Hostname: page-component-78c5997874-t5tsf Total loading time: 0 Render date: 2024-11-20T02:45:49.341Z Has data issue: false hasContentIssue false
  • English
  • Français

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

Published online by Cambridge University Press:  28 February 2007

D. K. Heyland
D. K. Heyland
Affiliation:
Department of Medicine and Department of Community Health and Epidemiology, Queen's University Faculty of Health Sciences, Kingston, Ontario K7L 2V7, Canada
Rights & Permissions [Opens in a new window]

Abstract

Core share and HTML view are not available for this content. However, as you have access to this content, a full PDF is available via the ‘Save PDF’ action button.

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.

Keywords

Parenteral nutritionEnteral nutritionCritically-ill
Type
Meeting Report
Information
Proceedings of the Nutrition Society , Volume 59 , Issue 3 , August 2000 , pp. 457 - 466
Copyright
Copyright © The Nutrition Society 2000

References

Abel, RM, Fischer, JE, Buckley, MJ, Barnett, GO & Austen, WG (1976) Malnutrition in cardiac surgical patients. Archives of Surgery 111, 45–50.CrossRefGoogle ScholarPubMed
Adams, S, Dellinger, EP, Wertz, MJ, Orekovich, MR, Simonowitz, D & Johansen, K (1986) Enteral versus parenteral nutritional support following laparotomy for trauma: A randomized prospective trial. Journal of Trauma 26, 882–890.CrossRefGoogle ScholarPubMed
Askanzi, J, Starker, PM, Olsson, C, Hensels, TW, Lockart, SH, Kinney, JM & Lasala, PA (1986) Effect of immediate postoperative nutritional support on length of hospitalization. Annals of Surgery 203, 236–239.CrossRefGoogle Scholar
American Society for Parenteral and Enteral Nutrition Board of Directors (1993) Guidelines for the use of parenteral and enteral nutrition in adult and pediatric patients. Journal of Parental and Enteral Nutrition 17, 1SA–52SA.Google Scholar
Baigrie, RJ, Devitt, PG & Watkin, DS (1996) Enteral versus parenteral nutrition after oesophagogastric surgery: A prospective randomized comparison. Australian and New Zealand Journal of Surgery 66, 668–670.CrossRefGoogle ScholarPubMed
Barton, RG (1994) Nutrition support in critical illness. Nutrition in Clinical Practice 9, 127–139.CrossRefGoogle ScholarPubMed
Basttistella, FD, Widergren, JT, Anderson, JT, Siepler, JK, Weber, JC & MacColl, K (1997) A prospective, randomized trial of intravenous fat emulsion administration in trauma victims requiring total parenteral nutrition. Journal of Trauma 43, 52–58.CrossRefGoogle Scholar
Bellatone, R, Doglietto, GB, Bossola, M, Pacelli, F, Negro, F, Sofo, L & Crucitti, F (1988) Preoperative parenteral nutrition in the high risk surgical patient. Journal of Parenteral and Enteral Nutrition 12, 195–197.CrossRefGoogle Scholar
Borzotta, AP, Pennings, J, Papasadero, B, Paxton, J, Mardesic, S, Barzotta, R, Parrott, A & Bledsoe, F (1994) Enteral versus parenteral nutrition after severe closed head injury. Journal of Trauma 37, 459–468.CrossRefGoogle ScholarPubMed
Bower, RH, Talamini, MA, Sax, HC (1986) Postoperative enteral nutrition vs parenteral nutrition. A randomized controlled trial. Archives of Surgery 121, 1040–1045.CrossRefGoogle ScholarPubMed
Brennan, MF, Pesters, PWT, Posner, M, Quesada, O & Shike, M (1994) A prospective randomized trial of total parenteral nutrition after major pancreatic resection for malignancy. Annals of Surgery 220, 436–444.CrossRefGoogle ScholarPubMed
