Thread by @LifeWithoutDiet

Now Dr. Jayshil Patel on feeding the unstable ICU patient. #SCCM2023 #ICUNutrition

Questions Patel will answer today. Situations where we might pause before giving nutrition. #SCCM2023 #ICUNutrition

Patel: risks of feeding include vomiting, gut ischemia. #SCCM2023 #ICUNutrition

Patel reminds us that paralytics do not work on smooth muscle, but rather the concomitant use of narcotics may be more to blame for decreased motility. #SCCM2023 #ICUNutrition

Patel: the villious tip last to get blood flow during shock means potential increased risk of ischemia w/ feeds… maybe? #SCCM2023 #ICUNutrition

Patel: much of our data on EARLY EN did not include whether those patients were on pressors or not. Enter : Nutrirea-2! Increased complications with pressors. But….. #ICUNutrition #SCCM2023

All data previously suggested bowel ischemia was very rare. (0.3%) So why the discrepancy? #ICUNutrition #SCCM2023

Dose of EN and norepinephrine equivalents played a role. Higher or both = more likely to have complications. #ICUNutrition #SCCM2023

#ICUNutrition #SCCM2023

Next, Patel discussion feeding in prone positioning. #SCCM2023 #ICUNutrition

Lots of data on prone feeding but 3 key points:
-only one small RCT
-amount of EN given is different
-all suggest that EN seems to be safe during prone positioning
#ICUNutrition #SCCM2023

Finally, feeding with ECMO. It’s more about the long haul, maintaining muscle, gut barrier, bone health, etc. #SCCM2023 #ICUNutrition

ECMO still increase risk of gut ischemia. #SCCM2023 #ICUNutrition

Again, lots of data, mostly observational. 3 showed improve outcomes, even in study w high ischemia rates. Generally accepted as safe. #SCCM2023 #ICUNutrition