One of the residents on the medical team asks you if he should stop the enteral feeding because the patient's blood pressure has been unstable

Question

What recommendations can you make to the patient's critical care team regarding feeding and hemodynamic status?

Answer 1

Patients may develop multisystem organ dysfunction due to multiple reasons such as bacterial translocation, inadequate fluid resuscitation, poor perfusion, inhalation injury, medications, and medical procedures. Nutritional regimens should be catered to meet the challenges of the condition and treatments. It will be important to discuss with the team the risk of gut ischemia if the patient's hemodynamic status further declines, especially if vasopressors are used, since this patient's TF is administered by nasojejunal enteral access.
Factors to be considered for those patients who are hemodynamically unstable include:
• Hemodynamic status: MAP <60
• Enteral access: Jejunal placement
• Medications: Addition of vasopressors, number of agents being used, and trend in titration of dose
• I/O: Urine output, nasogastric tube output (amount and content)
• Labs: Increased WBC
• Abdominal exam: Distention, firmness
Currently, the patient is hypotensive but mean arterial pressure remains acceptable at 71 mmHg per MD progress note dated 9/9 . Patient is not on any vasopressors. Will continue with EN at this time but will monitor very closely for changes in hemodynamic status, medications, I/O, abdominal exam, and biochemical indices.