Provision of enteral nutrition during vasopressor therapy for hemodynamic instability: an evidence-based review

Critical illness is associated with many complications that affect both medical and nutrition aspects of patient outcomes. Early enteral feeding is the preferred method of nutrition for patients in the intensive care unit due to apparent benefits in this patient population. However, these patients are also at risk for complications related to enteral nutrition (EN), which may be potentiated with the addition of vasopressors often used in the setting of hemodynamic instability. The clinician is often confronted with the decision of when to proceed with EN in critically ill patients who require vasopressors for hemodynamic support. This article reviews the effects of vasopressors on gastrointestinal blood flow, discusses complications associated with vasopressor use during EN, and proposes important considerations to determine the safety of EN in hemodynamically unstable patients requiring vasopressor support.