Role of dietitians in optimizing medical nutrition therapy in cardiac surgery patients: A secondary analysis of an international multicenter observational study

Abstract

Background: Better understanding the impact of dietetic services on nutrition practices seems required as it may represent an opportunity for optimization in post–cardiac surgery patients. The present study aims to evaluate and compare nutrition practices and clinical outcomes in post–cardiac surgery intensive care unit (ICU) patients with and without dietetic services. Methods: This is a secondary analysis of a multinational prospective observational study in patients (n = 237) with >72 h of post–cardiac surgical ICU stay with and without dietetic services describing nutrition practices and outcomes up to 12 days after ICU admission. Results: Dietetic services were available in 61.5% (8 of 13) ICUs (1.0 ± 0.5 full-time equivalents/10 beds). Enteral nutrition was initiated <48 h from ICU admission in 49.6% and 59.1% of patients at sites with vs without dietetic services, respectively. Parenteral nutrition was started within 118.3 ± 56.5 and 131.5 ± 69.2 h at sites with vs without dietetic services, respectively. Energy target (23.7 ± 4.8 vs 24.6 ± 4.8 kcal/kg body weight/day) and actual supply (10.5 ± 6.7 vs 10.3 ± 6.2 kcal/kg body weight/day) did not differ between the groups. Protein targets (1.4 ± 0.4 vs 1.1 ± 1.3 g/kg body weight/day) and actual protein provision (0.6 ± 0.4 vs 0.4 ± 0.3 g/kg body weight/day) were higher in patients at sites with vs without dietetic services. Conclusion: Improvements in medical nutrition therapy practices in patients after cardiac surgery are needed in ICUs with and without dietetic services. Appropriately staffed dietetic services as essential members of the medical care team may be crucial to transfer knowledge on adequate medical nutrition therapy strategies into practice.