PMID- 28427403 OWN - NLM STAT- MEDLINE DCOM- 20180412 LR - 20220330 IS - 1475-2891 (Electronic) IS - 1475-2891 (Linking) VI - 16 IP - 1 DP - 2017 Apr 20 TI - 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. PG - 24 LID - 10.1186/s12937-017-0245-6 [doi] LID - 24 AB - BACKGROUND: A strategy of limited preoperative fasting, with carbohydrate (CHO) loading and intraoperative infusion of omega-3 polyunsaturated fatty acids (omega-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 omega-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 omega-3 PUFA are infused intraoperatively. METHODS: Fifty-seven patients undergoing CABG were randomly assigned to receive 12.5% maltodextrin (200 ml, 2 h before anesthesia), without infusing omega-3 PUFA (CHO, n = 14); water (200 ml, 2 h before anesthesia), without infusing omega-3 PUFA (controls, n = 14); 12.5% maltodextrin (200 ml, 2 h before anesthesia) plus intraoperative omega-3 PUFA (0.2 mcg/kg) (CHO + W3, n = 15); or water (200 ml, 2 h before anesthesia) plus intraoperative omega-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. RESULTS: Two 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 omega-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). CONCLUSION: Preoperative curtailment of fasting was safe in this cohort. When implemented in conjunction with CHO loading and infusion of omega-3 PUFA during surgery, expedited recovery from CABG with CPB was observed. TRIAL REGISTRATION: NCT: 03017001. FAU - Feguri, Gibran Roder AU - Feguri GR AD - Federal University of Mato Grosso, Cuiaba, Brazil. gibranrf@yahoo.com.br. AD - General University Hospital, Cuiaba, Brazil. gibranrf@yahoo.com.br. AD - UNIC - University of Cuiaba, Cuiaba, Brazil. gibranrf@yahoo.com.br. AD - , Rua Mal. Floriano Peixoto, 1520/503 - Duque de Caxias II, CEP:78045-395, Cuiaba, Brazil. gibranrf@yahoo.com.br. FAU - de Lima, Paulo Ruiz Lucio AU - de Lima PRL AD - Cardiovascular Department, General University Hospital, Cuiaba, Brazil. FAU - de Cerqueira Borges, Danilo AU - de Cerqueira Borges D AD - General University Hospital, Cuiaba, Brazil. FAU - Toledo, Laura Ramos AU - Toledo LR AD - Nutrition Service, General University Hospital, Cuiaba, Brazil. FAU - Batista, Larissa Nadaf AU - Batista LN AD - General University Hospital, Cuiaba, Brazil. FAU - E Silva, Thais Carvalho AU - E Silva TC AD - General University Hospital, Cuiaba, Brazil. FAU - Segri, Neuber Jose AU - Segri NJ AD - Department of Statistics, Federal University of Mato Grosso, Cuiaba, Brazil. FAU - de Aguilar-Nascimento, Jose Eduardo AU - de Aguilar-Nascimento JE AD - Federal University of Mato Grosso and UNIVAG Medical School, Varzea Grande, Brazil. LA - eng PT - Journal Article PT - Randomized Controlled Trial DEP - 20170420 PL - England TA - Nutr J JT - Nutrition journal JID - 101152213 RN - 0 (Dietary Carbohydrates) RN - 0 (Fatty Acids, Omega-3) RN - 0 (Polysaccharides) RN - 7CVR7L4A2D (maltodextrin) SB - IM MH - Aged MH - Atrial Fibrillation/*epidemiology/prevention & control MH - Body Mass Index MH - Body Weight MH - Coronary Artery Bypass/*mortality MH - Cross Infection/*epidemiology/prevention & control MH - Dietary Carbohydrates/*administration & dosage MH - Dose-Response Relationship, Drug MH - Double-Blind Method MH - Endpoint Determination MH - Fatty Acids, Omega-3/*administration & dosage MH - Female MH - Humans MH - Incidence MH - Intensive Care Units MH - Length of Stay MH - Male MH - Middle Aged MH - Morbidity MH - Perioperative Care MH - Polysaccharides/administration & dosage MH - Postoperative Complications/*epidemiology/prevention & control MH - Preoperative Care MH - Treatment Outcome PMC - PMC5397791 OTO - NOTNLM OT - CAGB OT - Fasting OT - Metabolism OT - Myocardial revascularization OT - POAF OT - Perioperative care EDAT- 2017/04/22 06:00 MHDA- 2018/04/13 06:00 PMCR- 2017/04/20 CRDT- 2017/04/22 06:00 PHST- 2017/02/02 00:00 [received] PHST- 2017/04/11 00:00 [accepted] PHST- 2017/04/22 06:00 [entrez] PHST- 2017/04/22 06:00 [pubmed] PHST- 2018/04/13 06:00 [medline] PHST- 2017/04/20 00:00 [pmc-release] AID - 10.1186/s12937-017-0245-6 [pii] AID - 245 [pii] AID - 10.1186/s12937-017-0245-6 [doi] PST - epublish SO - Nutr J. 2017 Apr 20;16(1):24. doi: 10.1186/s12937-017-0245-6.