The Surgical/Trauma Patient

Abstract

In aiming for enhanced recovery and the reduction of postoperative morbidity, enhanced recovery after surgery concepts have introduced a new era in perioperative management. It is frequently not recognized that the enhanced recovery after surgery protocol does not overcome the necessity for appropriate perioperative nutritional and metabolic care, particularly with those in intensive care. Early detection and preoperative conditioning of patients at nutritional risk remains essential. In patients at risk where inadequate oral intake is anticipated for a longer period, nutritional support should be started early via the enteral route, possibly in combination with parenteral nutrition. For early enteral nutrition in the intensive care unit, a slow increase in the administration rate is recommended while observing the enteral tolerance by abdominal distension and gastric aspirate. While the length of time before combining enteral and parenteral nutrition with the appropriate supplementation is still under debate, immunomodulating substrates and diets have proven benefits in surgical high-risk patients.