Early Enteral Nutrition in Postoperative Cardiac Surgery Patients with Severe Hemodynamic Failure and Venoarterial (VA) Extracorporeal Membrane Oxygenation (ECMO)

  • Luis Daniel Umezawa Makikado
  • José Luis Flordelís Lasierra
  • José Luis Pérez-Vela
  • Juan Carlos Montejo González
Living reference work entry

Abstract

Most cardiac surgery patients are able to resume oral feeding in the first few hours after surgery, but in some of these patients, the postoperative course is complicated by hemodynamic failure. Patients with hemodynamic compromise are frequently hypercatabolic and unable to ingest food for several days, which leads to an energy deficit and a risk of malnutrition. However, enteral nutrition is often contraindicated because of a risk of mesenteric ischemia. At present, nutrition guidelines indicate that enteral nutrition should be withheld in patients with hemodynamic failure. These recommendations, nevertheless, are based essentially on expert opinions, and scientific evidence is still lacking. Moreover, recent data suggest that early onset enteral nutrition after cardiac surgery in patients with hemodynamic failure can be effective and safe even in those with severe circulatory compromise requiring extracorporeal membrane oxygenation. In this chapter, we address the pathophysiology of the splanchnic circulation in the hemodynamically unstable patient, the impacts of malnutrition, and the benefits of early enteral nutrition. Basic notions such as energy requirements, monitoring, and possible complications in these patients and other critically ill patients with hemodynamic failure are also discussed.

Keywords

Zinc Permeability Fermentation Ischemia Dopamine 

Abbreviations

ECMO

Extracorporeal membrane oxygenation

EN

Enteral nutrition

IABP

Intra-aortic balloon pump

IAP

Intra-abdominal pressure

IBW

Ideal body weight

ICU

Intensive care unit

MODS

Multiorgan dysfunction syndrome

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Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  • Luis Daniel Umezawa Makikado
    • 1
  • José Luis Flordelís Lasierra
    • 2
  • José Luis Pérez-Vela
    • 2
  • Juan Carlos Montejo González
    • 2
  1. 1.Intensive Care MedicineHospital Universitario Doce de OctubreMadridSpain
  2. 2.Intensive Care MedicineHospital Universitario “12 de Octubre”MadridSpain

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