Enteral Nutrition After Cardiovascular Surgery
Enteral Nutrition After Cardiovascular Surgery
Effect of enteral nutrition in the outcome of patients has the objective to determine the
 effect of implementing a nutritional support protocol on the outcome of cardiovascular
 surgery patients, the main justification of the study its the prevalence of malnutrition over
 the hospitalized patients and the way this complication influence the treatment efficacy, the
 risk of complications over these patients, the costs, the prognosis, mortality and hospital
 stay.

 This study will be a control clinical trial, randomized and double blind.
INTRODUCTION: Malnutrition is a complication that occurs frequently in hospitalized patients
 and influencing treatment efficacy, risks of complications, costs, prognosis, mortality and
 hospital stay. Cardiac Cachexia is a complication that is characterized by weight loss and
 suggests different mechanisms to explain it: poor diet, intestinal malabsorption, impaired
 metabolism, loss of nutrients through the digestive tract or urinary tract, increased protein
 loss and decreased anabolism, increased basal metabolic rate. It is reported a reduction in
 mortality in cardiac patients with higher body mass index (BMI), this potential protective
 effect is known as the obesity paradox. In a clinical study to determine whether BMI
 influences the risk of mortality in acute decompensated heart failure, the authors compared
 the BMI of 108 927 hospitalized patients and noted that hospital mortality was decreased as
 BMI increased, decreasing the risk of death 10% for every 5 unit increase in BMI of patients.
 Moreover, the enteral nutrition within the first 48hr after surgery, helps maintain the
 integrity of the intestinal mucosa and reduces the secretion of catabolic hormones. A
 meta-analysis shows that 85% of high-risk surgical patients tolerate enteral nutrition in the
 early postoperative period. As a nutritional support in critically ill patients, enteral
 keeps physiological mechanisms, a lower incidence of complications and low cost. Nutritional
 support in critically ill patients has three objectives: to conserve body mass, modulate
 immune function and metabolic response to moderate stress.

 OBJECTIVE OF THE STUDY: To determine the effect of implementing a nutritional support
 protocol on the outcome of cardiovascular surgery patients.

 METHODOLOGY: The investigators performed a controlled clinical trial in adult patients, both
 genders admitted to the coronary intensive care UMAE. IMSS No.1, having undergone cardiac
 surgery with or without pump. There will be a nutritional screening and patients with
 malnutrition are included at random to group A (which will immunomodulatory individualized
 diet) or group B (conventional nutritional treatment). The protocol will be given nutritional
 support enterally during their hospital stay. The progress of nutritional status will be
 measured by weight, BMI, albumin, transferrin, total count of lymphocytes and total proteins
 in addition to the hospital stay, complications and mortality. A comparison of the effect of
 individualized nutritional support with a standard control group will be performed.

 ANALYSIS: The results will be emptied in a database in Excel. The investigators will use
 statistical packages: NCSS 2007 (01/07/1919) and SPSS (15.0). Qualitative variables will be
 expressed as percentages, quantitative variables as mean and standard deviation if the
 distribution is normal. The results will be analyzed according to intention to treat.
 Comparison of nutritional status by various quantitative indicators will be made by paired t
 test or Mann Whitney according to their distribution. Categorical variables were expressed as
 proportions and compared using Chi Square test. All tests will be considered significant p
 values less than 5%.
Inclusion Criteria:

 -  Patients undergoing cardiac surgery for revascularization, valve implant.

 -  Patients with some degree of malnutrition or at risk of malnutrition according to the
 implementation of the Nutritional Risk Screening-2002.

 -  By letter of informed consent.

 Exclusion Criteria:

 -  Patients with cancer diagnosis, liver disease, kidney disease.

 -  Patients who decide to come out the study

 -  Patients who are transferred to other hospitals

 -  Patients with complications that prevent them from receiving enteral nutritional.