Optimizing Nutrition Delivery in Critically Ill Patients on Vasopressors.

Paul E Wischmeyer

Journal: The Surgical clinics of North America 2026;106(2):249-260

PMID: 41997641

Abstract

Early enteral nutrition (EN) in critically ill patients receiving vasopressors remains controversial due to concerns about gut ischemia and feeding intolerance. Current evidence supports a cautious, individualized approach emphasizing resuscitation status, vasopressor dose, and feeding strategy. Observational and randomized trials suggest trophic EN may be safe and beneficial in patients postresuscitation on low-to-moderate norepinephrine doses, whereas full-dose EN on higher-dose vasopressors increases gastrointestinal complications. Practical recommendations include gastric-only trophic feeding, slow advancement, and vigilant intolerance monitoring. Emerging predictive tools and guidelines advocate for trophic EN during resuscitated shock, highlighting the urgent need for validated bedside decision aids and randomized trials.

Address: Department of Anesthesiology, Duke Clinical Research Institute, Duke University Hospital, DUMC, BOX 3094, MAIL #412301 Erwin Road 5692 HAFS, Durham, NC 27710, USA. Electronic address: [email protected].

DOI: 10.1016/j.suc.2025.12.009

MeSH Terms: Humans, Critical Illness, Vasoconstrictor Agents, Enteral Nutrition, Critical Care