Early Enteral Nutrition Tolerance in Patients With Cardiogenic Shock Requiring Mechanical Circulatory Support

Background: Enteral nutrition (EN) is recommended within the first 24–48 h for patients with hemodynamic stability, following admission to an intensive care unit (ICU). However, for patients with approximate stable hemodynamics requiring mechanical circulatory support and vasoactive drugs, the application of early EN remains controversial. We sought to evaluate the tolerance of early EN in patients with cardiogenic shock who required vasoactive drugs and mechanical circulatory support after cardiac surgery.Methods: This single-center, prospective observational study included patients with cardiogenic shock, requiring vasoactive drugs and mechanical circulatory support after cardiac surgery, undergoing EN. The primary endpoint was EN tolerance and secondary endpoints were mortality, length of mechanical ventilation, and length of ICU stay.Results: From February 2019 to December 2020, 59 patients were enrolled, of which 25 (42.37%) developed intolerance within 3 days of starting EN. Patients in the EN intolerant group had a longer median length of mechanical ventilation (380 vs. 128 h, p = 0.006), a longer median ICU stay (20 vs. 11.5 days, p = 0.03), and a higher proportion of bloodstream infections (44 vs. 14.71%, p = 0.018). The median EN calorie levels for all patients in the first 3 days of EN were 4.00, 4.13, and 4.28 kcal/kg/day, respectively. Median protein intake levels of EN in the first 3 days were 0.18, 0.17, and 0.17 g/kg/day, respectively. No significant difference was observed in the median dose of vasoactive drugs between the groups (0.035 vs. 0.05 μg/kg/min, p = 0.306).Conclusions: Patients with cardiogenic shock after cardiac surgery had a high proportion of early EN intolerance, and patients with EN intolerance had a worse prognosis, but no significant correlation was identified between EN tolerance and the dose of vasoactive drugs.

Disease severity as a risk factor for enteral feeding intolerance in the early period of acute pancreatitis

The purpose of the study was to assess the dependence of development of enteral nutrition intolerance on the disease form and condition severity during early AP with severe progression predictors. Materials and Methods. An open randomized controlled study has been carried out. The study included 64 patients, 31 of them having a severe and 33 — moderately severe forms of the disease. The criteria of enteral nutrition intolerance were: discharge via the nasogastric tube > 500ml simultaneously or > 500 ml/day, compared to the amount fed enterally over 24hrs; aggravation of pain; abdominal distension, diarrhea, nausea and vomiting. Indices possessing a predictive value were identified with the help of logit regression. The null hypothesis was rejected at p<0.05.Results. The APACHE-II score (OR — 1.134, 95% CI: 1.068-1.2, p=0.01) and CPR concentration (OR — 1.006, 95% CI: 1.005-1.013, p=0.001) affect independently the development of a large gastric residual volume. The fact of surgery predicts large gastric residual volumes (OR — 1.821, 95% CI: 2.529-9.19, p=0.001), nausea and vomiting (OR — 2.077, 95% CI: 1.075-4.012, p=0.021). The SOFA score is associated with large gastric residual volumes (OR — 1.349, 95% CI: 1.18-1.539, p= 0.001), pain (OR — 1.203, 95% CI: 1.065-1.364, p= 0.003), nausea and vomiting (OR — 1.167, 95% CI: 1.028-1.324, p= 0.018). The moderately severe form is accompanied with a lower incidence of large gastric residual volumes (OR — 0.354, 95% CI: 0.201-0.611, p=0.001), pain (OR — 0.475, 95% CI: 0.284-0.795, p=0.004), nausea and vomiting (OR — 0.519, 95% CI: 0.304-0.888, p=0.018), and abdominal distension (OR — 0.342, 95% CI: 0.193-0.607, p=0.001). Conclusions. The development and severity of early enteral nutrition intolerance during early acute pancreatitis with severe progression predictors depend on the severity of condition (APACHE-II), extent of multiple organ dysfunction (SOFA), the fact of surgery, form of the disease, and C-reactive protein concentration. A combined use of independent factors increases their predictive value.

Effect of early enteral nutrition on critical care outcomes in patients with acute ischemic stroke

Objective Stroke-associated pneumonia (SAP) is a comorbidity of ischemic stroke related to clinical outcomes. Early enteral nutrition (EEN; within 48 hours) reduces the incidence of infection and length of intensive care unit (ICU)/hospital stay. The relationship between EEN and critical care outcomes, including SAP, in patients with ischemic stroke has been insufficiently studied. Methods We recruited 499 patients in this retrospective observational study. We evaluated SAP incidence within 14 days from admission. Patients were divided into an EEN group and a late EN group (LEN; start later than EEN). We compared groups regarding background and length of ICU/hospital stay. Results EN was started within 48 hours in 236 patients. SAP was diagnosed in 94 patients (18.8%), with most in the LEN group (28.1% vs. 8.5%). Median [interquartile range] lengths of hospitalization (22 [12–30] days vs. 35 [20–45] days) and ICU stay (4 [2–5] days vs. 6 [3–8] days) were longer in the LEN group. EEN reduced the incidence of SAP. By contrast, consciousness disturbance and worsening consciousness level increased the SAP incidence. Increased age and National Institutes of Health Stroke Scale score were associated with start of prolonged EN. Conclusions We found that EEN may reduce SAP risk.

Early enteral nutrition in acute pancreatitis - how beneficial is it?

Background: Acute pancreatitis is an inflammatory disease of pancreas and is one of the leading cause of acute abdomen requiring hospital admission. Nutritional support plays a crucial role in this hypercatabolic state in not only providing calories but also in preventing complications and decreasing recovery time.Methods: This prospective study was done among 120 patients with acute moderate and severe pancreatitis who got admitted in department of general surgery at Saveetha Medical College and Hospital, Chennai, Tamil Nadu, India between 2018 and 2019.Results: 67 (55.8%) patients were in early enteral and 53 (44.2%) were in parenteral/delayed enteral group. Maximum number of patients were in 30-40 years age group. The mean of patient age was 40.33. Mean duration of hospital stay in enteral group was 7.06 and in parenteral/delayed enteral group it was 14.09 (p<0.001). Mean pain score in enteral group was 2.69 and in parenteral group it was 6.51 (p<0.001).Conclusions: There was significant (p<0.001) decrease in hospital stay duration and pain score in early enteral group compared to parenteral/delayed enteral group. Infections related to feeding route was found high in parenteral group. No significant difference found in complications of acute pancreatitis. Hence early enteral feeding is more beneficial in terms of shortened hospital stay, decreased pain score leading to reduction in usage of analgesics and reducing the recovery time and less nutrition related complications in management of acute moderate and severe pancreatitis.