title: Nutrition Therapy in Critically Ill Patients Following Cardiac Surgery: Defining and Improving Practice.
abstract: Malnutrition is a predictor of poor outcome following cardiac surgery. We define nutrition therapy after cardiac surgery to identify opportunities for improvement.
  
  
  
  International prospective studies in 2007-2009, 2011, and 2013 were combined. Sites provided institutional and patient characteristics from intensive care unit (ICU) admission to ICU discharge for a maximum of 12 days. Patients had valvular, coronary artery bypass graft (CABG) surgery, or combined procedures and were mechanically ventilated and staying in the ICU for ≥3 days.
  
  
  
  There were 787 patients from 144 ICUs. In total, 120 patients (15.2%) had valvular surgery, 145 patients (18.4%) had CABG, and 522 patients (66.3%) underwent a combined procedure. Overall, 60.1% of patients received artificial nutrition support. For these patients, 78% received enteral nutrition (EN) alone, 17% received a combination of EN and parenteral nutrition (PN), and 5% received PN alone. The remaining 314 patients (40%) received no nutrition. The mean (SD) time from ICU admission to EN initiation was 2.3 (1.8) days. The adequacy of calories was 32.4% ± 31.9% from EN and PN and 25.5% ± 27.9% for patients receiving only EN. In EN patients, 57% received promotility agents and 20% received small bowel feeding. There was no significant relationship between increased energy or protein provision and 60-day mortality.
  
  
  
  Postoperative cardiac surgery patients who stay in the ICU for 3 or more days are at high risk for inadequate nutrition therapy. Further studies are required to determine if targeted nutrition therapy may alter clinical outcomes.
authors.affiliation: 1 Department of Medicine, University of Western Ontario, London, Ontario, Canada.|2 Gastroenterology, St Joseph's Healthcare Centre/London Health Sciences Centre, London, Ontario, Canada.
authors.forename: Adam
authors.initials: A
authors.lastname: Rahman
authors.affiliation: 3 Critical Care Medicine, Department of Anesthesia, Wake Forest University Medical Center, Winston-Salem, North Carolina, USA.
authors.forename: Ravi
authors.initials: R
authors.lastname: Agarwala
authors.affiliation: 1 Department of Medicine, University of Western Ontario, London, Ontario, Canada.|4 Critical Care/Trauma Centre, London Health Sciences Centre, Victoria Campus, London, Ontario, Canada.|5 Lawson Health Research Institute, London, Ontario, Canada.
authors.forename: Claudio
authors.initials: C
authors.lastname: Martin
authors.affiliation: 1 Department of Medicine, University of Western Ontario, London, Ontario, Canada.
authors.forename: Dave
authors.initials: D
authors.lastname: Nagpal
authors.affiliation: 1 Department of Medicine, University of Western Ontario, London, Ontario, Canada.
authors.forename: Michael
authors.initials: M
authors.lastname: Teitelbaum
authors.affiliation: 6 Clinical Evaluation Research Unit, Kingston General Hospital, Kingston, Ontario, Canada.|7 Department of Community Health and Epidemiology, Queen's University, Kingston, Ontario, Canada.|8 Department of Medicine, Queen's University, Kingston, Ontario, Canada.
authors.forename: Daren K
authors.initials: DK
authors.lastname: Heyland
mesh_terms: D000368:Aged; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D003422:Critical Care / Q000379:methods* / Q000592:standards; D016638:Critical Illness / Q000401:mortality / Q000628:therapy*; D004044:Dietary Proteins / Q000627:therapeutic use; D002149:Energy Intake; D004750:Enteral Nutrition; D005260:Female; D005765:Gastrointestinal Agents / Q000627:therapeutic use; D006801:Humans; D007362:Intensive Care Units; D007421:Intestine, Small; D007902:Length of Stay; D008297:Male; D044342:Malnutrition / Q000209:etiology / Q000517:prevention & control*; D008875:Middle Aged; D044623:Nutrition Therapy; D009751:Nutritional Requirements; D018529:Nutritional Support; D010288:Parenteral Nutrition; D011183:Postoperative Complications / Q000517:prevention & control*; D011446:Prospective Studies; D058996:Quality Improvement
chemical_list: D004044:Dietary Proteins; D005765:Gastrointestinal Agents
keywords: critical care; enteral nutrition; nutrition; nutrition support practice; parenteral nutrition; research and diseases