Perioperative Enteral and Parenteral Nutritional Therapies

Dear Colleagues,

We are pleased to invite you to submit original research or review papers focused on the nutritional strategies for preoperative and postoperative support for patients with surgical emergencies.

Malnutrition has been noted to be an important factor in surgical outcomes since 1936, when Dudley reported adverse outcomes in malnourished patients operated on for duodenal ulcer disease. In 1991, the VA Cooperative Trial reported that preoperative parenteral nutrition decreased serious complications in severely malnourished patients. Although this has been recognized for decades, malnutrition, and specifically disease-related malnutrition, in hospitalized patients has been increasing, resulting in morbidity, and increased hospital days, readmission rates, and healthcare costs.

Patients who present with surgical emergencies and baseline malnutrition, commonly seen in our more elderly population, present an even greater challenge for rescue, and require sophisticated nutritional therapies. Despite advances in treatments for cancer, trauma, and other diseases, appropriate and well-timed nutritional support is not universally applied. This may be partially due to published controversies that relate to parenteral nutrition and its potential harm when utilized inappropriately. New data are now available that can guide us to best utilize parenteral nutrition in surgical patients. 

Nutritional management of surgical patients is optimal when overseen by surgeons with expertise in operative interventions and nutritional support, as the catabolic reaction of the procedure and the risk of complications should be considered in the perioperative nutritional plan. When taken alone, without consideration of nutritional status, the new pathways of expedited care for intestinal surgery will not be effective in reducing the cost of care in patients with severe malnutrition. 

To be most effective and least harmful, the metabolic state of the patient must be considered. Patients who are stable, yet malnourished, have a metabolic state that differs from patients catabolic from injury, sepsis, or elective surgery. Different surgical approaches and procedures create variable stress responses and should also be considered. Patients may have underlying chronic infections, malignancies, or other inflammatory states that erode their protein stores and put them into a catabolic and starved state. 

Making the correct nutritional diagnosis and assessing nutritional risk is of paramount importance and will determine the course of therapy prescribed. It is important to understand routine vascular and enteral access and the available approaches that are possible in patients with more challenging anatomy. Ongoing metabolic and nutritional monitoring is needed, as the patient’s condition will be dynamic and adjustments in the nutritional plan will be required, or there may be risk complications from therapy. For patients with more prolonged courses, micronutrients will need to be repleted and monitored. Special surgical conditions such as obesity, an open abdomen, and extracorporeal membrane oxygenation need special consideration. 

This Special Issue aims to provide a road map for acute care surgeons to care for their patients with intestinal failure and to provide strategies to optimize elective surgery patients for all surgical specialties. In this Special Issue, original research articles and review papers are welcome. Research topics may include nutritional support in any of the areas below.

Suggested themes and article types for submissions:

1. Assessment and classification of malnutrition and the metabolism of starvation;
2. Metabolic stress response—differences between early and late stress responses;
3. Persistent inflammatory catabolic syndrome—potential therapies;
4. Sarcopenia and frailty—potential therapies;
5. Preoperative nutrition support—decision making regarding enteral or parenteral;
   • How to start
   • How to monitor
   • Determination of optimization
6. Nutritional support in critically ill trauma and surgical patients;
   • When to start
   • How to start
   • Enteral vs. parenteral—when enteral is not enough
   • Monitoring and glycemic control
   • Obesity
   • Open abdomen
   • entero-atmospheric fistulae
   • ecmo
7. Enteral access and challenges;
8. Vascular access and challenges;
9. Micronutrients;
10. Intestinal failure in patients with malignancy;
11. Intestinal fistulae nutritional and operative management;
12. Intestinal rehabilitation and the management of short bowel syndrome.

We look forward to receiving your contributions.

Prof. Dr. Patricia Marie Byers
Guest Editor

Dr. Ana Marie Reyes
Guest Editor Assistant

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 250 words) can be sent to the Editorial Office for assessment.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Nutrients is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2900 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

• nutrition support
• parenteral nutrition
• intestinal failure
• malnutrition
• short bowel syndrome
• enteral nutrition
• intestinal fistulae
• micronutrients
• vascular access
• enteral access