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2 - Nutrition

Published online by Cambridge University Press:  12 January 2010

By
Joseph D. Ansley
Edited by
Michael F. Lubin ,
Robert B. Smith ,
Thomas F. Dodson ,
Nathan O. Spell  and
H. Kenneth Walker
Joseph D. Ansley
Affiliation:
Emory University School of Medicine, Department of Surgery, Atlanta, GA
Michael F. Lubin
Affiliation:
Emory University, Atlanta
Robert B. Smith
Affiliation:
Emory University, Atlanta
Thomas F. Dodson
Affiliation:
Emory University, Atlanta
Nathan O. Spell
Affiliation:
Emory University, Atlanta
H. Kenneth Walker
Affiliation:
Emory University, Atlanta
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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.

Type
Chapter
Information
Medical Management of the Surgical Patient
A Textbook of Perioperative Medicine
 , pp. 21 - 31
Publisher: Cambridge University Press
Print publication year: 2006

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References

Cuthbertson, D.The metabolic response to injury and its nutritional implications: retrospect and prospect. J. Parenteral Enteral Nutr. 1979; 3: 108.CrossRefGoogle ScholarPubMed
Dudrick, S., Wilmore, D., Vars, H., & Rhoads, J.Long-term total parenteral nutrition with growth, development, and positive nitrogen balance. Surgery 1968; 64: 134.Google ScholarPubMed
Moore, F.Energy and the maintenance of the body cell mass. J. Parenteral Enteral Nutr. 1980; 4: 228.CrossRefGoogle ScholarPubMed
Gilder, H.Parenteral nourishment of patients undergoing surgical or traumatic stress. J. Parenteral Enteral Nutr. 1986; 10: 88.CrossRefGoogle ScholarPubMed
Hill, G.Body composition research: implications for the practice of clinical nutrition. J. Parenteral Enteral Nutr. 1992; 16: 197.CrossRefGoogle ScholarPubMed
Kudsk, K., Croce, M., Fabian, T.et al. Enteral versus parenteral feeding: effects on septic morbidity after blunt and penetrating abdominal trauma. Ann. Surg. 1992; 215: 503.CrossRefGoogle ScholarPubMed
Suchner, U., Kuhn, K., & Furst, P.The scientific basis of immunonutrition. Proc. Nutrit. Soc. 2000; 59: 553.CrossRefGoogle ScholarPubMed
McClave, S., Lowen, C., & Snider, H.Immunonutrition and enteral hyperalimentation of critically ill patients. Dig. Dis. Sci. 1992; 37: 1153.CrossRefGoogle ScholarPubMed
A.S.P.E.N. Board of Directors and Clinical Guidelines Task Force. Guidelines for the use of parenteral and enteral nutrition in adult and pediatric patients. J. Parenteral Enteral Nutr. 2002; 26.
Heymsfield, S., Bethal, R., Ansley, J.et al. Enteral hyperalimentation: an alternative to central venous hyperalimentation. Ann. Intern. Med. 1979; 90: 63.CrossRefGoogle ScholarPubMed
Parrish, C.Enteral feeding: the art and the science. Nutr. Clin. Pract. 2003; 18: 76.CrossRefGoogle Scholar
Blackburn, G., Bistrian, B., Maini, B.et al. Nutritional and metabolic assessment of the hospitalized patient. J. Parenteral Enteral Nutr. 1977; 1: 11.CrossRefGoogle ScholarPubMed
Baker, J., Detsky, A., Wesson, D.et al. Nutritional assessment: a comparison of clinical judgment and objective measurements. N. Engl. J. Med. 1982; 306: 969.CrossRefGoogle Scholar
Windsor, J. & Hill, G.Weight loss with physiologic impairment: basic indicator of surgical risk. Ann. Surg. 1988; 207: 290.CrossRefGoogle ScholarPubMed
Bistrian, B., Blackburn, G., Hallowell, E.et al. Protein status of general surgical patients. J. Am. Med. Assoc. 1974; 230: 858.CrossRefGoogle ScholarPubMed
Bistrian, B., Blackburn, G., Vitale, J.et al. Prevalence of malnutrition in general medical patients. J. Am. Med. Assoc. 1976; 235: 1567.CrossRefGoogle ScholarPubMed
Christou, N., Tellado-Rodriguez, J., Chartrand, L.et al. Estimating mortality risk in preoperative patients using immunologic, nutritional, and acute-phase response variables. Ann. Surg. 1989; 210: 69.CrossRefGoogle ScholarPubMed
Bistrian, B., Blackburn, G., Sherman, M.et al. Therapeutic index of nutritional depletion in hospitalized patients. Gynecol. Obstet. 1975; 141: 512.Google ScholarPubMed
Nixon, D., Heymsfield, S., Cohen, A.et al. Protein-caloric undernutrition in hospitalized cancer patients. Am. J. Med. 1980; 68: 683.CrossRefGoogle Scholar
