MINIREVIEW
Enteral Nutrition and Hepatosplanchnic Region
in Critically Ill Patients - Friends or Foes?
R. ROKYTA Jr., M. MATĚJOVIČ,
A. KROUŽECKÝ, I. NOVÁK
Intensive Care Unit, First Department of Internal Medicine,
Charles University Hospital Pilsen, Czech Republic
Received
February 20, 2002
Accepted April 24, 2002
Summary
Enteral nutrition (EN) is a preferred way of feeding in
critically ill patients unless obvious contraindications such as
ileus or active gastrointestinal bleeding are present. Early
enteral nutrition as compared to delayed EN or total parenteral
nutrition decreases morbidity in postsurgical and trauma
patients. The hepatosplanchnic region plays a pivotal role in
the pathophysiology of sepsis and multiple organ dysfunction
syndrome. The beneficial effects of EN on splanchnic perfusion
and energy metabolism have been documented both in healthy
volunteers and animal models of sepsis, hemorrhagic shock and
burns. By contrast, EN may increase splanchnic metabolic
demands, which in turn may lead to oxygen and/or energy
demand/supply mismatch, especially when hyperemic response to EN
is not preserved. Therefore, the timing of initiation and the
dose of EN in patients with circulatory failure requiring
vasoactive drugs are a matter of controversy. Interestingly, the
results of recent clinical studies suggest that early enteral
nutrition may not be harmful even in patients with circulatory
compromise. Nevertheless, possible onset of serious
complications, the non-occlusive bowel necrosis in particular,
have to be kept in mind. Unfortunately, there is only a limited
number of clinically applicable monitoring tools for the effects
of enteral nutrition in critically ill patients.
Key
words
Enteral nutrition • Hepatosplanchnic region • Critically ill •
Sepsis • Nonocclusive bowel necrosis
Reprint
requests
Richard Rokyta
Jr., M.D., Intensive Care Unit, First Department of Internal
Medicine, Charles University Hospital Plzen, Alej Svobody 80,
304 60 Plzen, Czech Republic, Fax: +420-19-7533100, E-mail:
rokyta@fnplzen.cz.
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