Fiber-Containing vs Fiber-Free Enteral Nutrition in Critically Ill Patients Receiving Vasopressors

Introduction: Fiber-containing (FC) enteral nutrition (EN) has been shown to decrease diarrhea and gastrointestinal complications in patients who are hemodynamically stable. However, in hemodynamically unstable patients requiring vasopressors, fiber may increase the risk of gastrointestinal mucosal injury and bowel ischemia. The purpose of this study was to assess EN tolerance and the incidence of adverse events in patients receiving either FC or fiber-free (FF) EN while on vasopressors.


Methods: This was a single-center, retrospective cohort study of patients admitted to the intensive care unit from January 1, 2022, through December 31, 2024, who received EN and concomitant vasopressors. Patients who received FC EN were compared to those who received FF EN. Outcomes included doses of nutrition provided, incidence of bowel ischemia, feeding intolerance, and other adverse events.


Results: A total of 35 patients were included, with 19 patients in the FC group and 16 patients in the FF group. All patients received norepinephrine, with 6 patients (31.6%) in the FC group and 2 patients (12.5%) in the FF group receiving additional vasopressors. In the FC group, 5 patients (26.3%) experienced abdominal distention compared to 4 patients (25%) in the FF group (OR 0.93, 95% CI 0.20 to 4.29, p > .9). Five patients (26.3%) in the FC group had diarrhea or constipation compared to 3 patients (18.8%) in the FF group (OR 0.65, 95% CI 0.13 to 3.26, p = .7). Four patients (21.1%) in the FC group developed aspiration compared to 2 patients (12.5%) in the FF group (OR 0.54, 95% CI 0.08 to 3.40, p = .7). Three patients (15.8%) in the FC group developed an ileus compared to no patients in the FF group (OR 0.14, 95% CI 0.01 to 2.99, p = .2). One patient (5.3%) in the FC group experienced bowel ischemia compared to no patients in the FF group (OR 0.37, 95% CI 0.01 to 9.82, p > .9). There were no significant differences in the number of calories or amount of protein provided to each group.


Conclusions: While limitations must be considered, this study did not indicate harm associated with fiber in patients receiving EN while on vasopressors. These results may help generate hypotheses for future studies for a more comprehensive evaluation.