Journal of Clinical Nutrition & Dietetics

Enteral Nutritional Therapy in the Critically Ill Patient Using Vasopressors

Introduction: Early Enteral Nutritional (EN) therapy can contribute significantly to reducing mortality in critically ill patients, but the indication for its initiation may be controversial in patients using vasopressors. Vasoactive drugs may contribute to intolerance of ET due to inadequate perfusion and poor splanchnic circulation, which favors the risk of mesenteric ischemia. The objective of this work was to review the possibilities, benefits and risks of early enteral nutrition therapy in critically ill patients using vasopressors.

Methods: A literature review of scientific articles was carried out in the Scielo, Lilacs, Capes, PubMed databases, using the main descriptors: "Enteral nutrition", "critical care", "vasopressors", "intensive care unit", "early enteral nutrition", considering the period from 2009 to 2020. The languages English, Portuguese and Spanish were considered. Inclusion criteria considered critically ill patients over 18 years of age, clinical or surgical, using vasopressor agents alone or associated, with or without use of Extracorporeal Membrane Oxygenation (ECMO). A total of 14 articles were selected according to the pre-established inclusion criteria. Observational, retrospective, prospective studies and randomized controlled trials were included. Type of study, patient profile, the association between enteral nutrition and use of vasopressors and the outcome were evaluated. Studies that evaluated mortality and length of stay and mechanical ventilation time were also analyzed.

Results: It is observed through the studies, that the use of enteral nutrition therapy for the critically ill patient using vasopressors can bring benefits for nutritional supply, preservation of the gastrointestinal tract, contributing to a reduction in mortality, mechanical ventilation time and length of hospital stay. However, we know that more analyses and studies are required for further conclusions.

Conclusion: Early EN is possible and indicated in most critically ill patients using vasoactive drugs in stable and decreasing doses, with adequate parameters of tissue perfusion.

Author(s): Neiza Seraphim Dyszy

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