Is parenteral nutrition really that risky in the intensive care unit?
OBJECTIVE
Although enteral nutrition is now the mainstay of nutrition delivery within intensive care, there is a blind faith in its benefits and a disregard of its risks. This has led to the belief that parenteral nutrition is no longer required as it is fraught with risks to the patient. This review attempts to dispel these myths and compares and contrasts the risks of enteral nutrition with those of parenteral nutrition in the critically ill.


RESULTS
A greater appreciation of the failings and risks associated with the delivery of enteral nutrition combined with improvements in the formulation and use of parenteral nutrition help explain why parenteral nutrition is not as risky as some have believed. Recent evidence has suggested that enteral nutrition in a few selected circumstances may even carry a higher mortality risk. Real outcome benefits have been described with the new glutamine-containing parenteral nutrition formulations.


CONCLUSIONS
Parenteral nutrition remains a valuable yet challenging weapon in our therapeutic armoury in the presence of gastrointestinal feed intolerance or failure. However, it should be used wisely and not indiscriminately because the majority of intensive care unit patients with a fully functional gastrointestinal tract may be fed safely with enteral nutrition.
Griffiths
Richard D
RD
Intensive Care Research Group, Department of Medicine, Duncan Building, UCD, University of Liverpool, Daulby Street, Liverpool L69 3GA, UK. rdg@liverpool.ac.uk
D003422:Critical Care / Q000379:methods*; D016638:Critical Illness / Q000628:therapy*; D004750:Enteral Nutrition; D006801:Humans; D007362:Intensive Care Units; D010288:Parenteral Nutrition / Q000009:adverse effects; D012307:Risk Factors