Kira Mascho, MD
Pediatric Critical Care Fellow
Rainbow Babies and Childrens Hospital
Cleveland, Ohio
Disclosure information not submitted.
Nori Minich
Data Manager/Analyst
Case Western Reserve University, United States
Disclosure information not submitted.
Steven Shein, MD, FCCM
Rainbow Babies & Children's Hospital
Cleveland, Ohio
Disclosure information not submitted.
Mallary Biros, PharmD, BCPS
Clinical Pharmacist Specialist
Rainbow Babies and Children's Hospital, United States
Disclosure information not submitted.
Michael Forbes, MD, FCCM
Pediatric Critical Care Physician
Akron Children's Hospital, United States
Disclosure information not submitted.
Title: Vasoactive Administration and Concurrent Enteral Nutrition in Critically Ill Pediatric Patients
Introduction: Enteral nutrition (EN) has been associated with improved outcomes in critically ill adults and tolerance with concurrent vasoactive use has been reported. Studies in critically ill children have found mixed results and vasoactive use remains a barrier to initiating EN. This study aims to describe the current EN practices and associated outcomes in patients admitted to the Pediatric Intensive Care Unit (PICU) while they are receiving vasoactive medications and secondarily to find a Vasoactive Inotrope Score (VIS) at which EN are well-tolerated.
Methods: With IRB approval, charts of patients < 19 yo in a mixed PICU unit who received norepinephrine for >24 hours between 2019-2020 were retrospectively reviewed. Patients in whom enteral nutrition was contraindicated or nutritional information was not available were excluded. Baseline demographics, diagnoses, illness severity, and outcome measurements (e.g. length of stay [LOS], duration of mechanical ventilation, and mortality) were collected. Data between groups was compared with Mann Whitney U tests (median [IQR]) or Fisher's Exact Test.
Results: Of 30 patients analyzed, 10 received EN while on vasoactive medications. The most common primary admitting diagnoses were sepsis, trauma, and cardiac arrest. Age, gender, and BMI z-scores did not significantly differ between groups. Compared to children who were not fed, EN administration was associated with a lower admission PRISM-3 score (11.5 [9.8-15.0] vs 17.5 [11.0-24.8], p=0.049) and longer PICU LOS (13.5 [8.8-21.5] vs 6.5 [3.0-12.0] days, p=0.017). There were no significant differences in duration of mechanical ventilation (82.5 [53.5-209.8] vs 180.0 [119.0-274.3] hours, p=0.169), PICU free-days (13.0 [0-22.0] vs 15.0 [5.3-21.3], p=0.745) or mortality (40% vs 10%, p=0.204). For the EN group, the median VIS at time of EN initiation was 4.
Conclusions: Overall, patients in the not fed group were significantly sicker and had a shorter PICU LOS. Their illness severity likely contributed to withholding EN and their shorter LOS and trend towards shorter mechanical ventilation was likely confounded by the mortality rate as PICU free days were not significantly different. A larger patient sample size is needed to further assess outcome differences between groups and to assess a VIS at which EN is generally tolerated.