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Nutrients. 2018 May 11;10(5). pii: E597. doi: 10.3390/nu10050597.

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

Author information

1
Department of Intensive Care Medicine, University Hospital RWTH, D-52074 Aachen, Germany. ahill@ukaachen.de.
2
3CARE-Cardiovascular Critical Care & Anesthesia Evaluation and Research, D-52074 Aachen, Germany. ahill@ukaachen.de.
3
Department of Anesthesiology and Intensive Care Medicine, National Pirogov Medical Center, 105203 Moscow, Russia. d10001letopisec@mail.ru.
4
Department of Anesthesiology and Intensive Care Medicine, E. Meshalkin National Medical Research Center, 630055 Novosibirsk, Russia. v.lomivorotov@gmail.com.
5
Department of Anesthesiology and Intensive Care Medicine, E. Meshalkin National Medical Research Center, 630055 Novosibirsk, Russia. sergefremov@mail.ru.
6
3CARE-Cardiovascular Critical Care & Anesthesia Evaluation and Research, D-52074 Aachen, Germany. andreas@goetzenich.net.
7
Department of Thoracic, Cardiac and Vascular Surgery, University Hospital RWTH, D-52074 Aachen, Germany. andreas@goetzenich.net.
8
Department of Intensive Care Medicine, University Hospital RWTH, D-52074 Aachen, Germany. cbenstoem@ukaachen.de.
9
3CARE-Cardiovascular Critical Care & Anesthesia Evaluation and Research, D-52074 Aachen, Germany. cbenstoem@ukaachen.de.
10
Department of Anesthesiology and Intensive Care Medicine, National Pirogov Medical Center, 105203 Moscow, Russia. zamyatinmn@pirogov-center.ru.
11
Department of Medicine, School of Health Sciences, 54124 Thessaloniki, Greece. mhourd@gapps.auth.gr.
12
Clinical Evaluation Research Unit, Kingston General Hospital, Kingston, ON K7L 2V7, Canada. dkh2@queensu.ca.
13
Department of Intensive Care Medicine, University Hospital RWTH, D-52074 Aachen, Germany. christian.stoppe@gmail.com.
14
3CARE-Cardiovascular Critical Care & Anesthesia Evaluation and Research, D-52074 Aachen, Germany. christian.stoppe@gmail.com.

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.

KEYWORDS:

cardiac surgery; cardiopulmonary bypass; enteral nutrition; nutrition risk stratification; pharmaconutrition; postoperative nutritional management; supplemental parenteral nutrition; systemic inflammatory response; underfeeding

PMID:
29751629
PMCID:
PMC5986477
DOI:
10.3390/nu10050597
[Indexed for MEDLINE]
Free PMC Article

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