O020 - DOSE-DEPENDENT EFFECTS OF NOREPINEPHRINE ON ENTERAL NUTRITION TOLERANCE AND CLINICAL OUTCOMES IN SEPTIC SHOCK

O020

DOSE-DEPENDENT EFFECTS OF NOREPINEPHRINE ON ENTERAL NUTRITION TOLERANCE AND CLINICAL OUTCOMES IN SEPTIC SHOCK

D. Hatzilia^1,*, A. E. Zouridaki², E. Diogou¹, M. Avgoulea¹, E. Christopoulou¹, C. Papadimos¹, M. Stratouli¹, M. Theodorakopoulou¹

¹ICU I, General Hospital Attikis "KAT", Kifisia, Greece, ²Medical School , University of Limerick, Limerick, Ireland

Rationale: We will evaluate the dose-dependent effects of norepinephrine(NE) on EN tolerance and its association with clinical outcomes in patients with septic shock

Methods: 1yr study,21-bed ICU of a tertiary hospital.EN intolerance defined by elevated gastric residual volumes(RGV),vomiting, abdominal distension,aspiration,diarrhea or GI bleeding.135 pts that stayed>48hrs with septic shock,NE and EN were included.Anthropometric data,BMI,SOFA,APACHE II,comorbidities,MAP,lactic acid,time of mechanical ventilation,initiation time of EN,NE dose at initiation,type and rate of EN formula,daily caloric intake,RGV>250ml,vomiting,abdominal distention,aspiration,diarrhea,GI bleeding,medication,GI motility,ICU,hospital stay and 28 day mortality were recorded

Results: 135pts with septic shock receiving NE and EN(mean age 64.2±13.5yrs; 55.6% male).EN intolerance in 48pts(35.6%),with a higher prevalence among females(67%vs36.8%,p=0.01).The intolerant group had significantly higher NE doses at EN initiation(median 0.42vs0.26mcg/kg/min,p<0.001),higher APACHE II and SOFA scores(p=0.01andp=0.003,respectively),and elevated lactate levels(p=0.001).EN intolerance was associated with delayed EN initiation, lower energy delivery(p<0.001),and higher rates of GI complications.Use of prokinetics and inotropes was significantly more common in the intolerant group (p<0.05).EN intolerance was also associated to longer ICU stay(median 14vs10 days,p=0.02),prolonged mechanical ventilation(p=0.03),and higher 28-day mortality(45.8%vs29.9%,p=0.048).Multivariate analysis identified norepinephrine dose>0.3mcg/kg/min(OR=2.7,p=0.003),female sex(OR=1.9,p=0.046),and APACHE II score(OR=1.05,p=0.017)as independent predictors of EN intolerance

Conclusion: A NE dose>0.3mcg/kg/min emerged as an independent predictor of intolerance.Early identification of at-risk pts may help guide individualized nutritional strategies and improve tolerance

Disclosure of Interest: None declared