Nutrición enteral (temprana) y estado hemodinámico en el paciente críticamente enfermo: ¿Qué debe saber el clínico de soporte nutricional?

Abstract

Multiple guides recommend early enteral nutritional support in critically ill patients, while enteral nutrition is contraindicated in hemodynamically unstable patients. The main risk attributed to enteral nutrition in this kind of patients is non-occlusive mesenteric ischemia, which shows a high mortality rate. Given the lack of concrete evidence in this area, this paper proposes the integral assessment of the patient considering clinical history, vasopressors (doses and tendencies), vital signs, clinical condition, and lactate levels, in order to begin with mainly early enteral support. Afterwards, close monitoring of signs of enteral intolerance and clinical deterioration, with the ability to start the diagnosis process and immediately approach an eventual case of mesenteric ischemia. Topics in this paper include enteral feeding access route, support modality, which formulas to use, and basic concepts of shock and its management, and proposed pathophysiological mechanisms for non-occlusive mesenteric ischemia.

Incompatibilities and Interactions Drugs-Artificial Enteral Nutrition in a Hospital Institution in Cartagena/Colombia

“…Therefore, authors such as Galindo and Monares, supported by the ASPEN and ESPEN guidelines, warn that mesenteric ischemia and, on rare occasions, intestinal necrosis may occur. which has a high risk of mortality and therefore AEN administration should be avoided in patients requiring vasoactive agents (22). It is important to highlight that within the relevant data of this study, two cases of mesenteric ischemia were presented, but the limitations of this study do not allow establishing that this condition is due, and it is left to the institution where this study was carried out to do the analysis of these cases.…”