Nutritional support for patients with abdominal surgical pathology: the view of a surgeon and an anesthesiologist — opponents or allies?

Abstract

BACKGROUND: Nutritional support in abdominal surgery is a complex aspect of intensive care with many contradictions in available recommendations and in relation to interdisciplinary interaction. The challenges of assessing nutritional status and timing of the start and methods of clinical nutrition have not yet been resolved. Research has not yet explained whom and how to feed in the intensive care unit, nor has it proved the need for an early start of enteral nutrition or assessed the scale of the problems, such as the lack of uniform views and low adherence to clinical recommendations. AIM: To analyze the effectiveness of early enteral nutrition in achieving optimal treatment results in patients with abdominal surgical pathology and assess the depth of knowledge and adherence to clinical recommendations of specialists providing care to this cohort. MATERIALS AND METHODS: The study included 50 patients, 32 of whom started early enteral nutrition and 18 received later enteral nutrition. A survey of 41 specialists (surgeons and intensivists) from three leading hospitals in Tyumen was also conducted. The main set of clinical material was conducted on the basis of the Regional Clinical Hospital No. 1 (Tyumen). RESULTS: The study demonstrated the advantages of early enteral nutrition over delayed nutrition by an average of 48 h by reducing the length of hospital stay and resuscitation stage of treatment and minimizing pulmonary complications. Moreover, a survey of specialists assisting this cohort showed a lack of consensus in treatment approaches and insufficient adherence of patients with abdominal surgical pathology to existing clinical recommendations on clinical nutrition. CONCLUSIONS: Further research on nutritional support in patients with abdominal surgical pathology should aim at reducing the decision-making time in favor of an earlier and combined method of nutritional support, which can be facilitated by enhancing literacy and promoting adherence to clinical recommendations of specialists at the interdisciplinary level.