McClave, S., Mitoraj, T., Thielmeier, K.et al. Differentiating subtypes (hypoalbuminemic vs. marasmic) of protein-calorie malnutrition: incidence and clinical significance in a university hospital setting. J. Parenteral Enteral Nutr. 1992; 16: 337.CrossRefGoogle Scholar
Dahn, M., Jacobs, L., Smith, S.et al. The significance of hypoalbuminemia following injury and infection. Am. Surg. 1985; 51: 340.Google ScholarPubMed
Sun, X., Iles, M., & Weissman, C.Physiologic variables and fluid resuscitation in the postoperative intensive care unit patient. Crit. Care Med. 1993; 21: 555.CrossRefGoogle ScholarPubMed
Way, C. IIIVariability of the Harris–Benedict equation in recently published textbooks. J. Parenteral Enteral Nutr. 1992; 16: 566.Google ScholarPubMed
Cortes, V. & Nelson, L.Errors in estimating energy expenditure in critically ill surgical patients. Arch. Surg. 1989; 124: 287.CrossRefGoogle ScholarPubMed
McClave, S., Lowen, C., Kleber, M.et al. Clinical use of the respiratory quotient obtained from indirect calorimetry. J. Parenteral Enteral Nutr. 2003; 27: 21.CrossRefGoogle ScholarPubMed
Konstantinides, F., Boehm, K., Radmer, W.et al. Pyrochemiluminescence: real time, cost-effective method for determining total urinary nitrogen in clinical nitrogen balance studies. Clin. Chem. 1988; 34: 2518.Google ScholarPubMed
Detsky, A., Baker, J., O'Rourke, K.et al. Perioperative parenteral nutrition: a meta-analysis. Ann. Intern. Med. 1987; 107: 195.CrossRefGoogle ScholarPubMed
The Veterans Affairs Total Parenteral Nutrition Cooperative Study Group. Perioperative total parenteral nutrition in surgical patients. N. Engl. J. Med. 1991; 325: 525.CrossRef
Eisenberg, J., Glick, H., Buzby, G.et al. Does perioperative total parenteral nutrition reduce medical care costs? J. Parenteral Enteral Nutr. 1993; 17: 201.CrossRefGoogle ScholarPubMed
Campos, A. & Mequid, M.A critical appraisal of the usefulness of perioperative nutritional support. Am. J. Clin. Nutr. 1992; 55: 117.CrossRefGoogle ScholarPubMed
Heyland, D., MacDonald, S., Keefe, L.et al. Total parenteral nutrition in the critically ill patient – a meta-analysis. J. Am. Med. Assoc. 1998; 280: 2013.CrossRefGoogle ScholarPubMed
Bethal, R., Jansen, R., Heymsfield, S.et al. Nasogastric hyperalimentation through a polyethylene catheter: an alternative to central venous hyperalimentation. Am. J. Clin. Nutr. 1979; 32: 1112.CrossRefGoogle Scholar
Vanek, V.Ins and outs of enteral access. Part I: Short-term enteral access. Nutr. Clin. Pract. 2002; 17: 275.CrossRefGoogle ScholarPubMed
Caulfield, K., Page, C., & Pestana, C.Technique for intraduodenal placement of transnasal enteral feeding catheters. Nutr. Clin. Pract. 1991; 6: 23.CrossRefGoogle ScholarPubMed
Kalliafas, S., Choban, P., Ziegler, D.et al. Erythromycin facilitates postpyloric placement of nasoduodenal feeding tubes in intensive care unit patients: randomized, double-blinded, placebo-controlled trial. J. Parenteral Enteral Nutr. 1996; 20: 385.CrossRefGoogle ScholarPubMed
Moore, F., Moore, E., Jones, T.et al. TEN versus TPN following abdominal trauma: reduced septic morbidity. J. Trauma 1989; 29: 916.CrossRefGoogle ScholarPubMed
Weltz, C., Morris, J., & Mullen, J.Surgical jejunostomy in aspiration risk patients. Ann. Surg. 1992; 215: 140.CrossRefGoogle ScholarPubMed
Ford, E., Hull, S., Jennings, L.et al. Clinical comparison of tolerance to elemental or polymeric enteral feedings in the postoperative patient. J. Am. Coll. Nutr. 1992; 11: 11.CrossRefGoogle ScholarPubMed
Mowatt-Larssen, C., Brown, R., Wojtysiak, S.et al. Comparison of tolerance and nutritional outcome between a peptide and a standard enteral formula in critically ill, hypoalbuminemic patients. J. Parenteral Enteral Nutr. 1992; 16: 20.CrossRefGoogle Scholar
Heyland, D.Immunonutrition in the critically ill patient: putting the cart before the horse. Nutr. Clin. Pract. 2002; 17: 267.CrossRefGoogle Scholar
Chapman, G., Curtas, S., & Meguid, M.Standardized enteral orders attain caloric goals sooner: a prospective study. J. Parenteral Enteral Nutr. 1992; 16: 149.CrossRefGoogle ScholarPubMed
Guenter, P., Settle, R., Perlmutter, S.et al. Tube feeding-related diarrhea in acutely ill patients. J. Parenteral Enteral Nutr. 1991; 15: 277.CrossRefGoogle ScholarPubMed
