“Shock is a common critical illness characterized by microcirculatory disorders and insufficient tissue perfusion. Patients with shock and hemodynamic instability generally require vasopressors to maintain the target mean arterial pressure. Enteral nutrition (EN) is an important therapeutic intervention in critically ill patients and has unique benefits for intestinal recovery. However, the initiation of early EN in patients with shock receiving vasopressors remains controversial.”
“It remains a therapeutic challenge in critical care nutrition therapy to determine the initiation time of EN in patients with shock receiving vasopressors and the safe threshold region for initiating EN with vasopressors. Therefore, the current review aimed to summarize the evidence on the optimal and safe timing of early EN initiation in patients with shock receiving vasopressors to improve clinical practice.”

“There is currently no sufficient and definitive evidence to clarify the optimal time to initiate early EN; however, recent observational studies have indicated that early EN can be delivered safely, which can benefit critically ill patients. Although the current consensus is
that EN support is not incompatible with vasopressors, the complex effects of vasopressors on the gut should also be considered. The risks and benefits of early EN should be weighed carefully for each patient with shock requiring vasopressors. In addition to vasopressor dose, the factors, such as EN delivery dose, disease severity, and route of nutritional support, also affect nutritional provision in patients with shock.”

Wang, Luping et al. “When can we start early enteral nutrition safely in patients with shock on vasopressors?.” Clinical nutrition ESPEN vol. 61 (2024): 28-36. Free Full Text