Current practices in nutrition therapy in cardiac surgery patients: An international multicenter observational study

Stoppe C 1 , Dresen E 1 , Wendt S 2 , Elke G 3 , Patel JJ 4 , McKeever L 5 Show all authors , Chourdakis M 6 , McDonald B 7 , Meybohm P 1 , Lindner M 3 , Arora RC 8 , O'Brien B 9 , von Dossow V 10 , Efremov S 11 , Lomivorotov V 12 , Compher C 13 , Yaung J 14 , Imai T 14 , Nurok M 14 , Ho A 15 , von Loeffelholz C 16 , Hing FP 17 , Jiang X 18 , Heyland DK 18

Affiliations 

  • 1 Department of Anaesthesiology, Intensive Care, Emergency, and Pain Medicine, University Hospital Wuerzburg, Wuerzburg, Germany
  • 2 Department of Intensive Care Medicine, University Hospital, RWTH Aachen, Aachen, Germany
  • 3 Department of Anesthesiology and Intensive Care Medicine, University Medical Center Schleswig-Holstein, Kiel, Germany
  • 4 Division of Pulmonary and Critical Care Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
  • 5 Department of Kinesiology and Nutrition, University of Illinois, Chicago, Illinois, USA
  • 6 School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki (AUTH), Thessaloniki, Greece
  • 7 Division of Cardiac Anesthesiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
  • 8 Section of Cardiac Surgery, Department of Surgery, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
  • 9 Departments of Cardiac Anesthesiology and Intensive Care Medicine, German Heart Center Berlin and Charité - Universitätsmedizin, Berlin, Germany
  • 10 Institute of Anesthesiology, Heart and Diabetes Centre North Rhine Westphalia, Ruhr-University Bochum, Bad Oeynhausen, Germany
  • 11 Department of Anesthesiology and Intensive Care, Saint Petersburg State University Hospital, St. Petersburg, Russian Federation
  • 12 Department of Anesthesiology and Intensive Care, E. Meshalkin National Medical Research Center, Novosibirsk, Russian Federation
  • 13 School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA
  • 14 Departments of Anesthesiology and Cardiac Surgery, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
  • 15 Departments of Cardiac Surgery and Critical Care Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
  • 16 Department of Anesthesiology and Intensive Care Medicine, Jena University Hospital, Jena, Germany
  • 17 Dietetics & Food Services, National Heart Institute, Kuala Lumpur, Malaysia
  • 18 Clinical Evaluation Research Unit, Queen's University, Kingston, Ontario, Canada
JPEN J Parenter Enteral Nutr, 2023 Jul;47(5):604-613.
PMID: 36912124 DOI: 10.1002/jpen.2495

Abstract

BACKGROUND: Cardiac surgery patients with a prolonged stay in the intensive care unit (ICU) are at high risk for acquired malnutrition. Medical nutrition therapy practices for cardiac surgery patients are unknown. The objective of this study is to describe the current nutrition practices in critically ill cardiac surgery patients worldwide.

METHODS: We conducted a prospective observational study in 13 international ICUs involving mechanically ventilated cardiac surgery patients with an ICU stay of at least 72 h. Collected data included the energy and protein prescription, type of and time to the initiation of nutrition, and actual quantity of energy and protein delivered (maximum: 12 days).

RESULTS: Among 237 enrolled patients, enteral nutrition (EN) was started, on average, 45 h after ICU admission (range, 0-277 h; site average, 53 [range, 10-79 h]). EN was prescribed for 187 (79%) patients and combined EN and parenteral nutrition in 33 (14%). Overall, patients received 44.2% (0.0%-117.2%) of the prescribed energy and 39.7% (0.0%-122.8%) of the prescribed protein. At a site level, the average nutrition adequacy was 47.5% (30.5%-78.6%) for energy and 43.6% (21.7%-76.6%) for protein received from all nutrition sources.

CONCLUSION: Critically ill cardiac surgery patients with prolonged ICU stay experience significant delays in starting EN and receive low levels of energy and protein. There exists tremendous variability in site performance, whereas achieving optimal nutrition performance is doable.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

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