2 - Nutrition

Summary

The nutritional status of surgical patients and the metabolic response to injury are recognized as important factors in wound healing, postoperative complications, infection, and the overall recovery from surgical procedures. Providing appropriate nutritional support to surgical patients can be difficult, however, because surgical disease and surgical procedures often do not allow the normal oral intake of the nutritionally complete diet that is needed to maintain adequate muscle mass, visceral proteins, and metabolism. Inadequate intake may result from obstructive lesions of the gastrointestinal tract, malabsorption, anorexia related to cancer or other debilitating conditions, postoperative ileus, or the necessity for prolonged bowel rest. A major advance in resolving the problem of inadequate nutritional intake was made by Dudrick and colleagues, who developed a concentrated total parenteral nutrition (TPN) solution that could be administered through the large-caliber, high-flow central veins. This significant development has been followed by more than three decades of clinical application and additional nutritional research leading to many refinements in the composition of the solutions and to a new understanding of nutritional processes in health and disease.

The increased knowledge and interest in nutrition resulting from the development of TPN techniques has stimulated many other nutrition-related activities and specialized research. Some of the most active and productive areas include the biochemical response to traumatic stress, advances in body composition research, the importance of the enteral route of nutrient administration, and the potential for enhancement of the immune system with specialized diets.