EFFECT OF POSTOPERATIVE COMPLICATIONS ON NUTRITIONAL-STATUS - THERAPEUTIC CONSEQUENCES

The occurrence of a postoperative complication represents an additiona l stress factor for patients and leads in many cases rapidly to a maln utrition status. Thus a nutritional support is required as soon as the foreseeable duration of starvation has a longer duration than one wee k. Considering its lower risk of septic complications and lower cost, enteral feeding should be initiated as soon as possible. Appraisal of caloric needs with standard formulas often leads to inappropriate nutr itional management. Therefore the requirements should be assessed by i ndirect calorimetry if available. Nutritional support is a part of the management of a postoperative septic patient. It must be initiated wh en initial phase of haemodynamic instability is amended. Branched chai n aminoacids, medium chain triglycerids and other specific nutrients h ave failed to demonstrate a red clinical beneficial effect. In case of acute respiratory failure, nutritional support must be cautions with regard to caloric load, as carbohydrates may increase CO2 production a nd lipids may worsen hypoxaemia. In case of postoperative acute renal failure, nutritional management is facilitated by continuous haemofilt ration techniques allowing an unlimited nutrient intake. Solutions con taining only essential aminoacids are not recommended. During severe a cute pancreatitis, enteral feeding is indicated when ileus does not pe rmit the use of the intestinal tract. Jejunal access must be preferred to stomach or duodenum. Lipid emulsions can be used safely if serum t riglyceride concentrations remain below 4 g . L(-1) during infusion an d below 2 g . L(-1) between infusions.