Enteral Nutrition Safety With Advanced Treatments (Extracorporeal Membrane Oxygenation, Prone Positioning, and Infusion of Neuromuscular Blockers)

被引:15
作者
Al-Dorzi, Hasan M. [1 ]
Arabi, Yaseen M. [1 ]
机构
[1] King Saud bin Abdulaziz Univ Hlth Sci, Coll Med, King Abdullah Int Med Res Ctr, Intens Care Dept,King Abdulaziz Med City, ICU2,Mail Code 1425,POB 22490, Riyadh 11426, Saudi Arabia
关键词
critical illness; enteral nutrition; extracorporeal membrane oxygenation; gastrointestinal motility; neuromuscular blockade; prone position; vasoconstrictor agents; CRITICALLY-ILL PATIENTS; ENERGY-EXPENDITURE; SUPPORT; ADULTS; THERAPY; MULTICENTER; PREVALENCE; GUIDELINES; BLOCKADE; RISK;
D O I
10.1002/ncp.10621
中图分类号
R15 [营养卫生、食品卫生]; TS201 [基础科学];
学科分类号
100403 ;
摘要
This review aims at assessing the safety and efficacy of enteral nutrition in critically ill patients receiving extracorporeal membrane oxygenation, prone positioning, and infusion of neuromuscular blockers. Existing data from randomized controlled trials demonstrate the survival benefit of early enteral nutrition in critically ill patients. Observational data have demonstrated that enteral nutrition in patients receiving extracorporeal membrane oxygenation, prone positioning, and infusion of neuromuscular blockers is generally safe. However, these patients are at increased risk for gastrointestinal complications from enteral nutrition because of critical illness-induced gastrointestinal dysfunction; associated shock; the concomitant use of vasopressor agents, sedatives, and narcotics; possibly mesenteric circulatory compromise; and regurgitation associated with prone positioning. Therefore, early enteral nutrition is generally recommended in these patients in the absence of severe gastrointestinal dysfunction or shock. To reduce the complications, early nutrition should be advanced gradually (trophic feeding or permissive underfeeding), the bed should be tilted to a maximum of 30 degrees, and concentrated nutritional formulae and the use of prokinetics may be considered to treat enteral feeding intolerance. Physicians should be vigilant about monitoring for early signs of acute mesenteric ischemia, which should lead to holding enteral feeding. Parenteral nutrition may be utilized in patients who cannot receive enteral nutrition or are unable to reach their nutrition goals by the end of the first week.
引用
收藏
页码:88 / 97
页数:10
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