Enteral nutrition for patients in septic shock: a retrospective cohort study

Abstract

<h4>Background</h4>Haemodynamic instability is frequently considered a contraindication to enteral feeding. However, gastrointestinal function and the success of enteral feeding have never been formally examined in patients with shock.<h4>Objective</h4>To assess the adequacy of enteral nutrition in mechanically ventilated septic patients with and without shock.<h4>Design, setting and participants</h4>Retrospective cohort study of septic patients receiving enteral nutrition in the intensive care unit of the Royal Adelaide Hospital in 2006. Patient data were obtained from case notes, nursing charts and dietitian notes. Enteral feeding was reviewed over a 7-day period in septic patients who were ventilated on more than 3 days. Adequacy of nutrition was defined as net calories delivered (including propofol) as a percentage of goal calories prescribed.<h4>Mean outcome measures</h4>Mean time to initiation of feeds; percentage of nutritional goals reached.<h4>Results</h4>43 patients (mean age, 54 [SD, 20] years; mean APACHE II score, 20 [SD, 8]) were identified, of whom 33 had shock. The median length of ICU stay was 13 days (range, 3-55 days), and 32 patients (74%) survived hospital. Seventeen patients (40%) received <60% of goal nutrition over the 7 days. Overall calorie delivery improved over time and peaked at 86% of goal calories by Day 6. The mean time from ICU admission to start of feeding was 1.4 (range, 0-8) days. The mean time to initiation of feeding was not different in patients with or without shock: 1.3 (SD, 1.7) days v 1.7 (SD, 1.3) days (P=0.16). Patients with shock had higher mean daily gastric aspirate volumes than those without (113 [SD, 153] mL v 39 [SD, 47] mL; P=0.02), but no difference was found in the percentage of their nutritional goals reached (69% [SD, 23%] v 77% [SD, 16%]; P=0.2).<h4>Conclusion</h4>Despite delayed gastric emptying, protocoldirected enteral feeding can be considered in patients with septic shock.