Nutritional support in the cardiac intensive care unit

Abstract

Optimal care of critically ill patients in the cardiac intensive care unit (CICU) includes adequate nutritional support. This review highlights the high prevalence of malnutrition in acute heart failure, acute coronary syndrome, cardiogenic shock and post-cardiac arrest, and its adverse impact on prognosis. There is a lack of robust evidence regarding appropriate nutritional support in this patient population. Initiation of nutritional support with a comprehensive assessment of the patient's nutritional status is critical. High-risk cardiac patients who are not critically ill can receive oral nutrition adapted to individual risk factors or deficiencies, although overfeeding should be avoided in the acute phase. For critically ill patients at risk of or with malnutrition on admission, general principles include initiation of nutritional support within 48 hours of admission, preference for enteral over parenteral nutrition, preference for hypocaloric nutrition in the first week of ICU admission, and adequate micronutrient supplementation. Enteral nutrition in hemodynamically unstable patients carries a risk, albeit low, of intestinal ischemia. In the case of malnutrition, the risk of refeeding syndrome should always be considered.