Caracterización del inicio de la nutrición en pacientes con soporte vasopresor en cuidado intensivo: un estudio retrospectivo de un centro de alta complejidad en la ciudad de Medellín

Abstract

Introduction

The initiation of nutritional support in patients with shock represents a challenge in the intensive care unit. Despite the availability of clinical practice guidelines, the available evidence varies and limits precise recommendations regarding the timing, route of administration and initial dose of nutritional support.

Methods

An analytical study was conducted from a retrospective cohort of adult patients diagnosed with shock and treated between January 2023 and January 2025 at a high complexity institution in Medellin, Colombia. Characteristics of nutritional support initiation and clinical outcomes were described. Multivariate logistic regression analysis was performed to evaluate associations.

Results

Enteral nutrition was administered to 88.6% of patients, and in-hospital mortality was 30.4%. In multivariable analysis, age, use of vasopressin, and parenteral nutrition were associated with higher mortality; in addition, initiation of nutrition at 6-12 hours or after 24 hours, as well as a caloric intake of 21-25 kcal/kg/day, were associated with a higher risk compared with initiation at 13-24 hours and caloric intake of 11-15 kcal/kg/day. Nutrition-related complications occurred in 11% of cases.

Conclusion

In patients with shock, enteral nutrition can be considered after achieving adequate hemodynamic stability following resuscitation; initiation is safer when avoiding premature initiation or unjustified delays, with progressive caloric prescription according to clinical evolution.