OBJECTIVE: To evaluate the effects of post-pyloric enteral nutrition (EN) on hepato-splanchnic and systemic hemodynamics, metabolism and gastric mucosal energy balance in septic patients. DESIGN: Prospective clinical study. SETTING: Medical intensive care unit (ICU) in a university hospital. PATIENTS: Ten hemodynamically stable, mechanically ventilated patients with severe sepsis. Eight patients required norepinephrine. INTERVENTION: Low dose post-pyloric EN (Survimed, 40 ml bolus, 40 ml h(-1) continuously). MEASUREMENTS AND RESULTS: Three data sets: F1 = baseline fasting, EN(120) = after 120 min of EN, F2=120 min after EN cessation. In addition to global hemodynamics and gastric mucosal PCO(2), we measured hepato-splanchnic blood flow (HSBF) using continuous primed indocyanine green dye infusion with hepatic venous sampling. The mean arterial pressure remained unchanged. During EN systemic vascular resistance decreased ( p<0.05), while cardiac index increased (p<0.001). Simultaneously, HSBF increased during EN and decreased again at F2 (1.54 [0.88; 1.66] l min(-1) m(-2 )at F1; 1.72 [1.18; 1.83] l min(-1) m(-2 )at EN and 1.38 [0.91; 1.63] l min(-1) m-(2 )at F2, p<0.001). Hepatic venous acid base status, lactate/pyruvate ratio and splanchnic lactate balance remained unchanged. There was also no change in splanchnic oxygen extraction ratio or in gastric mucosal to arterial PCO(2) difference. CONCLUSION: The initiation of low dose post-pyloric EN in medical ICU patients with severe sepsis led to the parallel increase of systemic and hepato-splanchnic blood flow. Hepato-splanchnic energy metabolism, oxygen kinetics and gastric mucosal energy balance did not deteriorate during EN, suggesting that EN during sepsis may not be harmful even in patients requiring norepinephrine.
OBJECTIVE: To evaluate the effects of post-pyloric enteral nutrition (EN) on hepato-splanchnic and systemic hemodynamics, metabolism and gastric mucosal energy balance in septic patients. DESIGN: Prospective clinical study. SETTING: Medical intensive care unit (ICU) in a university hospital. PATIENTS: Ten hemodynamically stable, mechanically ventilated patients with severe sepsis. Eight patients required norepinephrine. INTERVENTION: Low dose post-pyloric EN (Survimed, 40 ml bolus, 40 ml h(-1) continuously). MEASUREMENTS AND RESULTS: Three data sets: F1 = baseline fasting, EN(120) = after 120 min of EN, F2=120 min after EN cessation. In addition to global hemodynamics and gastric mucosal PCO(2), we measured hepato-splanchnic blood flow (HSBF) using continuous primed indocyanine green dye infusion with hepatic venous sampling. The mean arterial pressure remained unchanged. During EN systemic vascular resistance decreased ( p<0.05), while cardiac index increased (p<0.001). Simultaneously, HSBF increased during EN and decreased again at F2 (1.54 [0.88; 1.66] l min(-1) m(-2 )at F1; 1.72 [1.18; 1.83] l min(-1) m(-2 )at EN and 1.38 [0.91; 1.63] l min(-1) m-(2 )at F2, p<0.001). Hepatic venous acid base status, lactate/pyruvate ratio and splanchnic lactate balance remained unchanged. There was also no change in splanchnic oxygen extraction ratio or in gastric mucosal to arterial PCO(2) difference. CONCLUSION: The initiation of low dose post-pyloric EN in medical ICU patients with severe sepsis led to the parallel increase of systemic and hepato-splanchnic blood flow. Hepato-splanchnic energy metabolism, oxygen kinetics and gastric mucosal energy balance did not deteriorate during EN, suggesting that EN during sepsis may not be harmful even in patients requiring norepinephrine.
Authors: G Hernandez; N Velasco; C Wainstein; L Castillo; G Bugedo; A Maiz; F Lopez; S Guzman; C Vargas Journal: J Crit Care Date: 1999-06 Impact factor: 3.425
Authors: Jennifer A Sim; M Horowitz; M J Summers; L G Trahair; R S Goud; A V Zaknic; T Hausken; J D Fraser; M J Chapman; K L Jones; A M Deane Journal: Intensive Care Med Date: 2012-10-25 Impact factor: 17.440
Authors: G Elke; E Kuhnt; M Ragaller; D Schädler; I Frerichs; F M Brunkhorst; M Löffler; K Reinhart; N Weiler Journal: Med Klin Intensivmed Notfmed Date: 2013-03-03 Impact factor: 0.840
Authors: Thu An Nguyen; Yasmine Ali Abdelhamid; Liza K Phillips; Leeanne S Chapple; Michael Horowitz; Karen L Jones; Adam M Deane Journal: World J Crit Care Med Date: 2017-02-04