Enhancing the Response to Parenteral Nutrition in Critical Care

Abstract

Parenteral nutrition (PN) is an essential component in the support of critically ill patients with gastrointestinal dysfunction. Although PN cannot fully reverse hypermetabolism and accelerated skeletal muscle breakdown observed during periods of critical illness, it can prevent the adverse effects associated with malnutrition. The use of PN is not without complications, so care must be taken to ensure successful clinical outcomes with this complex therapy. Strategies have been developed by practitioners to promote safe practices with implementation of PN therapy and optimize a patient's response to PN. Identification of appropriate patient populations, strict glucose control, and manipulation of macro- and micronutrients are techniques being used to augment a patient's response to PN administration. This article will review the novel methods used to enhance benefits received from PN during critical illness.

Systematic review: nutritional support in acute pancreatitis

“…Consistent with the previous systematic reviews, 7, 8 the present one demonstrated the clinical benefits of enteral nutrition in comparison with parenteral nutrition. The mounting data evidence that, most likely, this is not because of better nutritional effect of enteral nutrition over parenteral nutrition, but rather because of the marked differences between the groups with regard to intestine function 31–33 . In its turn, it suggests that (in)adequate intestine function may be either a confounder or an effect of nutrition.…”

Nutrition Support in Mechanically Ventilated, Critically Ill Adult Patients: Are We Ready for Evidence‐Based Clinical Practice Guidelines?

“…We go one step further to recommend that, as currently constituted, IV lipid emulsions be avoided in the average critically ill patient. 20 Despite the conflicting experimental evidence reviewed by Sacks, 49 there are 2 clinical studies comparing lipid-free PN to lipid-containing PN. 44,52 When aggregated, they suggest a statistically significant reduction in infectious complications associated with lipid free-PN (0.63, 95% CI 0.42-0.93; p ϭ .02).…”