Enteral nutrition and cardiovascular failure: from myths to clinical practice.

Details

Serval ID
serval:BIB_E6E0E433DAA5
Type
Article: article from journal or magazin.
Publication sub-type
Review (review): journal as complete as possible of one specific subject, written based on exhaustive analyses from published work.
Collection
Publications
Institution
Title
Enteral nutrition and cardiovascular failure: from myths to clinical practice.
Journal
Journal of Parenteral and Enteral Nutrition
Author(s)
Berger M.M., Chiolero R.L.
ISSN
0148-6071
Publication state
Published
Issued date
2009
Peer-reviewed
Oui
Volume
33
Number
6
Pages
702-709
Language
english
Abstract
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.
Keywords
Critically-Ill Patients, Splanchnic Blood-Flow, Intensive-Care-Unit, Cardiopulmonary Bypass, Cardiac-Surgery, Heart-Failure, Parenteral-Nutrition, Energy-Balance, Score, Patient
Pubmed
Web of science
Create date
24/11/2009 16:01
Last modification date
20/08/2019 16:09
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