Role of nutrition support in adult cardiac surgery: a consensus statement from an International Multidisciplinary Expert Group on Nutrition in Cardiac Surgery

Abstract

Nutrition support is a necessary therapy for critically ill cardiac surgery patients. However, conclusive evidence for this population, consisting of well-conducted clinical trials is lacking. To clarify optimal strategies to improve outcomes, an international multidisciplinary group of 25 experts from different clinical specialties from Germany, Canada, Greece, USA and Russia discussed potential approaches to identify patients who may benefit from nutrition support, when best to initiate nutrition support, and the potential use of pharmaco-nutrition to modulate the inflammatory response to cardiopulmonary bypass. Despite conspicuous knowledge and evidence gaps, a rational nutritional support therapy is presented to benefit patients undergoing cardiac surgery.

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.…”

“…2,3 One major factor contributing to this ''post-ICU disability'' is the loss of functional lean body mass, highlighting the importance of nutrition support as an integral component of the perioperative care of cardiac surgery patients. Since the first description of nutrition therapy in cardiac surgery patients in 1974 by Manners 4 and Stoppe and colleagues, 5 it has taken more than 3 decades years until the crucial role of adequate nutrition support has been ''rediscovered. ''…”

Prediction of Prolonged ICU Stay in Cardiac Surgery Patients as a Useful Method to Identify Nutrition Risk in Cardiac Surgery Patients: A Post Hoc Analysis of a Prospective Observational Study

“…Thus, patients with prolonged ICU stays more likely may benefit from intense nutrition intake compared with patients with shorter stays. 6,7,[10][11][12]32 DRM and its subtype cardiac cachexia represent a catabolic disorder, characterized by inflammation, malabsorption, metabolic dysfunction, and increased loss of nutrients, which is resistant to food intake alone and needs a multimodal therapeutic concept, including interventions such as physical exercise, improvement of bowel function, change of lifestyle, and adequate nutrition support. 13 While adequate preoperative optimization strategies represent a clinical imperative requiring validation by adequately powered clinical studies, 12 an early identification of patients at risk for a prolonged ICU stay may help to start an early initiation of adequate nutrition support postoperatively, to provide best-possible treatment and prevent a further aggravation in these critically ill patients.…”

“…6,7 Emerging evidence indicates that critically ill cardiac surgery patients are particularly prone to be at increased risk of malnutrition in the postoperative course. 8,9 In this setting, nutrition support was started later and had lowest total nutrition adequacy when compared with other surgical or medical ICU patients. 8 Low nutrition adequacy during the postoperative course is associated with an increased rate of infection, poor wound healing, reduced respiratory muscle mass, delayed weaning from mechanical ventilation, increased length of ICU stay, increased readmission rates, and high healthcare costs and shorter survival time.…”

“…8 Low nutrition adequacy during the postoperative course is associated with an increased rate of infection, poor wound healing, reduced respiratory muscle mass, delayed weaning from mechanical ventilation, increased length of ICU stay, increased readmission rates, and high healthcare costs and shorter survival time. 6,7,[10][11][12] While disease-related malnutrition (DRM) represents a specific type of malnutrition caused by a concomitant disease, 13 which cannot be easily treated by nutrition support only, the early identification of patients at nutrition risk may allow an early initiation of an adequate nutrition support during critical illness, to prevent a further aggravation of malnutrition. Although the cardiac surgery setting provides advantages due to its predictable inflammatory response and scheduled insult, valid assessment tools for the detection and evaluation of cardiac surgery patients at nutrition risk are still poorly investigated.…”