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426: ACCURATE DETERMINATION OF RESTING ENERGY EXPENDITURE IN THE CRITICALLY ILL ADULT

Learning Objectives: Gastrointestinal (GI) complications and malnutrition can result in poorer clinical outcomes following cardiac surgery. Extended cardiopulmonary bypass, low cardiac output and high dose vasopressors can lead to alterations in splanchnic perfusion which may contribute to enteral feeding challenges and intolerances. Currently, there is limited guidance for nutrition in postoperative cardiothoracic surgery patients in cardiogenic shock. To address the need for optimizing nutrition in this patient population, we created High Risk Enteral Nutrition Guidelines (HRENG) to provide clinical nutrition decision support for hemodynamically unstable post cardiothoracic surgery patients. Methods: HRENG included specifics on route, timing, type of formula, feeding rate, progression, monitoring, and energy targets for enteral nutrition and TPN initiation. EN was initiated on postoperative day 2–3 if the following hemodynamic parameters were met: vasopressor and inotrope requirements were stable or declining to support MAP goals > 60–70 mmHg, epinephrine < 0.08 mcg/kg/min, cardiac index > 2.2 L/min/m2, mixed venous oxygen saturation > 60%. EN was titrated 10 mL q 12 to 24 hours with target rate achieved in 3–4 days vs traditional EN protocols which advance to goal rate within 1–2 days. EN tolerance was monitored via abdominal exams and nasogastric tube output q 8 hrs. EN was held in the setting of hypotension and signs and symptoms of worsening GI function (abdominal distension, rapid increase in gastric tube output). Guidance was provided on the appropriateness of TPN initiation to prevent excessive calorie and protein deficits. Results: A retrospective cohort study of eligible critically ill CVICU patients was performed to assess the incidence of severe GI complications pre-and-post HRENG implementation. Chart review from 2015–2016 revealed inconsistent post-op feeding practices, in addition to several cases of severe GI complications. Following HRENG implementation in March 2017 to July 2018 86% (n = 26) of HRENG eligible patients who adhered to the guidelines resulted in 0% incidence of severe GI complications. Conclusions: Initiating EN in hemodynamically unstable post cardiac surgery patients remains equivocal amongst CVICU practitioners. Our study suggests implementation of clinical nutrition guidelines for patients at high risk for GI complications following cardiac surgery with circulatory compromise, may improve feeding practices, nutrient delivery, and decrease ENrelated complications.