Table 1:

Evidenced-Based Methods to Address EN Feeding Patients on Vasopressors:

Vasopressor Choice	Vasopressor Dose	Resuscitation Markers and Suggestions for EN Delivery Safety	Feeding Strategy	Signs of Intolerance
Norepinephrine, Norepinephrine /Dobutamine and Phenylephrine > Epinephrine > Vasopressin/Dopamine (Observational data and animal data supporting recommendation)	Keep Norepinephrine doses (equivalents) lower: < 1.0 ug/kg/min- more optimal 1.0 – 3.0 ug/kg/min-may be acceptable > 0.5 ug/kg/min – significant risk – should not be done	1. Lactate normalized or falling rapidly 2. Vasopressor dose decreasing or stable 3. Mixed Venous 02- WNL or elevated 4. Fluid requirements stabilizing, no ongoing active bleeding. 5. Limit crystalloid fluid over-resuscitation to reduce bowel edema (especially in septic shock – with more pronounced vascular leak)	1. Start with gastric delivered trophic feeding (10–20 cc/h) (NO post-pyloric feeding) 2. Advance EN slowly and watch for signs of intolerance 3. Consider elemental or peptide formula to minimize gut O2 consumption for absorption	1. Increased gastric residual (> 500 cc’s) 2. Abdominal distension 3. Nausea/Vomiting 4. New abdominal pain 5. Unexplained elevation in lactate with feeding initiation or escalation 6. Intra-abdominal hypertension or abdominal compartment syndrome