Nutrition support in cardiac surgery patients: Be calm and feed on!

Stoppe, Christian; Whitlock, Richard; Arora, Rakesh C.; Heyland, Daren K.

doi:10.1016/j.jtcvs.2019.02.132

Cited by 22 publications

(16 citation statements)

References 48 publications

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“…7 Our earlier PN approach, combined with a slower EN advancement of 10 ml every 12 or 24 h, often resulted in the "gold standard" nutrition therapy suggested for cardiac surgery patients with postoperative hemodynamic complications of combined low-volume EN with supplemental PN. 88 This combined EN + PN strategy increased calorie/protein delivery vs EN alone at our institution as previously demonstrated in other SICU populations. 89 Many healthcare providers are hesitant to initiate PN due to concern for potential increased risk of CLABSI; a valid concern based on early reports of PN linked to infection data.…”

Section: Individual Patient Characteristics: Pn In Cardiac Surgery Po...supporting

confidence: 63%

Improving nutrition practices for postoperative high‐risk heart transplant and ventricular assist device implant patients in circulatory compromise: A quality improvement pre– and post–protocol intervention outcome study

Modir¹,

Hadhazy

Teuteberg

et al. 2022

Nut in Clin Prac

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Background Patients undergoing heart transplant (HT) and ventricular assist device (VAD) implant may experience intra‐ and postoperative complications requiring high‐dose vasopressor agents and/or mechanical circulatory support. These complications increase the risk of nonocclusive bowel ischemia (NOBI) and inadequate enteral nutrition (EN) delivery, and guidance for this high‐risk patient population is limited. To optimize nutrition support practices in this patient population at our institution, we created the High‐Risk Nutrition Support Protocol (HRNSP) to improve nutrient delivery and promote safer EN practices in the setting of NOBI risk factors after HT and VAD implant. Methods We developed and implemented a nutrition support protocol as a quality improvement (QI) initiative. Data were obtained before (n = 62) and after (n = 52) protocol initiation. We compared nutrition and clinical outcomes between the pre‐ and post‐intervention groups. Results Fewer calorie deficits (P < 0.001), fewer protein deficits (P < 0.001), a greater proportion of calorie/protein needs met (P < 0.001), zero NOBI cases (0%), and decreased intensive care unit (ICU) length of stay (LOS) (P = 0.005) were observed with 100% (n = 52 of 54) HRNSP implementation success. Increased use of parenteral nutrition did not increase central line–associated bloodstream infections (P = 0.46). There was no difference in hospital LOS (P = 0.44) or 90‐day and 1‐year mortality (P = 0.56, P = 0.35). Conclusion This single‐center, QI pre‐ and post‐protocol intervention outcome study suggests that implementing and adhering to a nutrition support protocol for VAD implant/HT patients with hemodynamic complications increases nutrient delivery and is associated with reduced ICU LOS and NOBI.

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Section: Individual Patient Characteristics: Pn In Cardiac Surgery Po...supporting

confidence: 63%

Improving nutrition practices for postoperative high‐risk heart transplant and ventricular assist device implant patients in circulatory compromise: A quality improvement pre– and post–protocol intervention outcome study

Modir¹,

Hadhazy

Teuteberg

et al. 2022

Nut in Clin Prac

View full text Add to dashboard Cite

show abstract

“…Preliminary evidence demonstrates its effectiveness in general intensive care unit patients, and it will now require additional study in the cardiac surgical population. [125][126][127] Substantial research in this area is required before a comprehensive, perioperative, effective, and evidencebased approach can be established.…”

Section: Preoperative Correction Of Nutritional Deficiency When Feasible (Loe: Iia/cor: C-ld)mentioning

confidence: 99%

Enhanced Recovery After Cardiac Surgery (ERAS Cardiac) Recommendations: An Important First Step—But There Is Much Work to Be Done

Gregory

Grant²,

Manning

et al. 2020

Journal of Cardiothoracic and Vascular Anesthesia

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ENHANCED RECOVERY After Surgery (ERAS) is an international effort to develop perioperative programs aimed at optimizing patient outcomes and healthcare delivery efficiency. These programs are composed of intervention bundles based on the principles of best practice, standardized and consistent healthcare delivery, regular audit, and team feedback, all with a patient-centered focus. Implementation of such programs has resulted in patient and healthcare benefits, including promising early results within the cardiac surgical community. [1][2][3][4] There have been recent concerns that old dogma, typically rooted in clinical anecdotes and minimal peer-reviewed evidence, will be replaced with new dogma under the umbrella of "enhanced recovery" without validation in cardiac surgical patients. 5 An imprudent "changing of the guard" is a justifiable concern with any practice update. Gathering current evidence-based best practices was a key motivation for the creation of the original colorectal ERAS protocol.The Society for Enhanced Recovery After Cardiac Surgery (ERAS Cardiac) recently published "Guidelines for Perioperative Care in Cardiac Surgery" based on a systematic review and multidisciplinary consensus. 6 Twenty-two recommendations were graded according to currently accepted standards for level of evidence (LOE) and confidence of recommendation (COR) (Table 1). 7,8 The authors of this editorial represent the current anesthesiologist membership of the ERAS Cardiac Society. We have chosen a subset of the recommendations to discuss, including why each is important for patients during their recovery and which future steps are required to solidify the supporting evidence for each recommendation.

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“…Stoppe and colleagues 1 are recognized for their contributions in nutrition, and they provide a thoughtful reminder of the vital role of nutrition support in patients undergoing cardiac surgery (CS). They are to be commended for demanding that perioperative nutrition receive more than lip service and that we do nutrition support better.…”

Section: Subhasis Chatterjee MDmentioning

confidence: 99%

“…Perhaps the most thought-provoking message of Stoppe and colleagues' report 1 is that our inclination to ''always use the gut'' leads to most patients receiving enteral nutrition (EN) alone instead of EN plus supplemental PN, leading us to ignore the obvious benefits of EN þ PN. 2 For a variety of reasons-low cardiac output, vasoactive medications, fluid overload-patients after CS may not have optimal absorption of enteral contents.…”

Section: How?mentioning

confidence: 99%