Fekety, R. & Shah, A.Diagnosis and treatment of clostridium difficile colitis. J. Am. Med. Assoc. 1993; 269: 71.CrossRefGoogle ScholarPubMed
Eisenberg, P.Causes of diarrhea in tube-fed patients: a comprehensive approach to diagnosis and management. Nutr. Clin. Pract. 1993; 8: 119.CrossRefGoogle ScholarPubMed
Mcclave, S. & Chang, W.Feeding the hypotensive patient: does enteral feeding precipitate or protect against ischemic bowel? Nutr. Clin. Pract. 2003; 18: 279.CrossRefGoogle ScholarPubMed
Payne-James, J. & Khawaja, H.First choice for total parenteral nutrition: the peripheral route. J. Parenteral Enteral Nutr. 1993; 17: 468.CrossRefGoogle ScholarPubMed
Waxman, K., Day, A., Stellin, G.et al. Safety and efficacy of glycerol and amino acids in combination with lipid emulsion for peripheral parenteral nutrition support. J. Parenteral Enteral Nutr. 1992; 16: 374.CrossRefGoogle ScholarPubMed
Grant, J.Handbook of Total Parenteral Nutrition. Philadelphia: W. B. Saunders, 1992: 107–117.Google Scholar
Sitzman, J., Townsend, T., Siler, M.et al. Septic and technical complications of central venous catheterization: a prospective study of 200 consecutive patients. Ann. Surg. 1985; 202: 766.CrossRefGoogle Scholar
Williams, W.Infection control during parenteral nutrition therapy. J. Parenteral Enteral Nutr. 1985; 9: 735.CrossRefGoogle ScholarPubMed
Hoffman, K., Weber, D., Samsa, G.et al. Transparent polyurethane film as an intravenous catheter dressing: a meta-analysis of the infection risks. J. Am. Med. Assoc. 1992; 267: 2072.CrossRefGoogle Scholar
Cobb, D., High, K., Sawyer, R.et al. A controlled trial of scheduled replacement of central venous and pulmonary artery catheters. N. Engl. J. Med. 1992; 327: 1062.CrossRefGoogle ScholarPubMed
Pemberton, L., Lyman, B., Lander, V.et al. Sepsis from triple- vs single-lumen catheters during total parenteral nutrition in surgical or critically ill patients. Arch. Surg. 1986: 121: 591.CrossRefGoogle ScholarPubMed
Campos, A., Palazzi, M., & Meguid, M.Clinical use of total nutritional admixtures. Nutrition 1990; 6: 347.Google ScholarPubMed
Weinsier, R., Bacon, J., & Butterworth, C.Central venous alimentation: a prospective study of the frequency of metabolic abnormalities among medical and surgical patients. J. Parenteral Enteral Nutr. 1982; 6: 421.CrossRefGoogle ScholarPubMed
Berghe, G., Woutens, P., Weekers, F.et al. Intensive insulin therapy in critically ill patients. N. Engl. J. Med. 2001; 345: 1359.CrossRefGoogle ScholarPubMed
Leaseburge, L., Winn, N., & Schloerb, P.Liver test alterations with total parenteral nutrition and nutritional status. J. Parenteral Enteral Nutr. 1992; 16: 348.CrossRefGoogle ScholarPubMed
Buchmiller, C., Kleiman-Wexler, R., Ephgrave, K.et al. Liver dysfunction and energy source: results of a randomized clinical trial. J. Parenteral Enteral Nutr. 1993; 17: 301.CrossRefGoogle Scholar
Askanzi, J., Rosenaum, S. H., Heyman, A. I.et al. Respiratory changes induced by the large glucose loads of total parenteral nutrition. J. Am. Med. Assoc. 1980; 243: 1444.CrossRefGoogle Scholar
Maini, B., Blackburn, G., Bistrian, B.et al. Cyclic hyperalimentation: an optimal technique for preservation of visceral protein. J. Surg. Res. 1976; 20: 515.CrossRefGoogle ScholarPubMed
Kanematsu, T., Koyangi, N., Matsumata, T.et al. Lack of preventive effect of branched chain amino acid solution on postoperative hepatic encephalopathy in patients with cirrhosis: a randomized prospective trial. Surgery 1988; 104: 482.Google ScholarPubMed
Barrera, R.Nutritional support in cancer patients. J. Parenteral Enteral Nutr. 2002; 26: 563.CrossRefGoogle ScholarPubMed
Ziegler, T. R., Young, L. S., Benfell, K.et al. Clinical and metabolic efficacy of glutamine supplemented parenteral nutrition after bone marrow transplantation: a randomized, double-blind, controlled study. Ann. Intern. Med. 1992; 116: 821.CrossRefGoogle ScholarPubMed
Inoue, Y., Grant, J. P., & Snyder, P. J.Effect of glutamine-supplemented total parenteral nutrition on recovery of the small intestine after starvation atrophy. J. Parenteral Enteral Nutr. 1993; 17: 165.CrossRefGoogle ScholarPubMed

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