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A Journal on Anesthesiology, Resuscitation, Analgesia and Intensive Care
INTENSIVE CARE SMART 2003 - Milan, may 28-30
Minerva Anestesiologica 2003 April;69(4):275-80
Nutritional therapy in surgical patients: an update
Gianotti L., Nespoli L., Sargenti M., Nespoli A.
Dipartimento di Scienze Chirurgiche e Terapia Intensiva Università Milano-Bicocca, Monza, Italia
Patients undergoing major gastrointestinal surgery, often require an adequate artificial nutritional (AN) support for a pre-existing state of malnutrition and/or to overcome forced periods of postoperative starvation and/or for complications that alter the host metabolic response. When an indication to AN is given, enteral feeding should be preferred to parenteral nutrition because more physiological and less expensive. Moreover, recent data showed that patients fed enterally, rather than parenterally, in the postoperative period, have a significant better outcome with a reduction of morbidity and hospitalisation.
The supplementation of standard feeds with key nutrients having immunomodulatory properties, such as arginine, omega-3 fatty acids and glutamine (pharmaconutrients), allows to control effectively the surgery-induced immunosuppression and hyperinflammation. An analysis on the principles of evidence-based medicine, supports the hypothesis that the pre-perioperative use of formulas enriched with pharmaconutrients, significantly reduces the rate of infectious complications and saves health care resources.