Role of Nutrition Support in Adult Cardiac Surgery

A Consensus Statement From an International Multidisciplinary Expert Group on Nutrition in Cardiac Surgery

Christian Stoppe; Andreas Goetzenich; Glenn Whitman; Rika Ohkuma; Trish Brown; Roupen Hatzakorzian; Arnold Kristof; Patrick Meybohm; Jefferey Mechanick; Adam Evans; Daniel Yeh; Bernard McDonald; Michael Chourdakis; Philip Jones; Richard Barton; Ravi Tripathi; Gunnar Elke; Oliver Liakopoulos; Ravi Agarwala; Vladimir Lomivorotov; Ekaterina Nesterova; Gernot Marx; Carina Benstoem; Margot Lemieux; Daren K. Heyland


Crit Care. 2017;21(131) 

In This Article

The Scientific Rationale for Nutrition Therapy in the Cardiac Surgery ICU

Patients undergoing cardiac surgery are routinely exposed to significant systemic inflammation, causing organ injury and dysfunction. Cardiopulmonary bypass (CPB) triggers systemic inflammatory response syndrome (SIRS) with release of reactive oxygen species (ROS) and reactive nitrogen species (RNS) and mainly pro-inflammatory cytokines.[1–3] This often results in serious life-threatening complications with loss of physical capacity, associated with prolonged critical illness, which may negate any benefit from correction of the original, underlying cardiac disease. Such patients require aggressive, life-sustaining therapies to promote organ recovery and mid to long-term outcome advantages.[4]

Underfeeding is a major issue in cardiac surgery patients.[5,6] Table 1 demonstrates an overview of clinical studies investigating nutritional support in patients undergoing cardiac surgery. No sufficiently designed, adequately powered, randomized controlled trials investigating the effect of nutritional therapy initiated early in high-risk cardiac patients after surgery are available. Yet, several small studies have provided initial evidence on the feasibility and clinical significance of nutritional therapy in cardiac surgery patients. We therefore aimed to develop an expert-derived consensus on best nutritional practices in this patient population.