PP057 - EFFECT OF EARLY VS. LATE EN ON NUTRITIONAL ADEQUACY AND GASTROINTESTINAL TOLERANCE IN PATIENTS AFTER CARDIAC SURGERY
PP057
EFFECT OF EARLY VS. LATE EN ON NUTRITIONAL ADEQUACY AND GASTROINTESTINAL TOLERANCE IN PATIENTS AFTER CARDIAC SURGERY
S. Apaydin1,2,*, C. Stoppe1,2,3,4, S. Ott1,2, B. O'Brien1,2,4,5, P. Meybohm3, I. Metelec1, D. Catena4,6, M. Kleine-Brueggeney1,2,4, D. K. Heyland7, E. Dresen3
1Department of Cardiac Anaesthesiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité, 2Charité-Universitätsmedizin Berlin, Berlin, 3Department of Anaesthesiology, University Hospital Würzburg, Würzburg, 4German Centre for Cardiovascular Research (DZHK), Berlin, Germany, 5Department of Perioperative Medicine, St Bartholomew's Hospital and Barts Heart Centre, London, United Kingdom, 6Department of Anaesthesiology and Intensive Care Medicine (CCM/CVK), Charité-Universitätsmedizin Berlin, Berlin, Germany, 7Clinical Evaluation Research Unit and Department of Critical Care Medicine, Queen's University, Kingston, Canada
Rationale: Evidence on optimal timing of enteral nutrition (EN) after cardiac surgery remains limited despite guideline recommendations supporting early EN in critically ill patients, contributing to variability in clinical practice. Therefore, we evaluated the effects of early (<48 hours) vs. late (≥48 hours) initiation of EN after ICU admission on nutritional adequacy and gastrointestinal tolerance in high-risk cardiac surgery patients.
Methods: This secondary analysis of an international, multicenter randomized controlled trial included adult cardiac surgery patients receiving EN during ICU stay. Nutrition therapy data (route, prescribed energy and protein targets, and intake) were collected for up to 10 ICU days. Nutritional adequacy was defined as delivered energy and protein relative to prescribed targets.
Results: A total of 153 patients (71±10 years) were included; baseline characteristics were comparable. Early EN was initiated in 44% and late EN in 56%. EN-specific energy and protein adequacy were significantly higher with early EN (44.5±25.7% vs. 35.8±26.8%, P=0.02; 45.9±29.1% vs. 33.8±24.1%, P=0.01). Mean cumulative adequacy did not differ significantly (56.3±27.4% vs. 50.6±28.0%, P=0.14; 58.9±34.4% vs. 48.0±26.4%, P=0.06). Gastrointestinal symptoms were rare and comparable between groups (e.g., high gastric residual: 1.5% vs. 1.2%, P=0.94). While overall clinical outcomes were similar, postoperative delirium occurred significantly less in the early EN group (35.3% vs. 54.1%, P=0.01).
Conclusion: In high-risk cardiac surgery patients, early EN initiation may improve protein adequacy without compromising gastrointestinal tolerance and may be associated with reduced postoperative delirium. However, barriers to early initiation should be further identified, alongside improved clinician awareness.
Disclosure of Interest: None declared