title: Nutrition therapy for the critically ill surgical patient with aortic aneurysmal rupture: defining and improving current practice.
abstract: BACKGROUND
  Our goal is to define nutrition therapy in critically ill patients after surgical repair of acute ruptured or dissecting aortic aneurysm to identify opportunities for quality improvement.
  
  
  METHODS
  International, prospective studies in 2007-2009 and 2011 were combined. Sites provided institutional and patient characteristics including from intensive care units (ICUs) admission to ICU discharge for a maximum of 12 days. We selected patients with aortic aneurysmal rupture or acute dissection staying in the ICU for ≥ 3 days.
  
  
  RESULTS
  There were 104 eligible patients from 72 distinct ICUs analyzed. Overall, 86.5% received artificial nutrition. There were 50.0% patients who received enteral nutrition (EN) only, 29.8% patients received a combination of EN and parenteral nutrition (PN), 6.7% patients received PN only, and 13.5% did not receive any nutrition. The mean time from admission to initiation of EN was 3.0 days (SD ± 2.4 days). The adequacy of calories from nutrition support was 46.8% (range 0%-111%) with a mean of 10.0 kcal/kg/day. Of the total of 83 patients who received EN, 53 patients (63.8%) had interruption of EN. The reasons included fasting, intolerance, patients deemed too sick for enteral feeding, and loss of enteral feeding route. For patients with gastrointestinal intolerance, 3/30 patients (10%) received small bowel feeding and 23/30 patients (76.7%) of patients received motility agents.
  
  
  CONCLUSIONS
  Postoperative critically ill patients with aortic aneurysmal rupture or acute dissection are at high risk for inadequate nutrition therapy, and there may be inadequate utilization of strategies to improve nutrition uptake.
authors: Department of Medicine, University of Western Ontario, London, Ontario, Canada St. Joseph's Healthcare Centre/London Health Sciences Centre, London, Ontario, Canada.
authors: Adam
authors: A
authors: Rahman
authors: Department of Medicine, University of Western Ontario, London, Ontario, Canada Critical Care/Trauma Centre, London Health Sciences Centre, Victoria Campus, London, Ontario, Canada Lawson Health Research Institute, London, Ontario, Canada.
authors: Claudio
authors: C
authors: Martin
authors: Clinical Evaluation Research Unit, Kingston General Hospital, Kingston, Ontario, Canada Department of Community Health and Epidemiology, Queen's University, Kingston, Ontario, Canada Department of Medicine, Queen's University, Kingston, Ontario, Canada dkh2@queensu.ca.
authors: Daren K
authors: DK
authors: Heyland
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001019:Aortic Rupture / Q000188:drug therapy / Q000628:therapy*; D015992:Body Mass Index; D016638:Critical Illness / Q000628:therapy*; D002149:Energy Intake; D004750:Enteral Nutrition; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009752:Nutritional Status; D010288:Parenteral Nutrition; D011446:Prospective Studies; D016896:Treatment Outcome
keywords: aortic aneurysm; critical illness; malnutrition; nutrition therapy