Enteral nutrition in circulatory shock: friend or foe?
Journal
Current opinion in clinical nutrition and metabolic care
ISSN: 1473-6519
Titre abrégé: Curr Opin Clin Nutr Metab Care
Pays: England
ID NLM: 9804399
Informations de publication
Date de publication:
01 03 2021
01 03 2021
Historique:
pubmed:
5
1
2021
medline:
26
10
2021
entrez:
4
1
2021
Statut:
ppublish
Résumé
Circulatory shock is associated with reduced splanchnic blood flow and impaired gut epithelial barrier function (EBF). Early enteral nutrition (EN) has been shown in animal models to preserve EBF. There are limited human data informing early EN in circulatory shock and critical care nutrition guidelines provide disparate recommendations regarding the optimal timing and dose. The purpose of this review is to describe the harms and benefits of early EN in circulatory shock by identifying and appraising recent human data. The cumulative risk of nonocclusive bowel ischemia and necrosis in patients with circulatory shock is no higher than 0.3% across observational and randomized controlled trial-level data, and whether the risk is increased by EN delivery remains uncertain. Observational data suggest that early EN in circulatory shock is associated with improved clinical outcomes but data from robust randomized controlled trials remain equivocal, so the optimal timing and dose remain unknown. Based on the best available data, initiating restrictive dose EN into the stomach after initial resuscitation in patients with circulatory shock does not appear to be harmful. In fact, early EN may preserve EBF and improve clinical outcomes.
Identifiants
pubmed: 33394598
doi: 10.1097/MCO.0000000000000731
pii: 00075197-202103000-00011
doi:
Types de publication
Journal Article
Review
Langues
eng
Sous-ensembles de citation
IM
Pagination
159-164Informations de copyright
Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.
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