(455) Enteral Nutrition on Vasoactive Medications in the Surgical Critical Care Patient

Introduction: Benefits of early enteral nutrition are well documented including decreased hospital mortality, ICU and hospital length of stay (LOS), and decreased time on mechanical ventilation. Great variability exists regarding standardization of initiating enteral nutrition while on vasoactive medications. There are limited studies regarding the safety of standardized enteral nutrition protocols. We implemented an IRB approved, interventional prospective non-blinded study in our surgical ICU at the University of Kansas Medical Center with a standardized protocol for feeding while on vasoactive medications.

Methods: One year of retrospective data was collected prior to implementation of our protocol, which defined acceptable vasopressors for initiating and continuing enteral nutrition up to 0.3 mcg/kg/min of norepinephrine alone or 0.2 mcg/kg/min of norepinephrine and 2.4 units/hr of vasopressin. Prospective data was collected for one year after a three month washout period. The primary outcome was time from admission to initiation of feeds. Secondary outcomes included time from admission to goal feeds, ICU and hospital LOS, and total duration of vasopressor and enteral nutrition use. Patient populations were compared using Charlson Comorbidity Index and APACHE II scores. Pearson's chi-squared, Fisher's exact test, and t-tests were used to determine significance (a=0.05).

Results: Our groups showed no statistical differences in Charlson Comorbidity Index or APACHE II scores. The retrospective group did have a higher incidence of acute renal failure and norepinephrine dose required. There was no statistical significance in the primary outcome, but the prospective group did initiate enteral feeds sooner. Secondary outcomes showed no statistically significant differences. There was no evidence of worsening lactic acidosis or unplanned abdominal surgery following protocol implementation.

Conclusions: Our study showed evidence of safety of early initiation of enteral nutrition while on vasoactive medications with earlier initiation of feeds. The lack of statistical significance could be attributable to study limitations, including being a single center study with a small sample size. Future directions include collaborating with additional academic institutions to demonstrate safety as well as patient benefit.