Elsevier

Clinical Nutrition

Volume 25, Issue 2, April 2006, Pages 224-244
Clinical Nutrition

ESPEN GUIDELINES
ESPEN Guidelines on Enteral Nutrition: Surgery including Organ Transplantation

https://doi.org/10.1016/j.clnu.2006.01.015Get rights and content

Summary

Enhanced recovery of patients after surgery (“ERAS”) has become an important focus of perioperative management. From a metabolic and nutritional point of view, the key aspects of perioperative care include:

Enteral nutrition (EN) by means of oral nutritional supplements (ONS) and if necessary tube feeding (TF) offers the possibility of increasing or ensuring nutrient intake in cases where food intake is inadequate. These guidelines are intended to give evidence-based recommendations for the use of ONS and TF in surgical patients. They were developed by an interdisciplinary expert group in accordance with officially accepted standards and are based on all relevant publications since 1980. The guideline was discussed and accepted in a consensus conference.

EN is indicated even in patients without obvious undernutrition, if it is anticipated that the patient will be unable to eat for more than 7 days perioperatively. It is also indicated in patients who cannot maintain oral intake above 60% of recommended intake for more than 10 days. In these situations nutritional support should be initiated without delay. Delay of surgery for preoperative EN is recommended for patients at severe nutritional risk, defined by the presence of at least one of the following criteria: weight loss >10–15% within 6 months, BMI<18.5 kg/m2, Subjective Global Assessment Grade C, serum albumin <30 g/l (with no evidence of hepatic or renal dysfunction).

Altogether, it is strongly recommended not to wait until severe undernutrition has developed, but to start EN therapy early, as soon as a nutritional risk becomes apparent.

The full version of this article is available at www.espen.org.

Section snippets

Preliminary remarks

To make proper plans for the nutritional support of patients undergoing surgery, it is essential to understand the basic changes in body metabolism that occur as a result of injury. In addition, recent studies have shown that not only does surgery itself influence the response to nutritional support, but many of the perioperative routines also have a major impact on how well different nutritional treatments are tolerated by the postoperative patient.

Surgery, like any injury to the body elicits

When is EN necessary before solid organ transplantation?

Undernutrition is a major factor influencing outcome after transplantation, so optimising nutritional status is important (C).

In undernutrition, additional ONS or even TF is advised (C).

Regular assessment of nutritional status is necessary while monitoring patients on the waiting list before transplantation (C).

Recommendations for the living donor and recipient are no different from those for patients undergoing major abdominal surgery (C).

Comment: Undernutrition is likely to lead to a faster

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    For further information on methodology see Schütz et al.231 For further information on definition of terms see Lochs et al.232

    ☆☆

    The authors of the DGEM (German Society for Nutritional Medicine) guidelines on enteral nutrition in gastroenterology are acknowledged for their contribution to this article.

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