Cerra, FB, Benitez, RB, Blackburn, GL, Irwin, RS, Jeejeebhoy, K, Katz, DP, Pingleton, SK, Pomposelli, J, Roinbeau, JL, Shronts, E, Wolfe, RR & Zaloga, GP (1997) Applied nutrition in ICU patients: A consensus statement of the American College of Chest Physicians. Chest 111, 769–778.CrossRefGoogle ScholarPubMed
Cerra, FB, McPherson, JP, Konstantinides, FN, Konstantinides, NN & Teasley, KM (1988) Enteral nutrition does not prevent multiple organ failure syndrome (MOFS) after sepsis. Surgery 104, 727–733.Google Scholar
Chandra, RK (1983) Nutrition, immunity and infection: present knowledge and future direction. Lancet i, 688–691.CrossRefGoogle Scholar
Chiarelli, AG, Ferrarello, S, Piccioli, A, Abate, A, Chini, G, Berioli, MB, Peris, A & Lippi, R (1996) Total enteral nutrition versus mixed enteral and parenteral nutrition in patients in an intensive care unit. Minerva Anesthesiology 62, 1–7.Google Scholar
Dark, DS & Pingleton, SK (1993) Nutrition and nutritional support in critically ill patients. Journal of Intensive Care Medicine 8, 16–33.CrossRefGoogle Scholar
Deegan, H, Dent, S, Heyland, DK, Keefe, L & Drover, JW (1999) Supplemental parenteral nutrition in the critically ill patient: A retrospective study. Clinical Intensive Care 10, 131–136.CrossRefGoogle Scholar
Dempsey, DT, Mullen, JL & Buzby, GP (1988) The link between nutritional status and clinical outcome: can nutritional intervention modify it? American Journal of Clinical Nutrition 47, 352–356.CrossRefGoogle Scholar
Dudrick, SJ, Wilmore, DW, Vars, HM & Rhoads, J (1968) Long-term total parenteral nutrition with growth, development and a positive nitrogen balance. Surgery 64, 134–142.Google Scholar
Dunham, CM, Frankenfield, D, Belzberg, H (1994) Gut failure – predictor of or contributor to mortality in mechanically ventilated blunt trauma patients? Journal of Trauma 37, 30–34.CrossRefGoogle ScholarPubMed
Fan, S, Lo, C & Lai, ECS (1994) Perioperative nutritional support in patients undergoing hepatectomy for hepatocellular carcinoma. New England Journal of Medicine 331, 1547–1552.CrossRefGoogle ScholarPubMed
Fan, ST, Lau, WY, Wong, KK & Chan, YPM (1989) Preoperative parenteral nutrition in patients with oesophageal cancer: a prospective randomized clinical trial. Clinical Nutrition 8, 23–27.CrossRefGoogle Scholar
Figueras, J, Rafecao, A, Bianchi, A, Hernandez, F, Pi, F & Colomer, J (1988) Postoperative hypocaloric parenteral nutrition. Acta Chirurgica Scandinavica 154, 435–438.Google ScholarPubMed
Fleming, TR & DeMets, DL (1996) Surrogate end points in clinical trials: Are we being misled? Annals of Internal Medicine 125, 605–613.CrossRefGoogle ScholarPubMed
Freund, H, Hoover, HC, Atamian, S & Fischer, JE (1979) Infusion of the branched chain amino acids in postoperative patients. Annals of Surgery 190, 18–23.CrossRefGoogle ScholarPubMed
Galanos, AN, Pieper, CF, Kussin, PS, Winchell, MT, Fulkerson, WJ, Harrell FE, Jr, Teno, JM, Layde, P, Connors, AF Jr, Phillips, RS & Wenger, NS (1997) Relationship of body mass index to subsequent mortality among seriously ill hospitalized patients. Critical Care Medicine 25, 1962–1968.CrossRefGoogle ScholarPubMed
