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Cardiogenic shock and nutrition: safe?

Ronan Thibault| Claude Pichard| Jan Wernerman| Karim Bendjelid
Clinical Perspective
Volume 37, Issue 1 / January , 2011

Pages 35 - 45

Abstract

Cardiogenic shock is a common diagnosis in patients in the intensive care unit (ICU), and is characterized by a decreased cardiac output in the presence of adequate intravascular volume associated with an inadequate tissue perfusion including a physiological reduction in the splanchnic territory. It may occur in isolation as a reflection of cardiac pathology, or it may be part of a shock syndrome involving other pathogenic mechanisms. As the use of enteral nutrition (EN) is associated with an increase in mesenteric arterial output, EN could be deleterious by overwhelming the mechanisms of mesenteric adaptation. Accordingly, EN has been suspected to increase the risk of mesenteric ischaemia, bacterial translocation and sepsis in ICU patients with cardiogenic shock. International guidelines recommend a cautious use of EN within 72 h following cardiogenic shock. Recent evidence indicates that mesenteric arterial output may decrease during parenteral nutrition administration, suggesting that parenteral nutrition could have a protective effect on splanchnic organs in ICU patients with cardiogenic shock. Contrary to former beliefs, several meta-analyses have shown that parenteral nutrition is not associated with increased mortality. Exclusive EN is associated with negative energy balance and the combination of EN with supplemental parenteral nutrition during the first days following ICU admission has been proposed to prevent negative energy balance. Such a nutritional strategy could also be beneficial for the mesenteric circulation in cardiogenic shock, and consequently may improve the clinical outcome of patients with cardiogenic shock. Clinical trials are warranted to verify these hypotheses.

Keywords

References

  1. Mann HJ, Nolan PE Jr (2006) Update on the management of cardiogenic shock. Curr Opin Crit Care 12:431–436
    • View reference on publisher's website
    • View reference on PubMed
  2. Task Force for Diagnosis and Treatment of Acute and Chronic Heart Failure 2008 of European Society of Cardiology; Dickstein K, Cohen-Solal A, Filippatos G et al (2008) ESC guidelines for the diagnosis and treatment of acute and chronic heart failure 2008. Eur Heart J 29:2388–2442
    • View reference on publisher's website
    • View reference on PubMed
  3. Schunn CD, Daly JM (1995) Small bowel necrosis associated with postoperative jejunal tube feeding. J Am Coll Surg 180:410–416
    • View reference on PubMed
  4. Dvir D, Cohen J, Singer P (2006) Computerized energy balance and complications in critically ill patients: an observational study. Clin Nutr 25:37–44
    • View reference on publisher's website
    • View reference on PubMed
  5. Villet S, Chiolero RL, Bollmann MD, Revelly JP, Cayeux RNMC, Delarue J, Berger MM (2005) Negative impact of hypocaloric feeding and energy balance on clinical outcome in ICU patients. Clin Nutr 24:502–509
    • View reference on publisher's website
    • View reference on PubMed
  6. Reilly PM, Wilkins KB, Fuh KC, Haglund U, Bulkley GB (2001) The mesenteric hemodynamic response to circulatory shock: an overview. Shock 15:329–343
    • View reference on publisher's website
    • View reference on PubMed
  7. Creteur J, De Backer D, Sun Q, Vincent JL (2004) The hepatosplanchnic contribution to hyperlactatemia in endotoxic shock: effects of tissue ischemia. Shock 21:438–443
    • View reference on publisher's website
    • View reference on PubMed
  8. Doursout MF, Oguchi T, Fischer UM, Liang Y, Chelly B, Hartley CJ, Chelly JE (2008) Distribution of NOS isoforms in a porcine endotoxin shock model. Shock 29:692–702
    • View reference on PubMed
  9. Alpert JS, Becker RC (1993) Cardiogenic shock: elements of etiology, diagnosis, and therapy. Clin Cardiol 16:182–190
    • View reference on publisher's website
    • View reference on PubMed
  10. Lim N, Dubois MJ, De Backer D, Vincent JL (2003) Do all nonsurvivors of cardiogenic shock die with a low cardiac index? Chest 124:1885–1891
