[TJS4] TSCCM-JSICM Symposium4
Perioperative critical care

[TJS4-3] Perioperative nutrition therapy

Kaweesak Chittawatanarat (Department of Surgery, Chiang Mai University, Thailand)

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Nutrition support is a part of treatment in perioperative critical care and enteral nutrition is a more prefer route on the standard recommendation. However, there are some limitations on perioperative enteral nutrition initiation especially in the patient undergone abdominal surgery. In addition, the critically ill associated gut dysmotility might be an aggravated factor. On the large prospective survey in the Thai-University-based surgical intensive care units (SICU), THAI-SICU study, the target of enteral nutrition was increasing during the first week after SICU admission. The amount of nutrition support was on the steady state around day 7^th – 10^th. The energy provision proportion of enteral and parenteral nutrition support were different between institute participated in this multicenter study. However, the complication including ICU mortality, 28-d mortality and sepsis occurrence between institutes were not different after adjusted the confounder variables. In this survey, the average total received energy is 20 kcal/kg/d after the first week. The nutrition factors affecting the mortality or sepsis occurrence in this prospective observation was body mass index, type of nutrition rout before admission, severe weight loss, preadmission albumin less than or equal 2.5 mg/dL and at risk of according to NRS-2002. On the nationwide survey in Thailand, the screening and assessment is an important process on nutrition care process. The routine screening and assessment lead to organize the hospital multi-disciplinary nutrition support team, promotion of enteral nutrition either hospital or commercial formula. Currently, there were still have the controversy issues on nutrition support in critically ill patients, this include the amount of protein needs, the composition of macronutrient, the specialized amino acid such as glutamine, micronutrient replacement, the type of fatty acid as omega-3 fatty acid, routine gastric residual volume measurement on high risk of aspiration patients, and probiotics. In conclusion, although the beginning of nutrition during peri-operative period might be delayed in non-nutrition risk patient, nutrition support should be early initiated in malnourish patient. The adequacy of nutrition support and promotion of early mobilization lead to enhance of recovery period and result in favorable outcomes.