Nutrition and Metabolic Support of the ACS Patient: Understanding Goals and Ways to Achieve Them

Abstract

Nutritional support for the critically ill emergency general surgery (EGS) patient is a love-hate relationship with most acute care surgeons. Most everyone agrees with the SCCM/ASPEN guideline recommendation to use early enteral nutrition in critically ill patients, but this isn’t always possible when caring for the postoperative EGS patients. These patients often have open abdomens, bowel in discontinuity, and require repeat operations. Additionally, increasingly these patients are surviving their prolonged ICU stays but are now progressing into chronic critical illness (CCI) with dismal long-term outcomes. They experience persistent low-grade inflammation that drives ongoing catabolism, and despite aggressive nutritional support, they lose tremendous lean body mass which contributes their long-term functional disabilities. There are a lot of misconceptions surrounding nutrition supplementation in CCI patients after EGS. Nutritional support of these patients is paramount to their recovery, and a recent stress on anabolic nutrition could prove beneficial for this vulnerable patient population.