    • View reference on publisher's website
    • View reference on PubMed
  11. Siegenthaler N, Giraud R, Piriou V, Romand JA, Bendjelid K (2010) Microcirculatory alterations in critically ill patients: pathophysiology, monitoring and treatments. Ann Fr Anesth Reanim 29:135–144
    • View reference on PubMed
  12. Reynolds HR, Hochman JS (2008) Cardiogenic shock: current concepts and improving outcomes. Circulation 117:686–697
    • View reference on publisher's website
    • View reference on PubMed
  13. Hasper D, Hummel M, Kleber FX, Reindl I, Volk HD (1998) Systemic inflammation in patients with heart failure. Eur Heart J 19:761–765
    • View reference on publisher's website
    • View reference on PubMed
  14. De Backer D, Creteur J, Dubois MJ, Sakr Y, Vincent JL (2004) Microvascular alterations in patients with acute severe heart failure and cardiogenic shock. Am Heart J 147:91–99
    • View reference on publisher's website
    • View reference on PubMed
  15. Weil MH, Nakagawa Y, Tang W, Sato Y, Ercoli F, Finegan R, Grayman G, Bisera J (1999) Sublingual capnometry: a new noninvasive measurement for diagnosis and quantitation of severity of circulatory shock. Crit Care Med 27:1225–1229
    • View reference on publisher's website
    • View reference on PubMed
  16. Marik PE (2001) Sublingual capnography: a clinical validation study. Chest 120:923–927
    • View reference on publisher's website
    • View reference on PubMed
  17. Carrico CJ, Meakins JL, Marshall JC, Fry D, Maier RV (1986) Multiple-organ-failure syndrome. Arch Surg 121:196–208
    • View reference on PubMed
  18. Verdant CL, De Backer D, Bruhn A, Clausi CM, Su F, Wang Z, Rodriguez H, Pries AR, Vincent JL (2009) Evaluation of sublingual and gut mucosal microcirculation in sepsis: a quantitative analysis. Crit Care Med 37:2875–2881
    • View reference on publisher's website
    • View reference on PubMed
  19. Cerný V, Cvachovec K (2000) Gastric tonometry and intramucosal pH – theoretical principles and clinical application. Physiol Res 49:289–297
    • View reference on PubMed
  20. Uusaro A, Ruokonen E, Takala J (1996) Splanchnic oxygen transport after cardiac surgery: evidence for inadequate tissue perfusion after stabilization of hemodynamics. Intensive Care Med 22:26–33
  21. Berger MM, Revelly JP, Cayeux MC, Chiolero RL (2005) Enteral nutrition in critically ill patients with severe hemodynamic failure after cardiopulmonary bypass. Clin Nutr 24:124–132
    • View reference on publisher's website
    • View reference on PubMed
  22. Kolkman JJ, Groeneveld AB, Meuwissen SG (1994) Effect of ranitidine on basal and bicarbonate enhanced intragastric pCO2: a tonometric study. Gut 35:737–741
    • View reference on publisher's website
    • View reference on PubMed
  23. Moneta GL, Taylor DC, Helton WS, Mulholland MW, Strandness DE Jr (1988) Duplex ultrasound measurement of postprandial intestinal blood flow: effect of meal composition. Gastroenterology 95:1294–1301
    • View reference on PubMed
  24. Gatt M, MacFie J, Anderson AD, Howell G, Reddy BS, Suppiah A, Renwick I, Mitchell CJ (2009) Changes in superior mesenteric artery blood flow after oral, enteral, and parenteral feeding in humans. Crit Care Med 37:171–176
    • View reference on publisher's website
    • View reference on PubMed
  25. Sidery MB, Macdonald IA, Cowley AJ, Fullwood LJ (1991) Cardiovascular responses to high-fat and high-carbohydrate meals in young subjects. Am J Physiol 261:H1430–H1436
    • View reference on PubMed
  26. Sieber C, Beglinger C, Jäger K, Stalder GA (1992) Intestinal phase of superior mesenteric artery blood flow in man. Gut 33:497–501
    • View reference on publisher's website
    • View reference on PubMed
  27. Brundin T, Aksnes AK, Wahren J (1997) Whole body and splanchnic metabolic and circulatory effects of glucose during beta-adrenergic receptor inhibition. Am J Physiol 272:E678–E687
    • View reference on PubMed
  28. McClave SA, Chang WK (2003) Feeding the hypotensive patient: does enteral feeding precipitate or protect against ischemic bowel? Nutr Clin Pract 18:279–284
    • View reference on publisher's website