Gys, T, Peeters, R & Hubens, A (1990) The value of short-term peripheral parenteral nutrition after colorectal surgery: a comparative study with conventional postoperative intravenous fluid. Acta Chirurgica Belgica 90, 234–239.Google ScholarPubMed
Hadfield, RJ, Sinclair, DG, Houldsworth, PE & Evans, TW (1995) Effects of enteral and parenteral nutrition on gut mucosal permeability in the critically ill. American Journal of Respiratory Critical Care Medicine 152, 1545–1548.CrossRefGoogle ScholarPubMed
Hadley, MN, Grahm, TW, Harrington, T, Schiller, WR, McDermott, MK & Posillico, DB (1986) Nutritional support and neurotrauma: A critical review of early nutrition in forty-five acute head injury patients. Neurosurgery 19, 367–373.CrossRefGoogle ScholarPubMed
Hamaoui, E, Lefkowitz, R, Olender, L, Krasnopolsky-Levine, E, Favale, M, Webb, H & Hoover, EL (1990) Enteral nutrition in the early postoperative period: A new semi-elemental formula versus total parenteral nutrition. Journal of Parental and Enteral Nutrition 14, 501–507.CrossRefGoogle ScholarPubMed
Herndon, DN, Barrow, RE, Stein, M, Linares, H, Rutan, TC, Rutan, R & Abston, S (1989) Increased mortality with intravenous supplemental feeding in severely burned patients. Journal of Burn Care and Rehabilitation 10, 309–313.CrossRefGoogle ScholarPubMed
Herrmann, FR, Safran, C, Levkoff, SE & Minaker, KL (1992) Serum albumin level on admission as a predictor of death, length of stay, and readmission. Archives of Internal Medicine 152, 125–130.CrossRefGoogle ScholarPubMed
Heyland, DK, Cook, DJ & Guyatt, G (1993) Enteral nutrition in the critically-ill patient: a review. Intensive Care Medicine 19, 435–442.CrossRefGoogle Scholar
Heyland, DK, MacDonald, S, Keefe, L & Drover, JW (1998) Total parenteral nutrition in the critically ill patient: A meta-analysis. Journal of the American Medical Association 280, 2013–2019.CrossRefGoogle ScholarPubMed
Holter, AR & Fischer, JE (1977) The effects of perioperative hyperalimentation on complications in patients with carcinoma and weight loss. Journal of Surgical Research 23, 31–34.CrossRefGoogle ScholarPubMed
Hwang, TL, Mou, SC & Chen, MF (1993) The importance of a source of sufficient protein in postoperative hypocaloric partial parenteral nutritional support. Journal of Parenteral and Enteral Nutrition 17, 254–256.CrossRefGoogle Scholar
Jimenez, FJ, Leyba, CO, Jimenez, LMJ, Valdecasas, MSG & Montro, JG (1995) Study of hypocaloric peripheral parenteral nutrition in postoperative patients. Clinical Nutrition 14, 88–96.CrossRefGoogle Scholar
Kalfarentzos, F, Kehagias, J, Mead, N, Kokkinis, K & Gogos, CA (1997) Enteral nutrition is superior to parenteral nutrition in severe acute pancreatitis: Results of a randomized prospective trial. British Journal of Surgery 84, 1665–1669.Google ScholarPubMed
Keefe, L, Drover, JW & Heyland, DK (2000) Use of a multidisciplinary, multifaceted approach to aligning nutrition practice with a ‘best practice in a critical care’ setting: Results of a seven year study. Journal of Parental and Enteral Nutrition (In the Press).Google Scholar
Kudsk, KA, Croce, MA, Fabian, TC, Minard, G, Tolley, EA, Poret, A, Kuhl, MR & Brown, RO (1992) Enteral versus parenteral feeding. Annals of Surgery 215, 503–513.CrossRefGoogle ScholarPubMed
Lim, STK, Choa, RG, Lam, KH, Wong, J & Ong, GB (1981) Total parenteral nutrition versus gastrostomy in the preoperative preparation of patients with carcinoma of the oesophagus. British Journal of Surgery 68, 69–72.CrossRefGoogle ScholarPubMed
