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