    • View reference on PubMed
  29. Parker DR, Carlisle K, Cowan FJ, Corrall RJ, Read AE (1995) Postprandial mesenteric blood flow in humans: relationship to endogenous gastrointestinal hormone secretion and energy content of food. Eur J Gastroenterol Hepatol 7:435–440
    • View reference on PubMed
  30. Sidery MB, Macdonald IA, Blackshaw PE (1994) Superior mesenteric artery blood flow and gastric emptying in humans and the differential effects of high fat and high carbohydrate meals. Gut 35:186–190
    • View reference on publisher's website
    • View reference on PubMed
  31. Marik PE, Lorenzana A (1996) Effect of tube feedings on the measurement of gastric intramucosal pH. Crit Care Med 24:1498–1500
    • View reference on publisher's website
    • View reference on PubMed
  32. Revelly JP, Tappy L, Berger MM, Gersbach P, Cayeux C, Chioléro R (2001) Early metabolic and splanchnic responses to enteral nutrition in postoperative cardiac surgery patients with circulatory compromise. Intensive Care Med 27:540–547
  33. Purcell PN, Davis K Jr, Branson RD, Johnson DJ (1993) Continuous duodenal feeding restores gut blood flow and increases gut oxygen utilization during PEEP ventilation for lung injury. Am J Surg 165:188–193
    • View reference on publisher's website
    • View reference on PubMed
  34. Rokyta R Jr, Matejovic M, Krouzecky A, Senft V, Trefil L, Novak I (2004) Post-pyloric enteral nutrition in septic patients: effects on hepato-splanchnic hemodynamics and energy status. Intensive Care Med 30:714–717
  35. Fisher AJ, Paulson EK, Kliewer MA, DeLong DM, Nelson RC (1998) Doppler sonography of the portal vein and hepatic artery: measurement of a prandial effect in healthy subjects. Radiology 207:711–715
    • View reference on PubMed
  36. Brundin T, Wahren J (1993) Whole body and splanchnic oxygen consumption and blood flow after oral ingestion of fructose or glucose. Am J Physiol 264(4 Pt 1):E504–E513
    • View reference on PubMed
  37. Jorba R, Fabregat J, Borobia FG, Torras J, Poves I, Jaurrieta E (2000) Small bowel necrosis in association with early postoperative enteral feeding after pancreatic resection. Surgery 128:111–112
    • View reference on publisher's website
    • View reference on PubMed
  38. Melis M, Fichera A, Ferguson MK (2006) Bowel necrosis associated with early jejunal tube feeding: a complication of postoperative enteral nutrition. Arch Surg 141:701–704
    • View reference on publisher's website
    • View reference on PubMed
  39. Berger MM, Berger-Gryllaki M, Wiesel PH, Revelly JP, Hurni M, Cayeux C, Tappy L, Chioléro R (2000) Intestinal absorption in patients after cardiac surgery. Crit Care Med 28:2217–2223
    • View reference on publisher's website
    • View reference on PubMed
  40. Zaloga GP, Roberts PR, Marik P (2003) Feeding the hemodynamically unstable patient: a critical evaluation of the evidence. Nutr Clin Pract 18:285–293
    • View reference on publisher's website
    • View reference on PubMed
  41. Berger MM, Mustafa I (2003) Metabolic and nutritional support in acute cardiac failure. Curr Opin Clin Nutr Metab Care 6:195–201
    • View reference on publisher's website
    • View reference on PubMed
  42. ASPEN Board of Directors, the Clinical Guidelines Task Force (2002) Guidelines for the use of parenteral and enteral nutrition in adult and pediatric patients. JPEN J Parenter Enteral Nutr 26(1 suppl):1SA–138SA
    • View reference on publisher's website
  43. van Venrooij LM, de Vos R, Borgmeijer-Hoelen MM, Haaring C, de Mol BA (2008) Preoperative unintended weight loss and low body mass index in relation to complications and length of stay after cardiac surgery. Am J Clin Nutr 87:1656–1661
    • View reference on PubMed
  44. Anker SD, Ponikowski P, Varney S, Chua TP, Clark AL, Webb-Peploe KM, Harrington D, Kox WJ, Poole-Wilson PA, Coats AJ (1997) Wasting as independent risk factor for mortality in chronic heart failure. Lancet 349:1050–1053
    • View reference on publisher's website
    • View reference on PubMed
  45. Kesek DR, Akerlind L, Karlsson T (2002) Early enteral nutrition in the cardiothoracic intensive care unit. Clin Nutr 21:303–307
    • View reference on publisher's website