McClave, SA, Greene, L, Snider, H, Makk, LJK, Cheadle, WG, Owens, NA, Dukes, LG & Goldsmith, LJ (1997) Comparison of the safety of early enteral vs parenteral nutrition in mild acute pancreatitis. Journal of Parenteral and Enteral Nutrition 21, 14–20.CrossRefGoogle ScholarPubMed
Meguid, MM, Curtas, MS & Meguid, V (1988) Effects of pre-operative TPN on surgical risk preliminary status report. British Journal of Clinical Practice 42, Suppl., 53–58.Google Scholar
Moore, FA, Feliciano, DV, Andrassy, RJ, McArdle, AH, McL, Booth F, Morgenstein-Wagner, TB, Kellum, JM Jr, Welling, RE & Moore, EE (1992) Early enteral feeding, compared with parenteral, reduces postoperative septic complications. The results of a meta-analysis. Annals of Surgery 216, 172–183.CrossRefGoogle ScholarPubMed
Moore, FA, Moore, EE, Jones, TN, McCroskey, BL & Petersen, VM (1989) TEN versus TPN following major abdominal trauma – reduced septic morbidity. Journal of Trauma 29, 916–923.CrossRefGoogle ScholarPubMed
Müller, JM, Brenner, U, Dienst, C & Pichlmaier, (1982) Preoperative parenteral feeding in patients with gastrointestinal carcinoma. Lancet i, 68–71.CrossRefGoogle Scholar
Müller, JM, Keiler, HW, Brenner, U, Walter, M & Holzmüller, W (1986) Indications and effects of preoperative parenteral nutrition. World Journal of Surgery 10, 53–63.CrossRefGoogle ScholarPubMed
Ott, L, Young, B, Phillips, R, McClain, C, Adams, L, Dempsey, R, Tibbs, P & Ryo, UY (1991) Altered gastric emptying in the head-injured patient: relationship to feeding intolerance. Journal of Neurosurgery 74, 738–742.CrossRefGoogle ScholarPubMed
Preiser, JC, Berre, J, Carpentier, Y, Jolliet, P, Pichard, C, Van Gossum, A & Vincent, JL (1999) Management of nutrition in European intensive care units: results of a questionnaire. Intensive Care Medicine 25, 95–101.CrossRefGoogle ScholarPubMed
Rapp, RP, Young, B, Twyman, D, Bivins, BA, Haack, D, Tibbs, PA & Bean, JR (1983) The favorable effect of early parenteral feeding on survival in head-injured patients. Journal of Neurosurgery 58, 906–912.CrossRefGoogle ScholarPubMed
Reilly, J, Mehta, R, Teperman, L, Cemaj, S, Tzakis, A, Yanaga, K, Ritter, P, Rezak, A & Makowka, L (1990) Nutritional support after liver transplantation: A randomized prospective study. Journal of Parenteral and Enteral Nutrition 14, 386–391.CrossRefGoogle ScholarPubMed
Reinhardt, GF, Myscofski, JW, Wilkens, DB, Dobrin, PB, Mangan JE, Jr & Stannard, RT (1980) Incidence and mortality of hypoalbumenic patients in hospitalized veterans. Journal of Parental and Enteral Nutrition 4, 357–359.CrossRefGoogle ScholarPubMed
Sackett, DL (1989) Rules of evidence and clinical recommendations on the use of antithrombotic agents. Chest 95, 2S-4S.CrossRefGoogle ScholarPubMed
Sacks, HS, Chalmers, TC & Smith H, Jr (1983) Randomized versus historical assignment in controlled trials. New England Journal of Medicine 309, 1353–1361.Google Scholar
Sako, K, Lore, JM, Kaufman, S, Razack, MS, Bakamijan, V & Reese, P (1981) Parenteral hyperalimentation in surgical patients with head and neck cancer: A randomized study. Journal of Surgical Oncology 16, 391–402.CrossRefGoogle ScholarPubMed
Sandström, R, Drott, , Hyttander, A, Arfuidsson, B, Scherstén, T, Wickström, I & Lundholm, K (1993) The effect of postoperative intravenous feeding (TPN) on the outcome following major surgery evaluated in a randomized study. Annals of Surgery 217, 185–195.CrossRefGoogle ScholarPubMed
