Abstract
Background. The aim of study was to test the hypothesis that early enteral nutrition (EN) with calorie-dense and protein rich enteral formula improves enteral energy and protein delivery in critically ill cardiac patients. Methods. Prospective randomized pilot study of 40 ventilated adult patients undergoing elective cardiac surgery with use of cardiopulmonary bypass receiving inotropic support postoperatively. Patients were to receive either standard isocaloric (1000 Kcal/L and 38 g/L protein) early EN (n = 20) or calorie-dense and protein-rich (1300 Kcal/L and 66.7 g/L protein) early EN (n = 20). Results. The mean time to EN initiation was 27 ± 11 h. Early EN with the calorie-dense formula provided significantly more energy and protein enteral delivery on the 2nd, (p < 0.0001), 5th (p = 0.036), and 7th days (p = 0.024), and was associated with higher levels of prealbumin concentration on the 14th day (0.13 ± 0.01 g/L and 0.21 ± 0.1 g/L; p = 0.04) and significantly increased levels of transferrin on the 3rd, 5th, and 7th day (p < 0.05) after surgery. Conclusion. Present findings support hypothesis that early EN using a calorie-dense and protein rich formula leads to better enteral energy and protein delivery and higher levels of short-lived serum proteins.
Highlights
The impetuous development of malnutrition resulting from increased catabolic requirements as consequence of critical illness is a well-known clinical problem and of special relevance for patients undergoing cardiac surgery [1,2,3,4]
Owing to the risk of mesenteric ischemia. This is of particular relevance for patients after cardiac surgery with an adverse postoperative course
Despite the lack of high quality evidence indicating that early enteral nutrition (EN) mitigate morbidity and mortality [11], recent studies suggest that early EN is well tolerated and safe in patients with vasopressor or inotropic support if the dosage and hemodynamic status of the Nutrients 2017, 9, 1264; doi:10.3390/nu9111264
Summary
The impetuous development of malnutrition resulting from increased catabolic requirements as consequence of critical illness is a well-known clinical problem and of special relevance for patients undergoing cardiac surgery [1,2,3,4]. Haemodynamic compromise is a well-known obstacle that inhibits the early initiation of EN owing to the risk of mesenteric ischemia. This is of particular relevance for patients after cardiac surgery with an adverse postoperative course. With calorie-dense and protein rich enteral formula improves enteral energy and protein delivery in critically ill cardiac patients. Present findings support hypothesis that early EN using a calorie-dense and protein rich formula leads to better enteral energy and protein delivery and higher levels of short-lived serum proteins
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