par Wiesen, Patricia;Preiser, Jean-Charles
Référence Nutrition in Critical Care, Cambridge University Press, page (163-174)
Publication Publié, 2014-01
Partie d'ouvrage collectif
Résumé : Critically ill patients who have undergone gastrointestinal surgery have comparable nutritional needs to other critically ill patients. However, there are additional issues, particularly pertaining to feed delivery, and the presence of malignant disease, which warrant consideration. The nutritional requirements of patients who have had gastrointestinal surgery reflect their pre-morbid nutritional state, chronic health issues, the nature of their underlying gastrointestinal pathology, the mode of presentation, the type of surgery, and the severity and nature of their critical illness. This chapter discusses the nutritional management of such patients in the critical care setting, with particular reference to the type, timing, and route of nutritional support. Malnutrition is common in hospitalized patients, and especially so in patients undergoing gastrointestinal surgery. Causes include decreased oral intake, particularly in the elderly, impaired absorption due to bowel obstruction, previous resections or inflammatory conditions, and the presence of malignant disease. Nearly half of patients undergoing surgery for gastrointestinal malignancies are malnourished and the proportion is even greater amongst those with upper gastrointestinal cancers. Malnutrition is associated with impaired immune function, reduced muscle function, and poor wound healing. This translates into an increased risk of post-operative complications, length of hospital stay, and mortality. However, even in the absence of malnutrition, patients undergoing surgery are exposed to a period of post-operative catabolism and immuno-suppression.