Central European Journal of Medicine

, Volume 1, Issue 3, pp 284–291 | Cite as

Early postoperative gastric enteral nutrition improve gastric emptying after cardiac surgery

  • Alan Šustić
  • Marko Zelić
  • Igor Medved
  • Jadranko Sokolić
Research Article


Postoperative intragastric enteral feeding in cardiac surgery patients is frequently complicated by delayed gastric emptying. The aim of the study was to evaluate how early postoperative gastric enteral nutrition affects the gastric emptying in coronary artery by-pass graft (CABG) surgery patients.

In the prospective, randomized study 40 patients treated at intensive care unit after CABG surgery were studied. Patients were divided in two groups: enteral feeding group E (20 patients: age 59±8 yr.; male 70%) and control group C (20 patients: age 58±10 yr.; male 80%), respectively. Paracetamol absorption test was used to evaluate gastric emptying. In the group E postoperative gastric supply of enteral formula begun 18 hours after surgery and after 6 hours the supply was stopped and paracetamol solution was administrated by nasogastric tube. The patients in group C for.rst 24 hours received only crystalloid solutions intravenously and paracetamol solution by nasogastric tube. Blood samples were obtained at 0 (t0), 15 (t+15), 30 (t+30), 60 (t+60) and 120 (t+120) min after administration of paracetamol.

The values of plasma paracetamol concentration (PPC) at 15 and 120 min were significantly higher in group E vs. group C: (t+15) 3.3±2.5 vs. 1.7±1.9 and (t+120) 5.2−2.8 vs. 3.3±1.6 (p <0.05). The PPC values at 30 and 60 min were higher, but not signi.cantly, in group E vs. group C: (t+30) 3.7±2.0 vs. 2.9±2.7 and (t+60) 5.1±3.2 vs. 3.9±3.5 (p = NS). The area under the PPC curve was 429 ± 309 in the E group vs. 293 ± 204 in the group C (p < 0.05).

In conclusion an early postoperative gastric administration of nutritients after CABG surgery stimulates the gastric emptying.


Early postoperative enteral nutrition gastric emptying 


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  1. [1]
    P. Jolliet, C. Pichard, G. Biolo, R. Chiolero, G. Grimble, X. Levarve et al: “Enteral nutrition in intensive care patients: a practical approach”, Intensive Care Med., Vol. 24, (1998), pp. 848–859.PubMedCrossRefGoogle Scholar
  2. [2]
    M. Braga, L. Gianotti, A. Vignali, A. Cestari, P. Bisagni and V. DiCarlo: “Artificial nutrition after major abdominal surgery: impact of route of administration and composititon of the diet”, Crit. Care Med., Vol. 26, (1998), pp. 24–30.PubMedCrossRefGoogle Scholar
  3. [3]
    G. Minard and K.A. Kudsk: “Is early feeding beneficial? How early is early?”, New Horizons, Vol. 2, (1994), pp. 156–163.PubMedGoogle Scholar
  4. [4]
    L. Kompan, B. Kremžar, E. Gadžijev and M. Prosek: “Effects of early enteral nutrition on intestinal permeability and the development of multiple organ failure after multiple injury”, Intensive Care Med., Vol. 25, (1999), pp. 157–161.PubMedCrossRefGoogle Scholar
  5. [5]
    M.M. Berger, M. Berger-Gryllaki, P.H. Weisel, J.P. Revelly, M. Hurni, C. Cayeux et al: “Intestinal absorption in patients after cardiac surgery”, Crit. Care Med., Vol. 28, (2000), pp. 2217–2223.PubMedCrossRefGoogle Scholar
  6. [6]
    A. Šustić, Ž. Krznarić, M. Uravić, Ž. Fučkar, D. Štimac and Ž. Župan: “Influence on gallbladder volume by early postoperative gastric enteral nutrition”, Clin. Nutr., Vol. 19, (2000), pp. 413–416.PubMedCrossRefGoogle Scholar
  7. [7]
    A. Šustić, M. Zelić, A. Protić, Ž. Župan, O. Šimić and K. Deša: “Metoclopramide improves gastric but not gallbladder emptying in cardiac surgery patients with early intragastric enteral feeding: randomized controlled trial”, Croat. Med. J., Vol. 46, (2005), pp. 65–70.Google Scholar
  8. [8]
    M. Sanaka, Y. Kuyama and M. Yamanaka: “Guide for judicious use the paracetamol absorption technique in the study of gastric emptying rate of liquids”, J. Gastroenterol., Vol. 33, (1998), pp. 785–791.PubMedCrossRefGoogle Scholar
  9. [9]
    M.M. Tarling, C.C. Toner, P.S. Withington, M.K. Baxter, R. Whelpton and D.R. Goldhill: “A model of gastric emptying using paracetamol absorption in intensive care patients”, Intensive Care Med., Vol. 23, (1997), pp. 256–260.PubMedCrossRefGoogle Scholar
  10. [10]
    P.E. Marik and G.P. Zaloga: “Early enteral nutrition in acutely ill patients: a systematic review”, Crit. Care Med., Vol. 29, (2001), pp. 2264–2270.PubMedCrossRefGoogle Scholar
  11. [11]
    S. Batson and S. Adam: “A study of problems associated with the delivery of enteral feed in critically ill patients in five ICUs in UK”, Intensive Care Med., Vol. 23, (1997), pp. 261–266.PubMedCrossRefGoogle Scholar
  12. [12]
    M. Braga, L. Gianotti, O. Gentilini, V. Parisi, C. Salis, V. DiCarlo: “Early postoperative enteral nutrition improves gut oxygenation and reduces costs compared with total parenteral nutrition”, Crit. Care Med., Vol. 29, (2001), pp. 242–248.PubMedCrossRefGoogle Scholar
  13. [13]
    B. De Jonghe, C. Appere-De-Vechi, M. Fournier, B. Tran, J. Merrer, J.C. Melchior et al: “A prospective survey of nutritional support practices in intensive care units patients: what is prescribed? What is delivered?”, Crit. Care Med., Vol. 29, (2001), pp. 8–12.PubMedCrossRefGoogle Scholar
  14. [14]
    R. MacLaren: “Intolerance to intragastric enteral nutrition in critically ill patients: complications and management”, Pharmacotherapy, Vol. 20, (2000), pp. 1486–1498.PubMedCrossRefGoogle Scholar
  15. [15]
    R. MacLaren, D.A. Kuhl, J.M. Gervasio, R.O. Brown, R.N. Dickerson, T.N. Livingston et al: “Sequential single doses of cisapride, erytromycin, and metoclopramide in critically ill patients intolerant to enteral nutrition: a randomized, placebo-controlled, crossover study”, Crit. Care Med., Vol. 28, (2000), pp. 438–444.PubMedCrossRefGoogle Scholar
  16. [16]
    P.E. Marik and G.P. Zaloga: “Gastric versus post-pyloric feeding: a systematic review”, Crit. Care, Vol. 7, (2003), pp. R46–R51.PubMedCrossRefGoogle Scholar

Copyright information

© Versita Warsaw and Springer-Verlag Berlin Heidelberg 2006

Authors and Affiliations

  • Alan Šustić
    • 1
  • Marko Zelić
    • 2
  • Igor Medved
    • 2
  • Jadranko Sokolić
    • 1
  1. 1.Departament of Anesthesiology and ICUUniversity Hospital RijekaRijekaCroatia
  2. 2.Departament of Cardiac SurgeryUniversity Hospital RijekaRijekaCroatia

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