Tuesday, January 30, 2018

Use of fiber in patients on vasopressor

Q: Fiber should be added to the enteral formulae in critically ill patients who are on vasopressors.

A) True
B) False

Answer:  False

Evidence for the regular use of fiber in critically ill patients is very weak and should be avoided. It can be used on a trial basis in patients who develop persistent motility problem secondary to enteral nutrition. Patients on vasopressors may develop bezoars from fiber and should be added with caution.

References / further reading:

1. McIvor AC, Meguid MM, Curtas S, et al. Intestinal obstruction from cecal bezoar; a complication of fiber-containing tube feedings. Nutrition 1990; 6:115. 

2. Dobb GJ, Towler SC. Diarrhoea during enteral feeding in the critically ill: a comparison of feeds with and without fibre. Intensive Care Med 1990; 16:252.  

3. Taylor BE, McClave SA, Martindale RG, et al. Guidelines for the Provision and Assessment of Nutrition Support Therapy in the Adult Critically Ill Patient: Society of Critical Care Medicine (SCCM) and American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.). Crit Care Med 2016; 44:390. 

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