Despite acute myocardial infarction and cardiac surgery accounting for 2 of the most common reasons patients are admitted to the intensive care unit, little attention and investigation have been directed specifically for these patients. This patient population therefore deserves special attention as they are often malnourished but require emergent interventions, making nutrition intervention challenging. This article reviews current medical interventions implemented in critically ill cardiothoracic patients and discusses evidence-based nutrition therapy, including enteral and parenteral feeding, glycemic control, and antioxidant provision.
GoldsteinDNeragi-MiandoabS. Mechanical bridge to decision: what are the options for the management of acute refractory cardiogenic shock?Curr Heart Fail Rep. 2011;8:51-58.
RossiMSgangaGMazzoneM. Cardiopulmonary bypass in man: role of the intestine in a self-limiting inflammatory response with demonstratable bacterial translocation. Ann Thorac Surg. 2004;77:612-618.
7.
OhriS. Systemic inflammatory response and and the splanchnic bed in cardiopulmonary bypass. Perfusion. 1996;11:200-212.
8.
BraunJPSchroederTBuehnerS. Splanchnic oxygen transport, hepatic function and gastrointestinal barrier after normothermic cardiopulmonary bypass. Acta Anaesthesiol Scand. 2004;48:697-703.
9.
MarascoSLukasGMcDonaldMMcMillanJIhleB. Review of ECMO (extra corporeal membrane oxygenation) support in critically ill adult patients. Heart Lung Circ. 2008;17S:S41-S47.
10.
LuPLinPYYangCFHungCHChanMYHsuTC. hemodynamic and metabolic effects of para- versus intraaortic counterpulsatile circualtion supports. ASAIO J. 2011;57:19-25.
TrägerKBAGeorgieffMRadamacherP. Therapeutixche Beeinflusung des Hepato-Slachnikusgebiets bei Traum und Sepsis. Mehr als VO2/DO2 Verhältnesse?Anaesthesist. 2000;49:451-454.
13.
ZalogaGRobertsPMarikP. Feeding the hemodynamically unstable patient: a critical evaluation of the evidence. Nutr Clin Pract. 2003;18: 285-293.
14.
McClaveSChangWK. Feeding the hypotensive patient: does enteral feeding precipitate or protect against ischemic bowel?Nutr Clin Pract. 2003;18:279-284.
15.
McClaveSMartindaleRGVanekVW. Guidelines for the provision and assessment of nutrition support therapy in the adult critically ill patient: Society of Critical Care Medicine (SCCM) and American Society for Parenteral and Enteral Nutrition (A.S.P.E.N). JPEN Parenter Enteral Nutr. 2009;33:277-316.
16.
RichMLellerAJSchechtmanKB. Increased complications and prolonged hospital stay in elderly cardiac surgical patients with low serum albumen. Am J Cardiol. 1989;63:714-718.
17.
LoopFGoldingLRMacmillanJP. Coronary artery surgery in women compared to men: analyses of risks and long-term results. J Am Coll Cardiol. 1983;1:383-390.
18.
EngelmanDAdamsDHBurneJG. Impact of body mass index and albumin on morbidity and mortality after cardiac surgery. J Thorac Cardiovasc Surg. 1999;118:866-873.
19.
HabibRZachariasASchwannTA. Effects of obesity and small body size on operative and long-term outcomes of coronary artery bypass surgery: a propensity-matched analysis. Ann Thorac Surg. 2005;79: 1976-1986.
20.
van VenrooijLde VosRBorgmeijer-HoelenMM. Preoperative unintended weight loss and low body mass index in relation to complications and length of stay after cardiac surgery. Am J Clin Nutr. 2008;87: 1656-1661.
21.
BergerMMustafaI. Metabolic and nutritional support in acute cardiac failure. Curr Opin Clin Nutr Metab Care. 2003;6:195-201.
22.
SanchezJSanchezLLDudrickSJ. Nutritional considerations in adult cardiothoracic surgical patients. Surg Clin North Am. 2011;91:857-875.
23.
ScurlockCRaikhelkarJMechanickJ. Impact of new technologies on metabolic care in the intensive care unit. Curr Opin Clin Nutr Metab Care. 2009;12(2):196-200.
24.
AnkerSCoatesAJS. Cardiac cachexia: a syndrome with impaired survival and immune and neuroendocrine activation. Chest. 1999;115: 836-847.
25.
NeubauerS. The failing heart—an engine out of fuel. N Engl J Med. 2007;356:1140-1151.
26.
TaegtmeyerH. Cardiac metabolism as a target for the treatment of heart failure. Circulation. 2004;110:894-896.
27.
FrankenfieldDAshcraftCM. Estimating energy needs in nutrition support patients. JPEN J Parenter Enteral Nutr. 2011;35:563-570.
28.
JeejeebhoyFKeithMFreemanM. Nutrition supplementation with MyoVive repletes essential cardiac myocyte nutrients and reduces left ventricular size in patients with left ventricular dysfunction. Am Heart J. 2002;143:1092-1100.
29.
VisserMDavidsMVerberneHJ. Rationale and design of a proof-of-concept trial investigating the effect of uninterrrupted perioperative (par)enteral nturition on amino acid profile, cardiomyocytes structure, and cardiac perfusion and metabolism of patients undergoing coronary artery bypass grafting. J Cardiothorac Surg. 2011;6:36-43.
30.
TepaskeRVelthiusHOudemans-van StraatenHM. Effect of preoperative oral immune enhancing nutritional supplement on patients at high risk of infection after cardiac surgery: a randomised placebo controlled trial. Lancet. 2001;358:696-701.
