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Intestinal absorption in patients after cardiac surgery
M M Berger1, M Berger-Gryllaki, P H Wiesel
1Anesthesiology and Surgical Intensive Care Unit, Centre Hospitalier Universitaire Vaudois, University of Lausanne, Switzerland. Mette.Berger@chuv.hospvd.ch
Critical Care Medicine
|August 2, 2000
Summary
Post-cardiac surgery patients show delayed, not suppressed, intestinal absorption, particularly after gastric feeding. Early enteral nutrition was well-tolerated, suggesting optimized feeding strategies are feasible.
Area of Science:
- Gastroenterology
- Cardiology
- Pharmacokinetics
Background:
- Assessing intestinal absorption and tolerance of early enteral nutrition is crucial for post-cardiac surgery patients.
- Hemodynamic status significantly impacts gastrointestinal function after major surgery.
Purpose of the Study:
- To evaluate intestinal absorption in cardiac surgery patients with adequate or altered hemodynamics.
- To assess the clinical tolerance of early enteral nutrition in these patients.
Main Methods:
- Prospective study comparing cardiac surgery patients (n=39) with healthy controls (n=6).
- Paracetamol pharmacokinetic study on days 1 and 3, with gastric or postpyloric administration.
- Hemodynamic status categorized into adequate (Group I) or failure (Group II).
Main Results:
- Gastric paracetamol administration showed reduced absorption on day 1 in all patients, normalizing postpyloric.
- Absorption approached normal by day 3, even with hemodynamic failure, suggesting delayed rather than suppressed absorption.
- Opiate dose negatively correlated with peak absorption on day 1 (p = .008).
Conclusions:
- Decreased pyloric motility, influenced by opiates, delays intestinal transit and absorption post-cardiac surgery.
- Postpyloric administration and early enteral nutrition are well-tolerated, supporting their clinical use.