title: How to feed complicated patients after surgery: what's new?
abstract: OBJECTIVE
  This clinical review focuses on the nutritional management of surgical patients with a severe postoperative complication. These patients having a succession of aggressions are at high risk of malnutrition. Our aim, following ICU patient studies, was to report the elements that could be applied for these patients.
  
  
  RESULTS
  Although early enteral nutrition is recommended, recent data focus more on parenteral nutrition. Because these patients probably had a poor nutritional intake for several days, the prescription of parenteral nutrition would appear to be valid in cases of inadequate or impossible enteral nutrition. Lipid emulsion decreasing long-chain triglyceride intake should be used. Moreover, administration of fish oil should be considered. Intravenous glutamine, decreasing new infections and hospital length of stay, should be prescribed only in patients without shock. Several studies and meta-analyses have suggested that a parenteral selenium supplementation in a severe patient can reduce mortality.
  
  
  CONCLUSIONS
  In severe surgical complicated patients, special care must be taken vis-à-vis nutritional intake. Such patients are likely to have an energy deficit and are at high risk of malnutrition. Nutritional assistance is necessary and should be quickly implemented with the usual recommendations.
authors.affiliation: aUnité de Nutrition Clinique Intensive bUnité transversale de Nutrition, Hospices Civils de Lyon, Hôpital de la Croix Rousse, Lyon, France.
authors.forename: Cécile
authors.initials: C
authors.lastname: Chambrier
authors.forename: Didier
authors.initials: D
authors.lastname: Barnoud
mesh_terms: D004750:Enteral Nutrition; D005395:Fish Oils / Q000008:administration & dosage; D005973:Glutamine / Q000008:administration & dosage; D006801:Humans; D008055:Lipids / Q000008:administration & dosage*; D010288:Parenteral Nutrition; D011183:Postoperative Complications / Q000178:diet therapy*; D012643:Selenium / Q000008:administration & dosage; D013514:Surgical Procedures, Operative
chemical_list: D005395:Fish Oils; D008055:Lipids; D005973:Glutamine; D012643:Selenium