Does Delaying Early Intravenous Fat Emulsion during Parenteral Nutrition Reduce Infections during Critical Illness?

Gerlach, Anthony T.; Thomas, Scott L.; Murphy, Claire V.; Stawicki, Stanislaw P; Whitmill, Melissa L.; Pourzanjani, Lydia; Steinberg, Steven M.; Cook, Charles H.

doi:10.1089/sur.2010.039

Cited by 15 publications

(30 citation statements)

References 28 publications

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“…While the recommendation to leave off fat the first week is based primarily on the Battistella study, 268 it is important to note serious criticisms of that trial. The study was completed 20 years ago, and the results have not been replicated 266 , 271 , 272 . The caloric goals were based on nonprotein calories (not total calories) such that the total calories delivered were greater than what was stated in the paper.…”

Section: H When Indicated Maximize Efficacy Of Pnmentioning

confidence: 99%

Guidelines for the Provision and Assessment of Nutrition Support Therapy in the Adult Critically Ill Patient

McClave

Taylor

Martindale

et al. 2016

J Parenter Enteral Nutr

2,575

1,248

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Section: H When Indicated Maximize Efficacy Of Pnmentioning

confidence: 99%

Guidelines for the Provision and Assessment of Nutrition Support Therapy in the Adult Critically Ill Patient

McClave

Taylor

Martindale

et al. 2016

J Parenter Enteral Nutr

2,575

1,248

View full text Add to dashboard Cite

“…No differences in infections, LOS, mechanical ventilation, or death were observed. The investigators concluded from this retrospective review that withholding SO‐based ILE did not improve infectious complications or clinical outcomes …”

Section: Studies Investigating Early Withholding Of So‐based Ilementioning

confidence: 94%

“…There was a single‐center retrospective trial evaluating delayed SO‐based ILE delivery . Based on the 2009 ASPEN/SCCM Guidelines for the provision and assessment of nutrition support therapy in the adult critically ill patients, the institution where the investigators practiced implemented a change in protocol by delaying SO‐based ILE within the first 7 days of hospitalization.…”

Section: Studies Investigating Early Withholding Of So‐based Ilementioning

confidence: 99%

“…Another retrospective study similar to the Gerlach et al. study made a change in practice and evaluated their patients receiving SO‐based ILE either immediately upon initiation of PN or after 7 days of PN infusion . The hospital was a tertiary care center with 142 ICU beds and a level 1 trauma center.…”

Section: Studies Investigating Early Withholding Of So‐based Ilementioning

confidence: 99%

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Controversies in the Use of Lipid Injectable Emulsion in Hospitalized Patients

Gervasio

2018

Nut in Clin Prac

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Soybean oil-based lipid injectable emulsion (SO-based ILE) is an 18-carbon, ω-6 macronutrient providing a concentrated source of calories, which can be administered in or with parenteral nutrition to patients unable to tolerate or consume adequate enteral nutrition. Beyond the provision of energy, SO-based ILE provides linoleic and linolenic acid, 2 essential fatty acids necessary for the prevention of essential fatty acid deficiency. However, SO-based ILE with its high levels of ω-6 fatty acids, long-chain triglycerides, phospholipid emulsifiers, and glycerin has been associated with worsening clinical outcomes, including increase of infections, lengthier intensive care and hospital stay, and prolonged mechanical ventilation. Recognizing this, studies have investigated omitting SO-based ILE in the critically ill patient for the first 7 days to observe if clinical outcomes are improved. Unfortunately, there is extremely limited research, and what is available is controversial. National guidelines have analyzed the studies, and they too are challenged to define a clear, high quality of evidence recommendation. It is important for the healthcare clinician to understand the research around this controversy to make best decisions for their patients.

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“…A cohort study of delayed intravenous lipid emulsion in adult surgical ICU patients demonstrated no change in infectious complications or mortality when compared with isocaloric PN containing lipid emulsions. 65 Increasing dextrose in PN to meet full calorie needs when lipid emulsion is withheld or limited may exceed limits for dextrose oxidation and exacerbate stress hyperglycemia.…”

Section: Nutrition Support Considerations For Glycemic Controlmentioning

confidence: 99%

Glucose Control in the Intensive Care Unit: A Nutrition Support Perspective

Krenitsky

2011

Nut in Clin Prac

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Hyperglycemia commonly occurs in acutely ill patients who receive nutrition support, even in patients without a history of diabetes. The traditional view that stress hyperglycemia may be a beneficial adaptive response has been replaced by data linking hyperglycemia with increased morbidity and mortality in critically ill populations. Initial randomized studies to control stress hyperglycemia with intensive insulin infusion reported dramatic decreases in infectious complications and decreased mortality. However, recent large multicenter trials have reported that intensive insulin therapy designed to normalize blood glucose resulted in an unacceptable increase in the incidence of hypoglycemia. Review of the methods, protocols, and nutrition provided during these randomized studies is crucial to understanding the different conclusions reached and how these results may be used to influence protocols in intensive care units today. Evidence is reviewed and practical considerations are provided for nutrition support regimens to minimize stress hypoglycemia and assist glucose management.

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Does Delaying Early Intravenous Fat Emulsion during Parenteral Nutrition Reduce Infections during Critical Illness?

Abstract: Withholding IVFE therapy during the first seven to ten days of PN did not influence infectious complications or the mortality rate in SICU patients. The benefits of delaying IVFE therefore may not be generalizable to all critically ill patients.

Cited by 15 publications

References 28 publications

Guidelines for the Provision and Assessment of Nutrition Support Therapy in the Adult Critically Ill Patient

Guidelines for the Provision and Assessment of Nutrition Support Therapy in the Adult Critically Ill Patient

Controversies in the Use of Lipid Injectable Emulsion in Hospitalized Patients

Glucose Control in the Intensive Care Unit: A Nutrition Support Perspective

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