Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Observational Study
. 2023 Nov 3;15(21):4665.
doi: 10.3390/nu15214665.

Parenteral Nutrition: Current Use, Complications, and Nutrition Delivery in Critically Ill Patients

Juan Carlos Lopez-Delgado  1   2 , Teodoro Grau-Carmona  3   4 , Esther Mor-Marco  5 , Maria Luisa Bordeje-Laguna  5 , Esther Portugal-Rodriguez  6 , Carol Lorencio-Cardenas  7 , Paula Vera-Artazcoz  8 , Laura Macaya-Redin  9 , Beatriz Llorente-Ruiz  10 , Rayden Iglesias-Rodriguez  11 , Diana Monge-Donaire  12 , Juan Francisco Martinez-Carmona  13 , Laura Sanchez-Ales  14 , Angel Sanchez-Miralles  15 , Monica Crespo-Gomez  16 , Cristina Leon-Cinto  17 , Jose Luis Flordelis-Lasierra  3   4 , Lluis Servia-Goixart  18   19 , On Behalf Of The Enpic Study Group
Affiliations
Observational Study

Parenteral Nutrition: Current Use, Complications, and Nutrition Delivery in Critically Ill Patients

Juan Carlos Lopez-Delgado et al. Nutrients. .

Abstract

Background: Parenteral nutrition (PN) is needed to avoid the development of malnutrition when enteral nutrition (EN) is not possible. Our main aim was to assess the current use, complications, and nutrition delivery associated with PN administration in adult critically ill patients, especially when used early and as the initial route. We also assessed the differences between patients who received only PN and those in whom EN was initiated after PN (PN-EN).

Methods: A multicenter (n = 37) prospective observational study was performed. Patient clinical characteristics, outcomes, and nutrition-related variables were recorded. Statistical differences between subgroups were analyzed accordingly.

Results: From the entire population (n = 629), 186 (29.6%) patients received PN as initial nutrition therapy. Of these, 74 patients (11.7%) also received EN during their ICU stay (i.e., PN-EN subgroup). PN was administered early (<48 h) in the majority of patients (75.3%; n = 140) and the mean caloric (19.94 ± 6.72 Kcal/kg/day) and protein (1.01 ± 0.41 g/kg/day) delivery was similar to other contemporary studies. PN showed similar nutritional delivery when compared with the enteral route. No significant complications were associated with the use of PN. Thirty-two patients (43.3%) presented with EN-related complications in the PN-EN subgroup but received a higher mean protein delivery (0.95 ± 0.43 vs 1.17 ± 0.36 g/kg/day; p = 0.03) compared with PN alone. Once adjusted for confounding factors, patients who received PN alone had a lower mean protein intake (hazard ratio (HR): 0.29; 95% confidence interval (CI): 0.18-0.47; p = 0.001), shorter ICU stay (HR: 0.96; 95% CI: 0.91-0.99; p = 0.008), and fewer days on mechanical ventilation (HR: 0.85; 95% CI: 0.81-0.89; p = 0.001) compared with the PN-EN subgroup.

Conclusion: The parenteral route may be safe, even when administered early, and may provide adequate nutrition delivery. Additional EN, when possible, may optimize protein requirements, especially in more severe patients who received initial PN and are expected to have longer ICU stays. NCT Registry: 03634943.

Keywords: complementary parenteral nutrition; critically ill patients; enteral nutrition; parenteral nutrition.

PubMed Disclaimer

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Study flow chart of patients included in the study.
Figure 2
Figure 2
Patterns of administration of parenteral (PN) and enteral nutrition (EN) in patients who initially received PN.
See this image and copyright information in PMC

References

    1. Lew C.C.H., Yandell R., Fraser R.J.L., Chua A.P., Chong M.F.F., Miller M. Association Between Malnutrition and Clinical Outcomes in the Intensive Care Unit: A Systematic Review. JPEN J. Parenter. Enter. Nutr. 2017;41:744–758. doi: 10.1177/0148607115625638. - DOI - PubMed
    1. Herrero Meseguer J.I., Lopez-Delgado J.C., Martínez García M.P. Recommendations for specialized nutritional-metabolic management of the critical patient: Indications, timing and access routes. Metabolism and Nutrition Working Group of the Spanish Society of Intensive and Critical Care Medicine and Coronary Units (SEMICYUC) Med. Intensiva (Engl. Ed.) 2020;44((Suppl. S1)):33–38. doi: 10.1016/j.medin.2019.12.017. - DOI - PubMed
    1. Vaquerizo Alonso C., Bordejé Laguna L., Fernández-Ortega J.F. Recommendations for specialized nutritional-metabolic management of the critical patient: Introduction, methodology and list of recommendations. Metabolism and Nutrition Working Group of the Spanish Society of Intensive and Critical Care Medicine and Coronary Units (SEMICYUC) Med. Intensiva. 2020;44((Suppl. S1)):1–14. doi: 10.1016/j.medin.2020.02.008. - DOI - PubMed
    1. Singer P., Blaser A.R., Berger M.M., Alhazzani W., Calder P.C., Casaer M.P., Hiesmayr M., Mayer K., Montejo J.C., Pichard C., et al. ESPEN guideline on clinical nutrition in the intensive care unit. Clin. Nutr. 2019;38:48–79. doi: 10.1016/j.clnu.2018.08.037. - DOI - PubMed
    1. Compher C., Bingham A.L., McCall M., Patel J., Rice T.W., Braunschweig C., McKeever L. Guidelines for the provision of nutrition support therapy in the adult critically ill patient: The American Society for Parenteral and Enteral Nutrition. JPEN J. Parenter. Enter. Nutr. 2022;46:12–41. doi: 10.1002/jpen.2267. - DOI - PubMed

Publication types