BergerMChioleroRL. Enteral nutrition and cardiovascular failure: from myths to clinical practice. JPEN J Parenter Enteral Nutr. 2009;33(6):702-709.
33.
WidlickaA. Enteral nutrition in the cardiothoracic intensive care unit: challenges and considerations. Nutr Clin Pract. 2008;23:510-520.
34.
RevellyJTappyLBergerMMGersbachPCayeuxCChioléroR. Early metabolic and splanchic responses to enteral nutrition in postoperative cardiac surgery patients with circulatory compromise. Intensive Care Med. 2001;27(3):540-547.
35.
BergerMRevellyJPCayeuxMCChioleroR. Enteral nutrition in critically ill patients with severe hemodynamic failure after cardiopulmonary bypass. Clin Nutr. 2005;24(1):124-132.
36.
KhalidIDoshiPDiGiovineB. Early enteral nutrition and outcomes of critically ill patients treated with vasopressors and mechanical ventilation. Am J Crit Care. 2010;19(3):261-268.
37.
MalbrainM. Different techniques to measure intra-abdominal pressure (IAP): time for a critical re-appraisal. Intensive Care Med. 2004;30: 357-371.
38.
MechanickJScurlockC. Glycemic control and nutritional strategies in the cardiothoracic surgical intensive care unit—2010: state of the art. Semin Thorac Surg. 2010;22(3):230-235.
39.
MarikPZalogaGP. Immunonutritin in critically ill patients: a systematic review and analysis of the literature. Intensive Care Med. 2008;34: 1980-1990.
40.
RiceTWheelerAPThompsonBTdeBoisblancBPSteingrubJRockP. Enteral omega-3 fatty acid, γ-linolenic acid, and antioxidant supplementation in acute lung injury. JAMA. 2011;306(14):1574-1581.
41.
Pontes-ArrudaAMartinsLFMaria de LimaS. Enteral nutrition with eicosapentaenoic acid, gamma-linolenic acid and antioxidants in the early treatment of sepsis: results from a multicenter, prospective, randomized, double-blinded, controlled study: the INTERSEPT Study. Crit Care. 2011;15:R144.
42.
VilletSChioloeroRLBollmannMDRevellyJPCayeuxRNMCDelarueJBergerMM. Negative impact of hypocaloric feeding and energy balance on clinical outcome in ICU patients. Clin Nutr. 2005;24:502-509.
43.
van den BergheGWoutersPWeekersF. Intensive insulin therapy in the critically ill patients. N Engl J Med. 2001;345(19):1359-1367.
44.
Anonymous. Intensive versus conventional glucose control in critically ill patients. N Engl J Med. 2009;360(13):1283-1297.
45.
HagaKMcClymontKLClarkeS. The effect of tight glycaemic control, during and after cardiac surgery, on patient mortality and morbidity: a systemic review and meta-analysis. J Cardiothorac Surg. 2011;6(3):1-10.
46.
FrioudAComte-PerretSNguyenSBergerMMRuchatPRuizJ. Blood glucose level on postoperative day 1 is predictive of adverse outcomes after cardiovascular surgery. Diabetes Metab. 2010;36(1):36-42.
47.
KumpfVJGervasioJ. Complications of parenteral feeding. In: GottschlichMMDeLeggeMHMattoxTMuellerCWorthingtonP eds. The ASPEN nutrition support core curriculum. Silver Spring, MD: American Society for Parenteral and Enteral Nutrition, 2007.
48.
EngelJMühlingJKwapiszMHeidtM. Glutamine administration in patients undergoing cardiac surgery and the influence on blood glutathione levels. Acta Anaesthesiol Scand. 2009;53(10):1317-1323.
49.
CastilloRRodrigoRPerezF. Antioxidant therapy reduces oxidative and inflammatory tissue damage in patients subjected to cardiac surgery with extracorporeal circulation. Basic Clin Pharmacol Toxicol. 2011;108(4):256-262.
50.
BergerMSoguelLShenkinA. Influence of early antioxidant supplements on clinical evolution and organ function in critically ill cardiac surgery, major trauma, and subarachnoid hemorrhage patients. Crit Care. 2008;12(4):R101.
51.
KaruITaalGZilmerKPruunsildCStarkopfJZilmerM. Inflammatory/oxidative stress during the first week after different types of cardiac surgery. Scand Cardiovasc J. 2010;44(22):119-124.
52.
EstívarizCGriffithDPMenghuaL. Efficacy of parenteral nutrition supplemented with glutamine dipeptide to decrease hospital infections in critically ill surgical patients. JPEN J Parenter Enteral Nutr. 2008;32(4):389-402.
53.
EngelJPitzSMühlingJ. Role of glutamine administration on T-cell derived inflammatory response after cardiopulmonary bypass. Clin Nutr. 2009;28 (1):15-20.
54.
FukushimaRYamazakiE. Vitamin C requirements in surgical patients. Curr Opin Clin Nutr Metab Care. 2010;13(6):669-676.
55.
RasoliSKourliourosAHarlingLAthanasiouT. Does prophylactic therapy with antioxidant vitamins have an effect on atrial fibrillation following cardiac surgery?Interact Cardiovasc Thorac Surg. 2011;13(1):82-85.
56.
StoppeCSchälteGRossaintR. The intraoperative decrease of selenium is associated with the postoperative development of multiorgan dysfunction in cardiac surgical patients. Crit Care Med. 2011;39(8):1879-1885.