Sax, HC, Warner, BW, Talamini, MA, Hamilton, FN, Bell RH, Jr, Fischer, JE & Bower, RH (1987) Early total parenteral nutrition in acute pancreatitis: Lack of beneficial effects. American Journal of Surgery 153, 117–123.CrossRefGoogle ScholarPubMed
Saxe, JM, Ledgerwood, AM, Lucas, CE & Lucas, WF (1994) Lower esophageal sphincter dysfunction precludes safe gastric feeding after head injury. Journal of Trauma 37, 581–584.CrossRefGoogle ScholarPubMed
Schroeder, D, Gillanders, L, Mahr, K & Hill, GL (1991) Effects of immediate postoperative enteral nutrition on body composition, muscle function, and wound healing. Journal of Parental and Enteral Nutrition 15, 376–383.CrossRefGoogle ScholarPubMed
Seidner, DL, Mascoli, EA, Istfan, NW, Porter, KA, Selleck, K, Blackburn, GL & Bistrian, BR (1989) Effects of long-chain triglyceride emulsions on reticuloendothelial system function in humans. Journal of Parental and Enteral Nutrition 13, 614–619.CrossRefGoogle ScholarPubMed
Smith, RC & Hartemink, RH (1988) Improvement of nutritional measures during preoperative parenteral nutrition in patients selected by the prognostic nutritional index: A randomized controlled trial. Journal of Parental and Enteral Nutrition 12, 587–591.CrossRefGoogle ScholarPubMed
The Veterans Affairs Total Parenteral Nutrition Cooperative Study Group (1991) Perioperative total parenteral nutrition in surgical patients. New England Journal of Medicine 325, 525–532.CrossRefGoogle Scholar
Thompson, BR, Julian, TB & Stremple, JW (1981) Perioperative total parenteral nutrition in patients with gastrointestinal cancer. Journal of Surgical Research 30, 497–500.CrossRefGoogle ScholarPubMed
Von Meyenfeldt, MF, Meijerink, WJHJ, Rouflart, MMJ, Builmaassen, MTHJ & Soeters, PB (1992) Perioperative nutritional support: a randomized clinical trial. Clinical Nutrition 11, 180–186.CrossRefGoogle Scholar
Wicks, C, Somasundaram, S, Bjamason, I, Menzies, IS, Routley, D, Potter, D, Tan, KC & Williams, R (1994) Comparison of enteral feeding and total parenteral nutrition after liver transplantation. Lancet 334, 837–840.CrossRefGoogle Scholar
Windsor, ACJ, Kanwar, S, Li, AGK, Barnes, E, Guthrie, JA, Spark, JI, Welsh, F, Guillou, PJ & Reynolds, JV (1998) Compared with parenteral nutrition, enteral feeding attentuates the acute phase response and improves disease severity in acute pancreatitis. Gut 42, 431–435.CrossRefGoogle Scholar
Windsor, JA & Hill, GL (1988) Risk factors of postoperative pneumonia: the importance of protein depletion. Annals of Surgery 208, 209–214.CrossRefGoogle ScholarPubMed
Woolfson, AMJ & Smith, JAR (1989) Elective nutritional support after major surgery: a prospective randomized trial. Clinical Nutrition 8, 15–21.CrossRefGoogle Scholar
Yamada, N, Koyama, H, Hioki, K, Yamada, T & Yamamoto, M (1983) Effect of postoperative total parenteral nutrition (TPN) as an adjunct to gastrectomy for advanced gastric carcinoma. British Journal of Surgery 70, 267–274.CrossRefGoogle ScholarPubMed
Young, B, Ott, L, Twyman, , Norton, J, Rapp, R, Tibbs, P, Haack, D, Brivins, B & Dempsey, R (1987) The effect of nutritional support on outcome from severe head injury. Journal of Neurosurgery 67, 668–676.CrossRefGoogle ScholarPubMed