Feeding intolerance and risk of poor outcome in patients undergoing cardiopulmonary bypass surgery.

Yanjuan Lin,Liangwan Chen,Yanchun Peng,Sailan Li,Meihua Chen,Qiong Chen

doi:10.1017/s0007114521000167

Yanjuan Lin, Liangwan Chen + Show 4 more

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https://doi.org/10.1017/s0007114521000167

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Abstract

We conducted a prospective, observational study to determine the incidence of feeding intolerance (FI) within 7 d of initiating enteral nutrition (EN) in patients undergoing cardiopulmonary bypass (CPB) and to evaluate the association between FI and a poor prognosis. Patients who underwent CPB surgery at Fujian Medical University Union Hospital between March 2020 and June 2020 were enrolled. According to the presence or absence of FI within 7 d after EN, patients were divided into FI and non-FI groups. According to the occurrence of a poor prognosis (death, gastrointestinal haemorrhage, acute kidney injury, liver insufficiency, neurological events (cerebral infarction, cerebral haemorrhage and epilepsy) and prolonged mechanical ventilation (> 48 h)), patients were divided into poor prognosis and good prognosis groups. The mean age of the 237 CPB patients, including 139 men and ninety-eight women, was 53·80 (sd 12·25) years. The incidence of FI was 64·14 %. Multivariate logistic regression analysis showed factors independently associated with poor prognosis after CPB included FI (OR 2·138; 95 % CI 1·058, 4·320), age (OR 1·033; 95 % CI 1·004, 1·063), New York Heart Association (NYHA) class III/IV cardiac function (OR 2·410; 95 % CI 1·079, 5·383), macrovascular surgery (OR 5·434; 95 % CI 1·704, 17·333) and initial sequential organ failure assessment score (OR 1·243; 95 % CI 1·010, 1·530). Thus, the incidence of FI within 7 d of EN after CPB was high, which was associated with a poor prognosis.

Highlights

The 2019 guidelines on enteral nutrition (EN) by the European Society for Clinical Nutrition and Metabolism (ESPEN) state that patients who can fully adapt to EN and have strong recovery ability should receive EN[1]
A case–control retrospective study reported that feeding intolerance (FI) within 3 d of admission to the neurological intensive care unit (ICU) was an independent predictor of poor prognosis in patients with severe neurological diseases[8]
We aimed to determine the incidence of FI and to investigate whether FI is associated with a poor prognosis in cardiopulmonary bypass (CPB) patients

Summary

Introduction

The 2019 guidelines on enteral nutrition (EN) by the European Society for Clinical Nutrition and Metabolism (ESPEN) state that patients who can fully adapt to EN and have strong recovery ability should receive EN[1]. During CPB, redistribution of blood flow to critical body organs, such as the brain, results in earlier reduction in blood flow to abdominal organs. Other factors, such as haemodilution, cause the gastrointestinal tract to be in a state of low perfusion and hypoxia, which leads to functional gastrointestinal injury[3,4]. A case–control retrospective study reported that FI within 3 d of admission to the neurological ICU was an independent predictor of poor prognosis in patients with severe neurological diseases[8]. We aimed to determine the incidence of FI and to investigate whether FI is associated with a poor prognosis in CPB patients

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