Cited by 130Clinical Nutrition and GastroenterologyAbdominal vascular conditions and treatmentsAbdominal Surgery and Complications

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Feeding the Hypotensive Patient: Does Enteral Feeding Precipitate or Protect Against Ischemic Bowel?

McClave, Stephen A., Chang, Wei‐Kuo·2003·Nutrition in Clinical Practice

DOI 10.1177/0115426503018004279

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Abstract

Although the enteral route of enteral feeding is the preferred method of nutrition support for critically ill patients, this important therapeutic strategy is not without risk. In human subjects, the digestion and absorption of nutrients induce typical hemodynamic changes, consisting of an increase in mesenteric blood flow at the expense of reduced systemic blood pressure. On rare occasion when providing aggressive enteral nutrition to critically ill patients, common symptoms of gastrointestinal intolerance may progress to a syndrome of abdominal distention, hypotension, and shock, with the development of small bowel ischemia or necrosis. Although the incidence of small bowel ischemia secondary to enteral feeding is low, the overall clinical outcome is still poor and carries a high mortality rate. Enteral feeding is well tolerated and is probably beneficial in most critically ill patients before and after a period of hypotension. Although enteral nutrition may be used with caution during the period of hypotension, evidence of poor gastrointestinal function (increased nasogastric tube output, unexplained abdominal pain, and abdominal distention), or development of dilated loops of bowel or intramural gas (pneumatosis intestinalis) on radiographic studies should be interpreted as potential indicators of gut ischemia. With progress in our understanding of the pathophysiology, diagnosis, and prevention of ischemic injury to the intestinal mucosa, the strategy of aggressive enteral feeding for critically ill patients may result in a reduction in this major complication and enhanced functional recovery from severe illness.

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“[7] Initiation of an enteral feed alters the intestinal supply– demand ratio,[8] leading to reperfusion injury[9] mediated by oxygen free radicals and neutrophil adhesion to the endothelium of mesenteric venules, which can result in NOMI.”
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“182,184 The use of vasopressors does not preclude EN in volume-replete patients with adequate MAP on stable pressor doses.”
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Background
Intraluminal fluid infusion in a rat jejunum ischemia/reperfusion model is associated with improved tissue perfusion and less mucosal damage.
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“(27) However, a growing body of medical literature now suggests that EN actually increases the blood flow to the gut and protects against bowel ischemia.”
Background
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Self-citation
Introduction of guidelines to facilitate enteral nutrition in a surgical intensive care unit is associated with earlier enteral feeding
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“Perceived barriers to the introduction of early enteral feeding in surgical patients seem to be anticipated anastomotic complications after bowel surgery [10], and increased risk of gut ischemia in hypotensive patients or patients on vasopressors [11].”
Background
Challenges Encountered in the Provision of Enteral Nutrition in Pediatric Intensive Care Unit: An Observational Study
Haseeb, M., Goiporia, M., Siddiqui, M. S., Sangle, A. L., Quadri, S. F., & Ravali, R. L. (2023) · Cureus · doi:10.7759/cureus.49285 · Cited by 2
“In addition, some physicians may be cautious about starting EN in critically ill patients due to concerns about potential mesenteric ischemia and non-occlusive bowel necrosis, particularly in hemodynamically unstable patients [15,16].”
Background
Gastrointestinal Tract: A Neglected Guardian Angel?
Kothekar, A. T., & Kulkarni, A. P. (2020) · Indian Journal of Critical Care Medicine · doi:10.5005/jp-journals-10071-23616 · Cited by 2
Enteral Nutrition Support in Coronary Care Unit Patients Receiving Extraocorporeal Membrane Oxygenation: An Observational Case Study
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Gastric feeding intolerance is not caused by mucosal ischemia measured by intragastric air tonometry in the critically ill.
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Editorial overview: Why, how, and to which part of the gastrointestinal tract should forced enteral feedings be delivered in patients?
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“The development of ischemic bowel is a rare but potentially fatal complication of enteral nutrition, occurring in <1 % of all patients [ 38 ].”
Background
Enterai Feeding during Circulatory Failure: Myths and Reality
Berger, M., & Chioléro, R. (2009) · Springer eBooks · doi:10.1007/978-3-540-92276-6_63 · Cited by 2
Enteral Access and Enteral Nutrition
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Self-citation
Improving the Outcome of Brain-Injured Patients by Non-Continuous Feeding to Prevent Dysbiosis
Corriero, A., Soloperto, R., Giglio, M., Taccone, F. S., Puntillo, F., & Preiser, J. (2026) · Nutrients · doi:10.3390/nu18172907
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How to Feed Critically Ill Patients
Hong, S. (2015) · JOURNAL OF ACUTE CARE SURGERY · doi:10.17479/jacs.2015.5.1.1 · Cited by 1
“영양은 혈역학적 변화에 따라 신중하게 결정하여야 하며 고위험 환자에게 경장영양을 하는 경우 면밀하게 복부상태를 확인하여 야 한다[4,5].”
Splanchnic Hypoperfusion and Enteral Feeding
Sinaga, W., Sutanto, L. B., & Syam, A. F. (2013) · The Indonesian Journal of Gastroenterology Hepatology and Digestive Endoscopy · doi:10.24871/141201335-38
“Therefore, enteral feeding in patients with high risk of splanchnic ischemia need to consider many matters (Table 1).(23) in critically ill patients.”
Background
„Early nutrition“ schon im Schockstadium?
Druml, W. (2011) · Intensivmedizin und Notfallmedizin · doi:10.1007/s00390-010-0232-z · Cited by 1
Total Parenteral Nutrition in the ICU: The Mount Sinai Hospital Experience
Neuman, T., Kohli-Seth, R., Wilson, S., & Bassily-Marcus, A. (2010) · doi:10.1177/1944451610378134 · Cited by 1

Authors: McClave, S. A., & Chang, W.
Affiliations: University of Louisville (US)
Tri-Service General Hospital (TW)
Corresponding author: McClave, Stephen A.
ORCID: McClave, Stephen A.
Chang, Wei‐Kuo
Venue: Nutrition in Clinical Practice
Publisher: Wiley
Published: 2003-08
Volume: 18
Issue: 4
Pages: 279-284
ISSN: 0884-5336 (ISSN-L)
1941-2452
DOI: 10.1177/0115426503018004279
OpenAlex: W2131083917
Cited by: 130
References: 0
Citations by year: 2026: 3 · 2025: 2 · 2024: 2 · 2023: 4 · 2022: 3 · 2021: 5 · 2020: 7 · 2019: 7 · 2018: 1 · 2017: 10 · 2016: 8 · 2015: 6 · 2014: 10 · 2013: 4 · 2012: 6
FWCI: 3.21
Type: journal article
Language: en
Open access: closed
Licence: onlinelibrary.wiley.com/termsAndConditions#vor (vor)
Locations: Nutrition in Clinical Practice (publishedVersion)
PubMed (publishedVersion)
Topics: Health Sciences › Nursing › Nutrition and Dietetics › Clinical Nutrition and Gastroenterology
Health Sciences › Medicine › Surgery › Abdominal vascular conditions and treatments
Health Sciences › Medicine › Surgery › Abdominal Surgery and Complications
Keywords: enteral nutrition, hypotension, small bowel ischemia, critically ill patients, mesenteric blood flow, gastrointestinal intolerance, pneumatosis intestinalis, intestinal necrosis

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Feeding the Hypotensive Patient: Does Enteral Feeding Precipitate or Protect Against Ischemic Bowel?

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