Indications for administration of parenteral nutrition in adults

Abstract

Background: Who benefits from parenteral nutrition (PN) has been the subject of much debate and 4 recent meta-analyses.

Methods: We reviewed the 4 meta-analyses that examined the prospective, randomized, clinical trials (PRCT) that compared PN with no nutrition support (standard care) for design, study population, outcomes evaluated, and results.

Results: Overall, a total of 113 PRCT were included in the 4 meta-analyses; however, only 4 studies were included in all of them. Despite the differences in populations studied and outcomes evaluated, some similarities emerged: (1) PN does not affect mortality; (2) PN does not reduce complications in normally nourished patients; (3) in malnourished patients, PN demonstrated a trend for reduced infections and complication rates; and (4) PN reduced postoperative complications in patients having surgery for cancer of the esophagus or stomach.

Conclusion: PN does not appear to be beneficial for most hospitalized patients. Among those with malnutrition or with upper gastrointestinal cancer, benefits may exist; however, these were influenced by quality of the study and year of publication.