particularly Critical Care Research and Practice when associated with recent oliguria), or sudden worsening of the hemodynamic situation of the patient should be regarded as possible indicators of intestinal ischemia (2). e casual relation between EEN and NOBN has yet to be clearly established in hemodynamic instability [19].…”

Section: Discussionmentioning

confidence: 99%

“…Shock is characterized by blood flow redistribution with vasoconstriction at splanchnic circulatory level and in peripheral tissues, in an attempt to maintain vital organs perfusion. is can give rise to an imbalance in the oxygen supply/demand ratio at intestinal level, with resulting ischemia [2]. e reported incidence ranges between 0.3% and 8.5%, with mortality ranging from 46% to 100% [3].…”

Section: Introductionmentioning

confidence: 99%

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Vasopressors and Nutrition Therapy: Safe Dose for the Outset of Enteral Nutrition?

Covello

Gava-Brandolis

Ribeiro

et al. 2020

Critical Care Research and Practice

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Background and Aims. Patients with hemodynamic instability need to receive intensive treatment as fluid replacement and vasoactive drugs. In the meantime, it is supposed to initiate nutritional therapy within 24 to 48 hours after admission to the intensive care unit (ICU), as an essential part of patient’s intensive care and better outcomes. However, there are many controversies tangential to the prescription of enteral nutrition (EN) concomitant to the use of vasopressor and its doses. In this way, the present study aimed to identify what the literature presents of evidence to guide the clinical practice concerning the safe dose of vasopressors for the initiation of nutritional therapy in critically ill patients. Methods. This review was carried out in PubMed, ProQuest, Web of Science, and Medline databases. The descriptors were used to perform the search strategy: Critical Care, Intensive Care Units, Vasoconstrictor Agents, and Enteral Nutrition. Inclusion criteria were patients of both genders, over 18 years of age, using vasoactive drugs, with the possibility of receiving EN therapy, and articles written in English, Portuguese, and Spanish. In addition, exclusion criteria were case reports, non-papers, and repeated papers. Results. 10 articles met our inclusion criteria. Conclusion. It was observed that there are many controversies about the supply of EN in critically ill patients using vasopressor, especially about the safe dose, and it was not possible to identify a cutoff value for the beginning therapy. Despite the drug doses, clinical signs are still the most important parameters in the evaluation of EN tolerance.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Vasopressors and Nutrition Therapy: Safe Dose for the Outset of Enteral Nutrition?

Covello

Gava-Brandolis

Ribeiro

et al. 2020

Critical Care Research and Practice

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“…Administration of enteral nutrition is of choice in critically ill patients if oral feeding is not possible. Early enteral nutrition (EN) should be initiated within the first 48 h of progression, after the resuscitation phase and once a stable shock situation has been reached (mean systolic blood pressure ≥65 mmHg after adequate resuscitation, stabilized and/or decreasing lactate levels and doses of vasopressors, and improvement of systemic perfusion) [ 19 ]. If, after the acute phase (7–10 days), 70% of the enteral protein-caloric needs are not achieved, add-on parenteral nutrition (PN) should be considered [ 20 ].…”

Section: Conference Sectionsmentioning

confidence: 99%

Smartfeeding: A Dynamic Strategy to Increase Nutritional Efficiency in Critically Ill Patients—Positioning Document of the Metabolism and Nutrition Working Group and the Early Mobilization Working Group of the Catalan Society of Intensive and Critical Care Medicine (SOCMiC)

Yébenes,

Bordeje-Laguna,

Lopez-Delgado

et al. 2024

Nutrients

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Adequate medical nutrition therapy for critically ill patients has an impact on their prognoses. However, it requires an individualized approach that takes into account the activity (phases of metabolic stress) and particularity of these patients. We propose a comprehensive strategy considering the patients’ nutritional status and the set of modifiable circumstances in these patients, in order to optimize/support nutritional efficiency: (1) A detailed anamnesis and an adequate initial nutritional assessment must be performed in order to implement medical nutrition therapy that is in line with the needs and characteristics of each patient. Furthermore, risks associated with refeeding syndrome, nutritrauma or gastrointestinal dysfunction must be considered and prevented. (2) A safe transition between nutrition therapy routes and between health care units will greatly contribute to recovery. The main objective is to preserve lean mass in critically ill patients, considering metabolic factors, adequate protein intake and muscle stimulation. (3) Continuous monitoring is required for the successful implementation of any health strategy. We lack precise tools for calculating nutritional efficiency in critically ill patients, therefore thorough monitoring of the process is essential. (4) The medical nutrition approach in critically ill patients is multidisciplinary and requires the participation of the entire team involved. A comprehensive strategy such as this can make a significant difference in the functional recovery of critically ill patients, but leaders must be identified to promote training, evaluation, analysis and feedback as essential components of its implementation, and to coordinate this process with the recognition of hospital management.

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“…EN may trigger intestinal ischemia in patients who are not hemodynamically (HD) stable. [ 8 ] Hence, clinical monitoring of gut function is essential before initiating EN. Critically ill patients on two or more vasopressors/inotropes in high doses are at the risk of developing complications such as gut ischemia, and this may get worse with inadvertent initiation of EN.…”

Section: G Rading C Riteriamentioning

confidence: 99%

Practice guidelines for nutrition in critically Ill patients: A relook for indian scenario

Mehta

Sunavala

Zirpe

et al. 2018

Indian Journal of Critical Care Medicine

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Background and Aim:Intensive-care practices and settings may differ for India in comparison to other countries. While international guidelines are available to direct the use of enteral nutrition (EN), there are no recommendations specific to Indian settings. Advisory board meetings were arranged to develop the practice guidelines specific to Indian context, for the use of EN in critically ill patients and to overcome challenges in this field.Methods:Various existing guidelines, meta-analyses, randomized controlled trials, controlled trials, and review articles were reviewed for their contextual relevance and strength. A systematic grading of practice guidelines by advisory board was done based on strength of the supporting evidence. Wherever Indian studies were not available, references were taken from the international guidelines.Results:Based on the literature review, the recommendations for developing the practice guidelines were made as per the grading criteria agreed upon by the advisory board. The recommendations were to address challenges regarding EN versus parenteral nutrition; nutrition screening and assessment; nutrition in hemodynamically unstable; route of nutrition; tube feeding and challenges; tolerance; optimum calorie-protein requirements; selection of appropriate enteral feeding formula; micronutrients and immune-nutrients; standard nutrition in hepatic, renal, and respiratory diseases and documentation of nutrition practices.Conclusion:This paper summarizes the optimum nutrition practices for critically ill patients. The possible solutions to overcome the challenges in this field are presented as practice guidelines at the end of each section. These guidelines are expected to provide guidance in critical care settings regarding appropriate critical-care nutrition practices and to set up Intensive Care Unit nutrition protocols.

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Nutrición enteral en el paciente crítico con inestabilidad hemodinámica

Cited by 14 publications

References 39 publications

Vasopressors and Nutrition Therapy: Safe Dose for the Outset of Enteral Nutrition?

Vasopressors and Nutrition Therapy: Safe Dose for the Outset of Enteral Nutrition?

Smartfeeding: A Dynamic Strategy to Increase Nutritional Efficiency in Critically Ill Patients—Positioning Document of the Metabolism and Nutrition Working Group and the Early Mobilization Working Group of the Catalan Society of Intensive and Critical Care Medicine (SOCMiC)

Practice guidelines for nutrition in critically Ill patients: A relook for indian scenario

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