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Utilizing Percutaneous Ventricular Assist Devices in Acute Myocardial Infarction Complicated by Cardiogenic Shock
Published on: June 12, 2021
Cardiogenic shock and nutrition: safe?
Ronan Thibault1, Claude Pichard, Jan Wernerman
1Nutrition Unit, Geneva University Hospital, Geneva, Switzerland.
Intensive Care Medicine
|November 19, 2010
Summary
Enteral nutrition (EN) may increase risks in cardiogenic shock patients. Parenteral nutrition (PN) might protect splanchnic organs, potentially improving outcomes. Further clinical trials are needed to confirm these findings.
Area of Science:
- Critical Care Medicine
- Gastroenterology
- Cardiology
Background:
- Cardiogenic shock (CS) impairs splanchnic perfusion, complicating nutritional support in intensive care unit (ICU) patients.
- Enteral nutrition (EN) may exacerbate mesenteric hypoperfusion and increase risks like ischemia and sepsis in CS.
- Parenteral nutrition (PN) may offer a protective effect on splanchnic circulation, contrary to previous concerns about mortality.
Purpose of the Study:
- To evaluate the potential risks of EN in cardiogenic shock patients.
- To explore the protective role of PN on splanchnic organs in cardiogenic shock.
- To assess the impact of combined EN and PN on energy balance and clinical outcomes.
Main Methods:
- Review of current evidence and guidelines regarding nutritional support in cardiogenic shock.
- Analysis of studies comparing EN, PN, and combined nutritional strategies.
- Examination of physiological effects on mesenteric arterial output and splanchnic perfusion.
Main Results:
- EN may overwhelm mesenteric adaptation mechanisms, increasing risks in cardiogenic shock.
- PN administration may decrease mesenteric arterial output, suggesting a protective effect.
- Meta-analyses indicate PN is not associated with increased mortality.
- Combined EN and PN may prevent negative energy balance and potentially benefit mesenteric circulation.
Conclusions:
- Nutritional strategies in cardiogenic shock require careful consideration of splanchnic perfusion.
- Parenteral nutrition may be a safer alternative or adjunct to enteral nutrition in cardiogenic shock.
- Further clinical trials are essential to validate the benefits of combined nutritional support for improving patient outcomes.
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