From the Research
There is no specific dose of norepinephrine that universally mandates stopping tube feeding, but high-dose vasopressors, typically defined as norepinephrine doses exceeding 0.3-0.5 mcg/kg/min, may necessitate holding tube feeding due to concerns about intestinal hypoperfusion and potential bowel ischemia. The decision to continue or hold enteral nutrition should be individualized based on the patient's overall clinical status, including assessment of bowel sounds, abdominal distension, gastric residual volumes, and other signs of feeding intolerance 1.
Key Considerations
- Clinical signs, such as bowel sounds, abdominal distension, and gastric residual volumes, are crucial in evaluating the tolerance of enteral nutrition in patients receiving vasopressors 2, 1.
- The use of high-dose vasopressors, such as norepinephrine, may increase the risk of intestinal hypoperfusion and bowel ischemia, but the exact dose at which this occurs is not well-defined 3.
- Enteral nutrition can be safely tolerated in many patients receiving vasopressors, but close monitoring is necessary to prevent complications 1.
Recommendations
- Tube feeding should be held when a patient requires high-dose vasopressors or when multiple vasopressors are needed to maintain hemodynamic stability, but the decision should be individualized based on the patient's clinical status 4, 1.
- Once hemodynamic stability improves with decreasing vasopressor requirements, tube feeding can typically be cautiously reintroduced, often starting at a lower rate and advancing as tolerated 4, 1.
- The choice to continue or hold enteral nutrition should be based on the patient's overall clinical status, rather than a specific dose of norepinephrine 2, 1.