Total parenteral nutrition: potion or poison?
The role of nutritional support in clinical care has burgeoned over the past 40 y. Initially, total parenteral nutri-tion (TPN) was considered to be the standard of care. Later, the concept that enteral nutrition (EN) promoted gut function and prevented the translocation of intestinal bacteria resulted in EN becoming the standard of care. Furthermore, TPN was consid-ered to be a dangerous form of therapy. Critical review of the data suggests that, in humans, TPN does not cause mucosal atrophy or increase bacterial translocation. Increased sepsis with TPN can be ascribed to overfeeding; the dangers of TPN-induced complications have been exaggerated. TPN is an equally effective alternative to EN when a risk of malnutrition is present and EN is not tolerated or when gut failure is present.
Jeejeebhoy
K N
KN
University of Toronto and St Michael's Hospital, Toronto, Ontario, Canada. jeebhoy@utoronto.ca
D000208:Acute Disease; D001284:Atrophy; D018988:Bacterial Translocation; D002404:Catheterization / Q000009:adverse effects; D016638:Critical Illness; D004750:Enteral Nutrition / Q000009:adverse effects; D006801:Humans; D015212:Inflammatory Bowel Diseases / Q000150:complications / Q000628:therapy; D007413:Intestinal Mucosa / Q000473:pathology; D009748:Nutrition Disorders / Q000517:prevention & control* / Q000628:therapy*; D010195:Pancreatitis / Q000150:complications / Q000628:therapy; D010289:Parenteral Nutrition, Total / Q000009:adverse effects; D011182:Postoperative Care / Q000009:adverse effects; D016032:Randomized Controlled Trials as Topic; D018805:Sepsis / Q000209:etiology*; D016896:Treatment Outcome; D014947:Wounds and Injuries / Q000150:complications / Q000628:therapy