Preoperative carbohydrate load and intraoperatively infused omega-3 polyunsaturated fatty acids positively impact nosocomial morbidity after coronary artery bypass grafting: a double-blind controlled randomized trial

Nutrition Journal

Research

Paulo Ruiz Lúcio de Lima¹  Neuber José Segri²  José Eduardo de Aguilar-Nascimento³  Gibran Roder Feguri⁴  Danilo de Cerqueira Borges⁵  Larissa Nadaf Batista⁵  Thaís Carvalho e Silva⁵  Laura Ramos Toledo⁶ 

[1] Cardiovascular Department, General University Hospital, Cuiabá, Brazil;Department of Statistics, Federal University of Mato Grosso, Cuiabá, Brazil;Federal University of Mato Grosso and UNIVAG Medical School, Varzea Grande, Brazil;Federal University of Mato Grosso, Cuiabá, Brazil;General University Hospital, Cuiabá, Brazil;UNIC - University of Cuiabá, Cuiabá, Brazil;Rua Mal. Floriano Peixoto, 1520/503 – Duque de Caxias II, CEP:78045-395, Cuiabá, Brazil;General University Hospital, Cuiabá, Brazil;Nutrition Service, General University Hospital, Cuiaba, Brazil;

关键词: Myocardial revascularization;    CAGB;    Perioperative care;    POAF;    Fasting;    Metabolism;   

DOI  :  10.1186/s12937-017-0245-6

 received in 2017-02-02, accepted in 2017-04-11,  发布年份 2017

来源: Springer

【 摘 要 】

BackgroundA strategy of limited preoperative fasting, with carbohydrate (CHO) loading and intraoperative infusion of omega-3 polyunsaturated fatty acids (ω-3 PUFA), has seldom been tried in cardiovascular surgery. Brief fasting, followed by CHO intake 2 h before anesthesia, may improve recovery from CABG procedures and lower perioperative vasoactive drug requirements. Infusion of ω-3 PUFA may reduce occurrences of postoperative atrial fibrillation (POAF) and shorten hospital stays. The aim of this study was to assess morbidity (especially POAF) in ICU patients after coronary artery bypass grafting (CABG)/cardiopulmonary bypass (CPB) in combination, if preoperative fasts are curtailed in favor of CHO loading, and ω-3 PUFA are infused intraoperatively.MethodsFifty-seven patients undergoing CABG were randomly assigned to receive 12.5% maltodextrin (200 ml, 2 h before anesthesia), without infusing ω-3 PUFA (CHO, n = 14); water (200 ml, 2 h before anesthesia), without infusing ω-3 PUFA (controls, n = 14); 12.5% maltodextrin (200 ml, 2 h before anesthesia) plus intraoperative ω-3 PUFA (0.2 mcg/kg) (CHO + W3, n = 15); or water (200 ml, 2 h before anesthesia) plus intraoperative ω-3 PUFA (0.2 mcg/kg) (W3, n = 14). Perioperative clinical variables and mortality were analyzed, examining the incidence of POAF, as well as the need for inotropic vasoactive drugs during surgery and in ICU.ResultsTwo deaths occurred (3.5%), but there were no instances of bronchoaspiration and mediastinitis. Neither ICU stays nor total postoperative stays differed by group (P > 0.05). Patients given preoperative CHO loads (CHO and CHO + W3 groups) experienced fewer instances of hospital infection (RR = 0.29, 95%CI 0.09–0.94; P = 0.023) and were less reliant on vasoactive amines during surgery (RR = 0.60, 95% CI 0.38–0.94; P = 0.020). Similarly, the number of patients requiring vasoactive drugs while recovering in ICU differed significantly by group (P = 0.008), showing benefits in patients given CHO loads. The overall incidence of POAF was 29.8% (17/57), differing significantly by group (P = 0.009). Groups given ω-3 PUFA (W3 and CHO + W3 groups) experienced significantly fewer instances of POAF (RR = 4.83, 95% CI 1.56–15.02; P = 0.001).ConclusionPreoperative curtailment of fasting was safe in this cohort. When implemented in conjunction with CHO loading and infusion of ω-3 PUFA during surgery, expedited recovery from CABG with CPB was observed.Trial registrationNCT: 03017001

【 授权许可】

CC BY   
© The Author(s). 2017