Supplemental Parenteral Nutrition: Review of the Literature and Current Nutrition Guidelines

Abstract

Parenteral nutrition has significantly and positively affected the clinical care of patients for >50 years. The 2016 Society of Critical Care Medicine/American Society for Parenteral and Enteral Nutrition guidelines for the provision of nutrition support to adult patients emphasize the role of this therapy in attenuating the stress response and impacting the immune response, among other benefits. Malnutrition in hospitalized patients remains a major problem; it is underdiagnosed and often undertreated. Malnourished patients are more likely to suffer from infections, pneumonia, and pressure ulcers, among other serious concerns. Enteral nutrition is considered first-line therapy in many of these patients; however, data suggest that many patients receive far less than prescribed amounts for a variety of reasons. Supplemental parenteral nutrition (SPN), used to augment nutrition support of appropriate adult patients and better meet nutrition goals, is not often used in the United States. The purposes of this review are to highlight selected studies in the literature that support and question the use and value of SPN in adult patients; propose consideration of 2 definitions for SPN, "early" and "traditional"; and encourage clinicians to consider SPN for appropriate patients.

Monitoring Response to Home Parenteral Nutrition in Adult Cancer Patients

“…PN can be total (TPN) when patients have no or negligible oral/enteral nutrition (<200 kcal/day) [ 22 ] or supplemental (SPN) when PN is added to oral/enteral nutrition to achieve protein and energy requirements [ 23 ].…”

Terapia nutricional a pacientes con insuficiencia respiratoria aguda y ventilación mecánica no invasiva: revisión narrativa de la literatura

“…Independiente del riesgo nutricional, la NP suplementaria debería iniciarse utilizando la vía de acceso más adecuada para el paciente (central o periférica) al tercer día de no lograr un aporte de 60 % de los requerimientos energéticos por vía oral o enteral. Por supuesto, se debe considerar la evolución, estado de salud y pronóstico del paciente (48) . La terapia nutricional tardía, después del día 8 según lo estipulado por ASPEN (35) se asocia a mayor déficit energético y mayores complicaciones.…”

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“…Independiente del riesgo nutricional, la NP suplementaria debería iniciarse utilizando la vía de acceso más adecuada para el paciente (central o periférica) al tercer día de no lograr un aporte de 60 % de los requerimientos energéticos por vía oral o enteral. Por supuesto, se debe considerar la evolución, estado de salud y pronóstico del paciente (48) . La terapia nutricional tardía, después del día 8 según lo estipulado por ASPEN (35) se asocia a mayor défi cit energético y mayores complicaciones.…”