pressors and nutrition

[B]

I have found a broad practice variation with respect to the use of
enteral
nutrition in patients on vasopressors for hemodynamic support, with
some
physicians adamantly against it and others tolerant, but with no
definition
of how high is too high a pressor dose to stop feeds. The literature
seems
poor also.
I was curious, what is your recommendations/practice pattern in this
patient
population- a patient who needs nutrition, but is on vasopressors? Do
you
have a cutoff pressor requirement dose?
That is it.
I thank you very much for your time.

Take care.

[JRCF]

yes, I believe a MAP of > 64mm Hg and a "steady" and/or "downward", "
pressor use is what ASPEN said few years ago in their
publications/guidelines*. I have followed this for > 20 years of practice
and so have the ICUs I have worked in.
*Sorry, I don't have access to them at the moment.

Cyndy

[JRCF]

http://www.scribd.com/doc/7336982/Decisions-to-Be-Made-When-Initiating-Enteral-Nutrition-Gastrointestinal-Endoscopy-Clinics-of-North-America-2007



http://www.pensa2007.org/P_Anthony_EN_critical_ill.pdf


These are all I have time for at the moment / online .

Just Google/Yahoo [enteral feeds and pressor use]

[ray.c...@charter.net]

I think the concept is not the pressors but rather the phase of the disease process. I think the ebb and flow thought process is a good one.

If the patient is improving or just not worsening, then it is reasonable to feed. How much? Start slow and give what they will tolerate. I personally think in this situation an elemental formula or designer stress formula is best. But that is more art than science.

If the dose of pressors is escalating or the pt is unstable etc, I don't think the gut is really going to process more than just a trickle.

I think this is probably the gestalt that you are running up against, whether thought out like this or not.

Hope this helps.
Ray Compton, MD, FACS
Sent from my Verizon Wireless BlackBerry

-----Original Message-----
From: B <crimsona...@hotmail.com>

Date: Sat, 7 Feb 2009 06:05:40

To: Critical Care Nutrition<criticalca...@googlegroups.com>

Subject: [Critical Care Nutrition] pressors and nutrition

[Annie]

I know this was posted over a month ago, I just joined and I saw this
so I wanted to respond ...
one of the attendings in the ICU will feed a pt who is on 5mcg or less
of pressors and one wont feed a pt @ all.

[JRCF]

Maybe I am the "odd man out", but we have fed enteral feedings to patients
for years as long as their MAP remains >64and not going up on pressors
delivery.

Cyndy,RD,CNSD

----- Original Message -----
From: "Annie" <aas...@gmail.com>
To: "Critical Care Nutrition" <criticalca...@googlegroups.com>

Sent: Friday, March 13, 2009 5:17 PM
Subject: [Critical Care Nutrition] Re: pressors and nutrition

[Michele McCall]

HI there,

I may also be odd! We have fed people on pressors for years.... as long as the pressors are maintaining adequate blood pressure (individual of course, but often MAP of 65 is used). Levophed and vasopressin.... no issues.

Bye for now,
Michele

Michele McCall
Critical Care Dietitian
Specialized Complex Care Program
St. Michael's Hospital
mcc...@smh.toronto.on.ca
416-864-6060 ext. 2556

[Rho]

ditto Michele. We try everyone on enteral even if it's trickle feed at
10 cc/hr for a couple of days until and if tolerated.

Recent review article in NCP 23:5:Oct.2008.

Rho

On Mar 16, 9:18 am, "Michele McCall" <MCCA...@smh.toronto.on.ca>
wrote:

> HI there,
>
> I may also be odd! We have fed people on pressors for years.... as long as the pressors are maintaining adequate blood pressure (individual of course, but often MAP of 65 is used). Levophed and vasopressin.... no issues.
>
> Bye for now,
> Michele
>
> Michele McCall
> Critical Care Dietitian
> Specialized Complex Care Program
> St. Michael's Hospital

> mcca...@smh.toronto.on.ca
> 416-864-6060 ext. 2556