Current practices in medical nutrition therapy in the cardiac surgical critical care setting - an international multicenter observational study

BACKGROUND: Cardiac surgery patients with prolonged stay in the intensive care unit (ICU) are at high-risk for acquired malnutrition. Medical nutrition therapy practices in cardiac surgery patients are unknown. The objective of this study is to describe current nutrition practices in critically ill cardiac surgery patients worldwide.

METHODS: We conducted a prospective observational study in 13 international ICUs involving mechanically ventilated cardiac surgery patients with an ICU stay of at least 72 hours. Collected data included calorie and protein prescription, type and time to initiation of nutrition, and actual quantity of energy and protein delivered (maximum: 12 days).

RESULTS: Among 237 enrolled patients, enteral nutrition (EN) was started, on average, 45 hours after ICU admission (range 0-277 hours; site average 53 [range 10-79 hours]). EN was prescribed in 187 (79%) patients and combined EN and parenteral nutrition (PN) in 33 (14%). Overall, patients received 44.2% (0.0-117.2%) of prescribed calories and 39.7% (0.0-122.8%) of prescribed protein. At a site level, the average nutritional adequacy was 47.5% (30.5-78.6%) for calories and 43.6% (21.7-76.6%) for protein received from all nutritional sources.

CONCLUSION: Critically ill cardiac surgery patients with prolonged ICU stay experience significant delays in starting EN and receive low levels of calories and protein. There exists tremendous variability in site performance, whereas achieving optimal nutrition performance is doable.

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