Current practices in nutrition therapy in cardiac surgery patients: An international multicenter observational study

Abstract

Background Cardiac surgery patients with a prolonged stay in the intensive care unit (ICU) are at high risk for acquired malnutrition. Medical nutrition therapy practices for cardiac surgery patients are unknown. The objective of this study is to describe the current nutrition practices in critically ill cardiac surgery patients worldwide. Methods We conducted a prospective observational study in 13 international ICUs involving mechanically ventilated cardiac surgery patients with an ICU stay of at least 72 h. Collected data included the energy and protein prescription, type of and time to the initiation of nutrition, and actual quantity of energy and protein delivered (maximum: 12 days). Results Among 237 enrolled patients, enteral nutrition (EN) was started, on average, 45 h after ICU admission (range, 0–277 h; site average, 53 [range, 10–79 h]). EN was prescribed for 187 (79%) patients and combined EN and parenteral nutrition in 33 (14%). Overall, patients received 44.2% (0.0%–117.2%) of the prescribed energy and 39.7% (0.0%–122.8%) of the prescribed protein. At a site level, the average nutrition adequacy was 47.5% (30.5%–78.6%) for energy and 43.6% (21.7%–76.6%) for protein received from all nutrition sources. Conclusion Critically ill cardiac surgery patients with prolonged ICU stay experience significant delays in starting EN and receive low levels of energy and protein. There exists tremendous variability in site performance, whereas achieving optimal nutrition performance is doable.

Nutrition support for patients on mechanical circulatory support

“…A prospective observational study evaluating current medical nutrition practices in cardiac surgery patients (including patients on MCS) illuminated an urgent need to improve MNT in this specific patient cohort [8 ▪ ]. Enteral nutrition (EN) was the predominant nutrition route ( n = 187 [79%] patients) and, on average, initiated with significant delay (45 h [range, 0–277 h] after ICU admission), and a combined regimen of EN and parenteral nutrition (PN), to compensate potential nutritional deficiencies was used in 14% of patients.…”

Optimizing Nutritional Status of Patients Prior to Major Surgical Intervention

“…2,55 In an international and multiinstitutional study, Heyland et al showed that when enteral feeding is started late, 38.8 hours after admission, patients received only 61.2% of calories and 57.6% of protein prescribed, with 74% of patients not meeting at least 80% of their energy target. 61 Undernutrition is particularly present in cardiac surgery 62,63 and in patients subject to esophagectomy. Patients undergoing esophagectomy could remain nutritionally compromised in the months/ years that follow and may never return to baseline.…”

Post-ICU nutrition: the neglected side of metabolic support

“…When considering the metabolism of ICU patients and their confounders, the significant difference between predicted and measured resting energy expenditure (REE) in mechanically ventilated patients is confirmed in recent work [1]. Although guidance is openly available, implementation remains a challenge, as nutritional adequacy (both in energy and protein) varies enormously, as proved by the 'NutritionDay' initiative [2], as well as several other publications, including inadequate feeding in the cardiac surgery subphenotype ICU population [3]. From a patient's perspective, continuity of care seems obvious.…”