PDF(Pubmed)
Abstract：
Nutritional support in critically ill patients is an essential aspect of treatment. In particular, the benefits of enteral nutrition (EN) are well recognized, and various guidelines recommend early EN within 48 hours in critically ill patients. However, there is still controversy regarding EN in critically ill patients with septic shock requiring vasopressors. Therefore, this case report aims to provide basic data for the safe and effective nutritional support in septic shock patients who require vasopressors. A 62-year-old male patient was admitted to the intensive care unit with a deep neck infection and mediastinitis that progressed to a septic condition. Mechanical ventilation was initiated after intubation due to progression of respiratory acidosis and deterioration of mental status, and severe hypotension required the initiation of norepinephrine. Due to hemodynamic instability, the patient was kept nil per os. Subsequently, trophic feeding was initiated at the time of norepinephrine dose tapering and was gradually increased to achieve 75% of the energy requirement through EN by the 7th day of enteral feeding initiation. Although there were signs of feeding intolerance during the increasing phase of EN, adjusting the rate of EN resolved the issue. This case report demonstrates the gradual progression and adherence to EN in septic shock patient requiring vasopressors, and the progression observed was relatively consistent with existing studies and guidelines. In the future, further case reports and continuous research will be deemed necessary for safe and effective nutritional support in critically ill patients with septic shock requiring vasopressors.
摘要：
重症患者的营养支持是治疗的重要方面。特别是,肠内营养（EN）的好处是公认的，各种指南建议危重患者在48小时内早期进行EN。然而,对于需要血管加压药的感染性休克危重患者的EN仍存在争议.因此,本病例报告旨在为需要血管加压药的感染性休克患者安全有效的营养支持提供基础数据。一名62岁的男性患者因颈部深部感染和纵隔炎进展为败血症而被送往重症监护病房。由于呼吸性酸中毒进展和精神状态恶化，插管后开始机械通气，严重的低血压需要开始去甲肾上腺素。由于血流动力学不稳定,该患者按操作系统保持为零。随后，在去甲肾上腺素剂量逐渐减少时开始营养喂养，并在肠内喂养开始的第7天通过EN逐渐增加以达到能量需求的75％。尽管在EN增加阶段有喂养不耐受的迹象，调整EN的速率解决了问题。该病例报告显示，在需要血管加压药的脓毒性休克患者中，EN的逐渐进展和依从性。观察到的进展与现有研究和指南相对一致.在未来,对于需要血管加压药的感染性休克危重患者,进一步的病例报告和持续研究对于安全有效的营养支持是必要的.
