Nutrition Assessment and Management of Left Ventricular Assist Device Patients

Nutrition evaluation and support is an integral component of left ventricular assist device (LVAD) therapy. Malnutrition in the LVAD patient contributes to a host of post-operative problems, such as infection and limited functional capacity, which compromise long-term outcomes. Comprehensive pre-operative evaluation of the LVAD patient should include a nutrition assessment and formalized plan to initiate and advance nutrition support while addressing the metabolic imbalances associated with heart failure. An interdisciplinary approach, including a nutrition support team, is desirable to manage these patients effectively. This article reviews essential aspects regarding nutrition management of these patients.

Nutrition support of the chronically critically ill patient

Providing nutrition and metabolic support to the CCI patient is based on the rational application of scientifically derived data and clinical experience with this unique population. Much of the data presented has been extrapolated from the critically ill ICU patients and the chronically ill hospitalized or nursing home patient, as there are limited data solely based on an experience with the CCI [table: see text] patient population. The key principles are: (1) primacy of protein provision and avoidance of overfeeding energy, (2) use of combined modality (enteral, parenteral, and oral) nutrition to meet needs as required, (3) use of adjunctive agents to promote nitrogen retention when needed, and (4) recognition of and adjustment for altered nutrient requirements (Table 3).