Enteral and Parenteral Nutrition in the Perioperative Period: State of the Art
Abstract
:1. Introduction
2. Nutritional Assessment and Population at Risk for Perioperative Malnutrition
Nutritional Risk Scoring (NRS) | ||||
---|---|---|---|---|
Initial Screening | ||||
Yes | No | |||
Is BMI < 20.5? | ||||
Has the patient lost weight within the last 3 months? | ||||
Has the patient reduced dietary intake in the last week? | ||||
Is the patient severely ill (e.g., in intensive therapy)? | ||||
Yes: If the answer is “Yes” to any question, the final screening is performed. | ||||
No: If the answer is “No” to all questions, the patient is re-screened at weekly intervals. If the patient, e.g., is scheduled for a major operation, a preventative nutritional care plan is considered to avoid the associated risk status. | ||||
Final Screening | ||||
Impaired Nutritional Status | Severity of Disease (≈Increase in Requirements) | |||
Absent Score 0 | Normal Nutritional Status | Absent Score 0 | Normal Nutritional Requirements | |
Mild Score 1 | Wt loss >5% in 3 months or Food intake below 50%–75% of normal requirement in preceding week | Mild Score 1 | Hip fracture * Chronic patients, in particular with acute complications: Cirrhosis *, COPD *. Chronic hemodialysis, diabetes, oncology | |
Moderate Score 2 | Wt loss >5% in 2 months or BMI 18.5–20.5+ impaired general condition or food intake 25%–60% of normal requirement in preceding week | Moderate Score 2 | Major abdominal surgery * Stroke * Severe pneumonia, hematologic malignancy | |
Severe Score 3 | Wt loss >5% in 1 month (>15% in 3 months) or BMI > 18.5+ impaired general condition or Food intake 0%–25% of normal requirement in preceding week in preceding week. | Severe Score 3 | Head injury * Bone marrow transplantation * Intensive care patients (APACHE410) | |
Score | + | Score | =Total score: | |
Score ≥3: The patient is nutritionally at-risk and a nutritional care plan is initiated. | ||||
Score <3: Weekly rescreening of the patient. If the patient, e.g., is scheduled for a major operation, a preventive nutritional care plan is considered to avoid the associated risk status. | ||||
* Indicates that a trial directly supports the categorization of patients with that diagnosis. |
3. Parenteral Nutrition
3.1. Benefits
Vitamin/Trace Element | Requirement |
---|---|
Thiamin (B1) | 6 mg |
Riboflavin (B2) | 3.6 mg |
Niacin (B3) | 40 mg |
Folic Acid | 600 μg |
Panthotenic Acid | 15 mg |
Pyridoxine | 6 mg |
Cyanocobalamin (B12) | 5 μg |
Biotin | 60 μg |
Ascorbic Acid (C) | 200 mg |
Vitamin A | 3300 IU |
Vitamin D | 200 IU |
Vitamin E | 10 IU |
Vitamin K | 150 μg |
Chromium | 10–15 μg |
Copper | 0.3–0.5 mg |
Iron | 1.0–1.2 mg |
Manganese | 0.2–0.3 mg |
Selenium | 20–60 μg |
Zinc | 2.5–5 mg |
Molybdenum | 20 μg |
Iodine | 100 μg |
Fluoride | 1 mg |
3.2. Risks and Complications of TPN
Catheter Insertion Complications |
Arterial puncture |
Pneumothorax |
Hemothorax |
Catheter & wire tip embolization |
Air embolism |
Thoracic duct injury |
Catheter malposition |
Cardiac arrhythmias |
Mediastinal air/hematoma |
Cardiac perforation |
Brachial plexus injury |
Catheter Related Complications |
Subclavian vein, internal jogular vein or Superior vena cava thrombosis |
Catheter site infection |
Septic phlebitis |
Catheter associated blood stream infection |
Metabolic Complications |
Hyperglycemia or hypoglycemia |
Ketoacidosis |
Azotemia & Hyperosmolar state |
Electrolyte imbalance |
Hypertriglyceridemia |
Metabolic acidosis |
Hepatic dysfunction |
Fluid overload |
Coagulopathy |
3.3. Preoperative TPN Use
3.4. Postoperative TPN Use
4. Enteral Nutrition
4.1. Benefits
4.2. Risks and Complications of EN
Mechanical Complications |
Aspiration |
Tube malposition |
Tube clogging |
Gastrointestinal Complications |
Nausea and vomiting |
Diarrhea or constipation |
Malabsorption/maldigestion |
Metabolic Complications |
Hyperglycemia or hypoglycemia |
Electrolyte imbalance |
Early satiety |
Dehydration |
Refeeding syndrome |
4.3. Preoperative Use
4.4. Postoperative Use
5. TPN vs. EN
Cost Effectiveness
6. Combined EN and TPN
7. Immunonutrition
8. Conclusion
Conflict of Interest
References
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Abunnaja, S.; Cuviello, A.; Sanchez, J.A. Enteral and Parenteral Nutrition in the Perioperative Period: State of the Art. Nutrients 2013, 5, 608-623. https://doi.org/10.3390/nu5020608
Abunnaja S, Cuviello A, Sanchez JA. Enteral and Parenteral Nutrition in the Perioperative Period: State of the Art. Nutrients. 2013; 5(2):608-623. https://doi.org/10.3390/nu5020608
Chicago/Turabian StyleAbunnaja, Salim, Andrea Cuviello, and Juan A. Sanchez. 2013. "Enteral and Parenteral Nutrition in the Perioperative Period: State of the Art" Nutrients 5, no. 2: 608-623. https://doi.org/10.3390/nu5020608