From the Research
Tube feeding should be avoided in patients on high doses of vasopressors because these medications significantly reduce blood flow to the gastrointestinal tract, creating a high risk of bowel ischemia and necrosis. When patients require high-dose vasopressors such as norepinephrine (>0.3-0.5 mcg/kg/min), epinephrine, vasopressin, or phenylephrine to maintain adequate blood pressure, the splanchnic circulation becomes severely compromised 1. The body redirects blood flow to vital organs like the heart and brain at the expense of the intestines. Attempting enteral nutrition in this state can worsen intestinal damage as the digestive process requires increased blood flow that cannot be adequately supplied.
Instead, parenteral nutrition should be considered if the patient requires prolonged nutritional support. Once hemodynamic stability improves and vasopressor requirements decrease (typically norepinephrine <0.3 mcg/kg/min), enteral feeding can be cautiously reintroduced, starting at a low rate and gradually advancing while monitoring for signs of feeding intolerance such as abdominal distension, increased gastric residuals, or worsening lactic acidosis. Some key points to consider when managing patients on high doses of vasopressors include:
- Monitoring blood pressure and adjusting vasopressor doses as needed to minimize the risk of bowel ischemia and necrosis
- Assessing the patient's overall hemodynamic status and adjusting nutritional support accordingly
- Considering alternative forms of nutritional support, such as parenteral nutrition, if enteral feeding is not tolerated
- Gradually advancing enteral feeding rates once hemodynamic stability is achieved and vasopressor requirements decrease. It's also important to note that the management of patients on high doses of vasopressors requires careful consideration of the patient's individual needs and circumstances, and should be guided by the latest clinical evidence and guidelines 2, 3.