Supplemental parenteral nutrition in the critically ill patient: a retrospective study

Deegan, H.; Dent, S.; Keefe, L.; Drover, JW; Heyland, D.K.

doi:10.1080/714028628

Cited by 3 publications

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“…In meta-analyses and in most studies conducted to date with protein-containing EN þ SPN, mortality was similar with EN þ SPN and with EN alone [17,18,32,34,110,111]. In a minority of studies, SPN was associated with an increase in mortality compared with EN alone [15,112,113].…”

Section: Supplemental Parenteral Nutritionmentioning

confidence: 92%

Review of evolution and current status of protein requirements and provision in acute illness and critical care

et al. 2021

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Nutrition therapy, by enteral, parenteral, or both routes combined, is a key component of the management of critically ill, surgical, burns, and oncology patients. Established evidence indicates overfeeding (provision of excessive calories) results in increased risk of infection, morbidity, and mortality. This has led to the practice of "permissive underfeeding" of calories; however, this can often lead to inadequate provision of guideline-recommended protein intakes. Acutely ill patients requiring nutritional therapy have high protein requirements, and studies demonstrate that provision of adequate protein can result in reduced mortality and improvement in quality of life. However, a significant challenge to adequate protein delivery is the current lack of concentrated protein solutions. Patients often have fluid administration restrictions and existing protein solutions are frequently not sufficiently concentrated to deliver a patient's protein requirements. This has led to the development of new enteral and parenteral nutrition solutions incorporating higher levels of protein in smaller volumes. This review article summarizes current evidence supporting the role of higher protein intakes, especially during the early phases of nutrition therapy in acute illness, methods for assessing protein requirements, as well as, the currently available high-protein enteral and parenteral nutrition solutions. There is sufficient evidence (albeit limited from true randomized, controlled studies) to indicate that earlier provision of guidelinerecommended protein intakes may be key to improving patient outcomes and that nutritional therapy that tailors caloric and protein intake to the patients' needs should be considered a desired standard of care.

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Section: Supplemental Parenteral Nutritionmentioning

confidence: 92%

Review of evolution and current status of protein requirements and provision in acute illness and critical care

et al. 2021

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“…The following are available online at , Table S1. Excluded Studies [ 15 , 16 , 33 , 34 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 ], and Table S2. Quality assessment of the selected studies by the Jadad Scale.…”

mentioning

confidence: 99%

Effect of Supplemental Parenteral Nutrition Versus Enteral Nutrition Alone on Clinical Outcomes in Critically Ill Adult Patients: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Alsharif

Aljuraiban

et al. 2020

Nutrients

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Enteral nutrition (EN) is considered the first feeding route for critically ill patients. However, adverse effects such as gastrointestinal complications limit its optimal provision, leading to inadequate energy and protein intake. We compared the clinical outcomes of supplemental parenteral nutrition added to EN (SPN + EN) and EN alone in critically ill adults. Electronic databases restricted to full-text randomized controlled trials available in the English language and published from January 1990 to January 2019 were searched. The risk of bias was evaluated using the Jadad scale, and the meta-analysis was conducted using the MedCalc software. A total of five studies were eligible for inclusion in the systematic review and meta-analysis. Compared to EN alone, SPN + EN decreased the risk of nosocomial infections (relative risk (RR) = 0.733, p = 0.032) and intensive care unit (ICU) mortality (RR = 0.569, p = 0.030). No significant differences were observed between SPN + EN and EN in the length of hospital stay, hospital mortality, length of ICU stay, and duration of mechanical ventilation. In conclusion, when enteral feeding fails to fulfill the energy requirements in critically ill adult patients, SPN may be beneficial as it helps in decreasing nosocomial infections and ICU mortality, in addition to increasing energy and protein intakes with no negative effects on other clinical outcomes.

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“…PN is used as a supplement or as the only source of nutrition in these patients (American Society for Parenteral and Enteral Nutrition Board of Directors, 1993;Cerra et al 1997). Evidence supporting this practice seems to be lacking (Deegan et al 1999). The purpose of the present paper is to systematically review, critically appraise and statistically aggregate all studies evaluating the effect of PN on complication and mortality rates in critically-ill patients.…”

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confidence: 99%

Parenteral nutrition in the critically-ill patient: more harm than good?

Heyland

2000

Proc. Nutr. Soc.

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While many studies have reported that providing parenteral nutrition (PN) can change nutritional outcomes, there are limited data that demonstrate that PN influences clinically-important end points in critically-ill patients. The purpose of the present paper is to systematically review and critically appraise the literature to examine the relationship between PN and morbidity and mortality in the critically-ill patient. Studies comparing enteral nutrition (EN) with PN and studies comparing PN with no PN were reviewed. The results suggest that EN is associated with reduced infectious complications in some critically-ill subgroups. PN, on the other hand, is associated with increased morbidity and mortality in critically-ill patients. When nutritional support is indicated, EN should be used preferentially over PN. Further studies are needed to define the optimal timing and composition of PN in patients not tolerating sufficient EN. Strategies to optimize EN delivery and minimize PN utilization in critically-ill patients are indicated.

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Supplemental parenteral nutrition in the critically ill patient: a retrospective study

Cited by 3 publications

References 0 publications

Review of evolution and current status of protein requirements and provision in acute illness and critical care

Review of evolution and current status of protein requirements and provision in acute illness and critical care

Effect of Supplemental Parenteral Nutrition Versus Enteral Nutrition Alone on Clinical Outcomes in Critically Ill Adult Patients: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Parenteral nutrition in the critically-ill patient: more harm than good?

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