Nutrition support practices in cardiothoracic surgery patients with gastrointestinal complications: An observational...

Gastrointestinal (GI) complications following cardiac surgery involving cardiopulmonary bypass are rare but life threatening. Despite GI complications having implications for nutrition delivery, nutrition support practices in this population have not been reported. We aimed to report nutrition support practices in patients with a GI complication following cardiac surgery during their postoperative admission to the intensive care unit (ICU).

This retrospective observational substudy was conducted at the Royal Adelaide Hospital between November 2012 and March 2020 on adult patients admitted to the ICU who had cardiac surgery performed with cardiopulmonary bypass and experienced a GI complication. Patient demographics and clinical data were extracted from the primary study. Additional nutrition data, including anthropometrics, route of feeding, nutrition provision, and dietetic consultation, were collected from ICU admission to discharge, censored at day 28.

Data were available for 94 patients (age: 69 ± 11 y; 66% male; Acute Physiology and Chronic Health Evaluation II score: 17 [14, 20]; body mass index: 29.0 ± 6.0 kg/m²). Forty-one patients (44%) were assessed by a dietitian, and 40 (98%) of these had documented energy (1746 [1579, 2053] kcal/day; 24.3 [21.0, 25.2] kcal/kg) and protein (82.5 [71.0, 90.0] g/day; 1.12 [0.97, 1.20] g/kg) requirements. Forty patients (43%) received enteral nutrition, of whom 92.5% were fed by nasogastric tube and 12% by postpyloric tube. Seventy-nine patients (84%) received oral nutrition, 13% of whom were prescribed oral nutrition supplements.

Despite nutritional risk, less than half of patients experiencing GI complications post cardiothoracic surgery were assessed by a dietitian during their postoperative admission to the ICU. Less than half received enteral nutrition support, with few receiving enteral feeds via postpyloric access. While most patients received oral nutrition, few received oral nutrition supplements. Future research should quantify energy and protein intake in this population as well as the relationship this may have with dietetic intervention.