Inotropic agents (E.g., Dobutamine, Milrinone)

No change to feeding plan recommended. Advance per feeding protocol.

Paralytics, Vasoactive Agents

(Includes but not limited to: e.g., vasopressin > 0.04 units/min, dopamine > 10 mcg/kg/min, norepinephrine > 5 mcg/min, phenylephrine > 50mcg/min, any epinephrine)

1. Elemental formula at 20 ml/hr – do not advance.

2. Consider TPN starting post injury day number 7 if enteral feeds are not tolerated or not tolerated at the goal rate.

3. Consider early initiation of TPN in high nutritional risk score or pre-existing malnutrition patients.

4. Hold enteral feeding if adding vasopressor, increasing dosages of vasopressors, or persistent MAP < 60 mmHg.