| Enteral nutrition and cardiovascular failure: from myths to clinical practice. | |
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MedLine Citation:
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PMID: 19892904 Owner: NLM Status: In-Process |
Abstract/OtherAbstract:
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Cardiovascular failure and low flow states may arise in very different conditions from both cardiac and noncardiac causes. Systemic hemodynamic failure inevitably alters splanchnic blood flow but in an unpredictable way. Prolonged low splanchnic blood flow causes intestinal ischemia, increased mucosal permeability, endotoxemia, and distant organ failure. Mortality associated with intestinal ischemia is high. Why would enteral nutrition (EN) be desirable in these complex patients when parenteral nutrition could easily cover energy and substrate requirements? Metabolic, immune, and practical reasons justify the use of EN. In addition, continuous enteral feeding minimizes systemic and myocardial oxygen consumption in patients with congestive heart failure. Further, early feeding in critically ill mechanically ventilated patients has been shown to reduce mortality, particularly in the sickest patients. In a series of cardiac surgery patients with compromised hemodynamics, absorption has been maintained, and 1000-1200 kcal/d could be delivered by enteral feeding. Therefore, early EN in stabilized patients should be attempted, and can be carried out safely under close clinical monitoring, looking for signs of incipient intestinal ischemia. Energy delivery and balance should be monitored, and combined feeding considered when enteral feeds cannot be advanced to target within 4-6 days. |
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Authors:
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Mette M Berger; René L Chiolero |
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Publication Detail:
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Type: Journal Article |
Journal Detail:
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Title: JPEN. Journal of parenteral and enteral nutrition Volume: 33 ISSN: 0148-6071 ISO Abbreviation: JPEN J Parenter Enteral Nutr Publication Date: 2009 Nov-Dec |
Date Detail:
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Created Date: 2009-11-06 Completed Date: - Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 7804134 Medline TA: JPEN J Parenter Enteral Nutr Country: United States |
Other Details:
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Languages: eng Pagination: 702-9 Citation Subset: IM |
Affiliation:
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Department of Intensive Care Medicine & Burns Centre, University Hospital, Lausanne, Switzerland. mette.berger@chuv.ch |
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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