PMID- 14767586
OWN - NLM
STAT- MEDLINE
DCOM- 20041021
LR  - 20181113
IS  - 0342-4642 (Print)
IS  - 0342-4642 (Linking)
VI  - 30
IP  - 4
DP  - 2004 Apr
TI  - Post-pyloric enteral nutrition in septic patients: effects on hepato-splanchnic 
      hemodynamics and energy status.
PG  - 714-7
AB  - OBJECTIVE: To evaluate the effects of post-pyloric enteral nutrition (EN) on 
      hepato-splanchnic and systemic hemodynamics, metabolism and gastric mucosal 
      energy balance in septic patients. DESIGN: Prospective clinical study. SETTING: 
      Medical intensive care unit (ICU) in a university hospital. PATIENTS: Ten 
      hemodynamically stable, mechanically ventilated patients with severe sepsis. 
      Eight patients required norepinephrine. INTERVENTION: Low dose post-pyloric EN 
      (Survimed, 40 ml bolus, 40 ml h(-1) continuously). MEASUREMENTS AND RESULTS: 
      Three data sets: F1 = baseline fasting, EN(120) = after 120 min of EN, F2=120 min 
      after EN cessation. In addition to global hemodynamics and gastric mucosal 
      PCO(2), we measured hepato-splanchnic blood flow (HSBF) using continuous primed 
      indocyanine green dye infusion with hepatic venous sampling. The mean arterial 
      pressure remained unchanged. During EN systemic vascular resistance decreased ( 
      p<0.05), while cardiac index increased (p<0.001). Simultaneously, HSBF increased 
      during EN and decreased again at F2 (1.54 [0.88; 1.66] l min(-1) m(-2 )at F1; 
      1.72 [1.18; 1.83] l min(-1) m(-2 )at EN and 1.38 [0.91; 1.63] l min(-1) m-(2 )at 
      F2, p<0.001). Hepatic venous acid base status, lactate/pyruvate ratio and 
      splanchnic lactate balance remained unchanged. There was also no change in 
      splanchnic oxygen extraction ratio or in gastric mucosal to arterial PCO(2) 
      difference. CONCLUSION: The initiation of low dose post-pyloric EN in medical ICU 
      patients with severe sepsis led to the parallel increase of systemic and 
      hepato-splanchnic blood flow. Hepato-splanchnic energy metabolism, oxygen 
      kinetics and gastric mucosal energy balance did not deteriorate during EN, 
      suggesting that EN during sepsis may not be harmful even in patients requiring 
      norepinephrine.
FAU - Rokyta, Richard Jr
AU  - Rokyta R Jr
AD  - Intensive Care Unit, Department of Internal Medicine I, School of Medicine, 
      Charles University Hospital Pilsen, Alej svobody 80, 304 60 Pilsen, Czech 
      Republic. rokyta@fnplzen.cz
FAU - Matejovic, Martin
AU  - Matejovic M
FAU - Krouzecky, Ales
AU  - Krouzecky A
FAU - Senft, Vaclav
AU  - Senft V
FAU - Trefil, Ladislav
AU  - Trefil L
FAU - Novak, Ivan
AU  - Novak I
LA  - eng
PT  - Clinical Trial
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20040206
PL  - United States
TA  - Intensive Care Med
JT  - Intensive care medicine
JID - 7704851
SB  - IM
MH  - Aged
MH  - Energy Metabolism
MH  - *Enteral Nutrition
MH  - Heart Rate
MH  - Hemodynamics/physiology
MH  - Hospitals, University
MH  - Humans
MH  - Intensive Care Units
MH  - Liver/blood supply
MH  - Middle Aged
MH  - Prospective Studies
MH  - Pyloric Antrum/metabolism/physiopathology
MH  - Regional Blood Flow
MH  - Sepsis/*therapy
MH  - Spleen/blood supply
MH  - Stroke Volume
EDAT- 2004/02/10 05:00
MHDA- 2004/10/22 09:00
CRDT- 2004/02/10 05:00
PHST- 2003/05/09 00:00 [received]
PHST- 2003/12/02 00:00 [accepted]
PHST- 2004/02/10 05:00 [pubmed]
PHST- 2004/10/22 09:00 [medline]
PHST- 2004/02/10 05:00 [entrez]
AID - 10.1007/s00134-003-2127-y [doi]
PST - ppublish
SO  - Intensive Care Med. 2004 Apr;30(4):714-7. doi: 10.1007/s00134-003-2127-y. Epub 
      2004 Feb 6.