Current Evidence about Nutrition Support in Cardiac Surgery Patients—What Do We Know?

Abstract

Nutrition support is increasingly recognized as a clinically relevant aspect of the intensive care treatment of cardiac surgery patients. However, evidence from adequate large-scale studies evaluating its clinical significance for patients’ mid- to long-term outcome remains sparse. Considering nutrition support as a key component in the perioperative treatment of these critically ill patients led us to review and discuss our understanding of the metabolic response to the inflammatory burst induced by cardiac surgery. In addition, we discuss how to identify patients who may benefit from nutrition therapy, when to start nutritional interventions, present evidence about the use of enteral and parenteral nutrition and the potential role of pharmaconutrition in cardiac surgery patients. Although the clinical setting of cardiac surgery provides advantages due to its scheduled insult and predictable inflammatory response, researchers and clinicians face lack of evidence and several limitations in the clinical routine, which are critically considered and discussed in this paper.

Multidimensional Approach to Frailty

“…Unfortunately, nutritional risk often remains undiagnosed in cardiac patients, and thus inadequately treated. Studies confirm that patients undergoing cardiac surgery are at a greater risk of iatrogenic malnutrition due to discontinuation of food supply in the early postoperative period (Hill et al, 2018). Most patients are admitted to cardiac surgery from 12-24 h prior to the procedure, which makes it impossible to undertake appropriate nutritional interventions even though the nutritional status has been assessed.…”

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

“…An integral component of these practice bundles includes preoperative and postoperative nutrition strategies developed to optimize the nutritional status of cardiac surgery patients with nutritional risk. 5,8,9 An inadequate or delayed initiation of nutritional support after surgery may aggravate preexisting malnutrition of cardiac surgery patients. Therefore, there is an urgent need to systematically identify malnourished patients who would most likely benefit from early initiated intense perioperative nutrition support.…”

“…Nutritional support is often withheld because of concerns for paralytic ileus, ischemia/reperfusion injury related to prolonged clamping of the aorta, and prolonged vasopressor support or hemodynamic instability. 8 In this context, the concept of combining EN þ PN may represent a promising strategy to increase the nutrition delivery in these critically ill patients. Preliminary evidence indicates beneficial effects of combined PN and EN (PN þ EN) in a general ICU population.…”

Evaluation of the delta of immature platelet fraction as a predictive biomarker of inflammatory response after cardiac surgery

“…Cardiac surgery (CS) is a major surgery associated with substantial morbi-mortality, especially in patients with high perioperative risk 1. Patients undergoing CS can frequently suffer from ischaemia–reperfusion injury.…”

“…Based on these variables which include laboratory and clinical data, both scores were designed to predict in-hospital mortality in patients admitted to the ICU. However, they are not specific for the evaluation of an IR, which has an important role in outcomes following CS 1…”