    • View reference on PubMed
  46. Mentec H, Dupont H, Bocchetti M, Cani P, Ponche F, Bleichner G (2001) Upper digestive intolerance during enteral nutrition in critically ill patients: frequency, risk factors, and complications. Crit Care Med 29:1955–1961
    • View reference on publisher's website
    • View reference on PubMed
  47. Pirlich M, Schütz T, Norman K, Gastell S, Lübke HJ, Bischoff SC, Bolder U, Frieling T, Güldenzoph H, Hahn K, Jauch KW, Schindler K, Stein J, Volkert D, Weimann A, Werner H, Wolf C, Zürcher G, Bauer P, Lochs H (2006) The German hospital malnutrition study. Clin Nutr 25:563–572
    • View reference on publisher's website
    • View reference on PubMed
  48. Correia MI, Waitzberg DL (2003) The impact of malnutrition on morbidity, mortality, length of hospital stay and costs evaluated through a multivariate model analysis. Clin Nutr 22:235–239
    • View reference on publisher's website
    • View reference on PubMed
  49. Pichard C, Kyle UG, Morabia A, Perrier A, Vermeulen B, Unger P (2004) Nutritional assessment: lean body mass depletion at hospital admission is associated with an increased length of stay. Am J Clin Nutr 79:613–618
    • View reference on PubMed
  50. Amaral TF, Matos LC, Tavares MM, Subtil A, Martins R, Nazaré M, Sousa Pereira N (2007) The economic impact of disease-related malnutrition at hospital admission. Clin Nutr 26:778–784
    • View reference on publisher's website
    • View reference on PubMed
  51. Heidegger CP, Darmon P, Pichard C (2007) Enteral vs. parenteral nutrition for the critically ill patient: a combined support should be preferred. Curr Opin Crit Care 14:408–414
    • View reference on publisher's website
  52. Kreymann KG, Berger MM, Deutz NE, Hiesmayr M, Jolliet P, Kazandjiev G, Nitenberg G, van den Berghe G, Wernerman J, DGEM (German Society for Nutritional Medicine), Ebner C, Hartl W, Heymann C, Spies C, ESPEN (European Society for Parenteral and Enteral Nutrition) (2006) ESPEN guidelines on enteral nutrition: intensive care. Clin Nutr 25:210–223
    • View reference on publisher's website
    • View reference on PubMed
  53. Heyland DK, Dhaliwal R, Drover JW, Gramlich L, Dodek P; Canadian Critical Care Clinical Practice Guidelines Committee (2003) Canadian clinical practice guidelines for nutrition support in mechanically ventilated, critically ill adult patients. JPEN J Parenter Enteral Nutr 27:355–373
    • View reference on publisher's website
    • View reference on PubMed
  54. Martindale RG, McClave SA, Vanek VW, McCarthy M, Roberts P, Taylor B, Ochoa JB, Napolitano L, Cresci G, American College of Critical Care Medicine, A.S.P.E.N. Board of Directors (2009) Guidelines for the provision and assessment of nutrition support therapy in the adult critically ill patient: Society of Critical Care Medicine and American Society for Parenteral and Enteral Nutrition: Executive Summary. Crit Care Med 37:1757–1761
    • View reference on publisher's website
    • View reference on PubMed
  55. McClave SA, Martindale RG, Vanek VW, McCarthy M, Roberts P, Taylor B, Ochoa JB, Napolitano L, Cresci G, A.S.P.E.N. Board of Directors, American College of Critical Care Medicine, Society of Critical Care Medicine (2009) Guidelines for the Provision and Assessment of Nutrition Support Therapy in the Adult Critically Ill Patient: Society of Critical Care Medicine (SCCM) and American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.). JPEN J Parenter Enteral Nutr 33:277–316
  56. Scurlock C, Mechanick JI (2008) Early nutrition support in the intensive care unit: a US perspective. Curr Opin Clin Nutr Metab Care 11:152–155
    • View reference on publisher's website
    • View reference on PubMed
  57. Gramlich L, Kichian K, Pinilla J, Rodych NJ, Dhaliwal R, Heyland DK (2004) Does enteral nutrition compared to parenteral nutrition result in better outcomes in critically ill adult patients? A systematic review of the literature. Nutrition 20:843–848
    • View reference on publisher's website
    • View reference on PubMed
  58. Artinian V, Krayem H, DiGiovine B (2006) Effects of early enteral feeding on the outcome of critically ill mechanically ventilated medical patients. Chest 129:960–967
