The Utility of Preoperative Nutrition Screenings and Postoperative Nutrition Protocols in Patients with Ventricular Assist Devices and Heart Transplantation

Abstract

Purpose Malnutrition can result in worse clinical outcomes following ventricular assist device (VAD) and heart transplantation (HT). Hemodynamic instability often leads to delays in optimal nutrition and increases the risk of iatrogenic malnutrition. In these settings, the exclusive or supplemental use of total parenteral nutrition (TPN) may enhance nutrition provision and avoid enteral nutrition (EN)-related complications. Nutrition screening and protocols may serve as a solution to address these issues by improving safety and delivery of EN/TPN in ICU settings. Methods Data were extracted from electronic medical records pre (2014-2016) and post (2017-2019) protocol implementation. The high-risk enteral nutrition guidelines (HRENG) were introduced in the setting of hemodynamic instability after VAD or HT: cardiogenic shock, need for ECMO, balloon pump, temporary mechanical support. Preoperative nutrition screenings were implemented to strengthen HRENG adherence. We assessed calorie/protein delivery POD 1-14, % of nutrition needs met, TPN start/end day, central line associated blood infection (CLABSI), ICU and total length of stay (LOS) and mortality rate. Results A total of 113 patients who met criteria of the HRENG were included. We compared 62 patients prior to the protocol to 51 managed after protocol implementation. Average 14 day calorie/protein deficits decreased (P Conclusion The implementation of preoperative nutrition screenings in conjunction with HRENG may not only facilitate earlier TPN initiation and decrease nutrient deficits, but decrease ICU LOS. Enhanced TPN use was not associated with higher CLABSI rates.