    • View reference on publisher's website
    • View reference on PubMed
  59. Dissanaike S, Pham T, Shalhub S, Warner K, Hennessy L, Moore EE, Maier RV, O’Keefe GE, Cuschieri J (2008) Effect of immediate enteral feeding on trauma patients with an open abdomen: protection from nosocomial infections. J Am Coll Surg 207:690–697
    • View reference on publisher's website
    • View reference on PubMed
  60. Koretz RL, Avenell A, Lipman TO, Braunschweig CL, Milne AC (2007) Does enteral nutrition affect clinical outcome? A systematic review of the randomized trials. Am J Gastroenterol 102:412–429
    • View reference on publisher's website
    • View reference on PubMed
  61. Neumayer LA, Smout RJ, Horn HG, Horn SD (2001) Early and sufficient feeding reduces length of stay and charges in surgical patients. J Surg Res 95:73–77
    • View reference on publisher's website
    • View reference on PubMed
  62. Hedberg AM, Lairson DR, Aday LA, Chow J, Suki R, Houston S, Wolf JA (1999) Economic implications of an early postoperative enteral feeding protocol. J Am Diet Assoc 99:802–807
    • View reference on publisher's website
    • View reference on PubMed
  63. Singer P, Berger MM, van den Berghe G, Biolo G, Calder P, Forbes A, Griffiths R, Kreyman G, Leverve X, Pichard C (2009) ESPEN guidelines on parenteral nutrition: intensive care. Clin Nutr 28:387–400
    • View reference on publisher's website
    • View reference on PubMed
  64. Cresci G, Cúe J (2008) The patient with circulatory shock: to feed or not to feed? Nutr Clin Pract 23:501–509
    • View reference on publisher's website
    • View reference on PubMed
  65. Pichard C, Kreymann GK, Weimann A, Buchardi H, Herrmann HJ, Schneider H (2008) Energy supply level correlates with ICU mortality: a multicentre study in a cohort of 1,209 patients. Intensive Care Medicine: abstract S97, European Society for Intensive Care Medicine (ESICM), Lisbon
  66. Woodcock NP, Zeigler D, Palmer MD, Buckley P, Mitchell CJ, Macfie J (2001) Enteral versus parenteral nutrition: a pragmatic study. Nutrition 17:1–12
    • View reference on publisher's website
    • View reference on PubMed
  67. De Jonghe B, Appere-De-Vechi C, Fournier M, Tran B, Merrer J, Melchior JC, Outin (2001) A prospective survey of nutritional support practices in intensive care unit patients: what is prescribed? What is delivered? Crit Care Med 29:8–12
    • View reference on publisher's website
    • View reference on PubMed
  68. Thibault R, Heidegger CP, Methot C et al (2009) Supplemental parenteral nutrition (SPN) in ICU patients for early coverage of energy target: preliminary report. Clin Nutr 4(Suppl. 2):36
  69. Huang YC, Yen CE, Cheng CH, Jih KS, Kan MN (2000) Nutritional status of mechanically ventilated critically ill patients: comparison of different types of nutritional support. Clin Nutr 19:101–107
    • View reference on publisher's website
    • View reference on PubMed
  70. Jeejeebhoy KN (2001) Total parenteral nutrition: potion or poison? Am J Clin Nutr 74:160–163
    • View reference on PubMed
  71. Simpson F, Doig GS (2005) Parenteral vs. enteral nutrition in the critically ill patient: a meta-analysis of trials using the intention to treat principle. Intensive Care Med 31:12–23
  72. Braunschweig CL, Levy P, Sheean PM, Wang X (2001) Enteral compared with parenteral nutrition: a meta-analysis. Am J Clin Nutr 74:534–542
    • View reference on PubMed
  73. Peter JV, Moran JL, Phillips-Hughes J (2005) A meta-analysis of treatment outcomes of early enteral versus early parenteral nutrition in hospitalized patients. Crit Care Med 33:213–220
    • View reference on publisher's website
    • View reference on PubMed
  74. Dhaliwal R, Jurewitsch B, Harrietha D, Heyland DK (2004) Combination enteral and parenteral nutrition in critically ill patients: harmful or beneficial? A systematic review of the evidence. Intensive Care Med 30:1666–1671
  75. Ziegler TR (2009) Parenteral nutrition in the critically ill patient. N Engl J Med 361:1088–1097
    • View reference on publisher's website
    • View reference on PubMed

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