Maximizing efficacy from parenteral nutrition in critical care: appropriate patient populations, supplemental parenteral nutrition, glucose control, parenteral glutamine, and alternative fat sources.
The gastrointestinal tract is the preferred route for nutritional support in hospitalized patients. Patients with a functioning gastrointestinal tract, including those with pancreatitis or inflammatory bowel disease and those receiving chemotherapy, should be fed enterally. Parenteral nutrition (PN) should be limited to patients with gastrointestinal failure, including those with short gut syndrome, high-output fistula, prolonged ileus, or bowel obstruction. PN is associated with numerous complications, most notably increased risk of serious infection. Emerging data suggest that immunologic complications of PN may result from hyperglycemia and use of n-6 polyunsaturated fatty acids. Safety may be improved with a low-calorie formula and ensuring tight glycemic control with an insulin protocol. A lipid emulsion containing fish oil, olive oil, or both should replace soybean-containing emulsions. Supplemental glutamine, 0.2 g/kg/d to 0.5 g/kg/d, has been shown to reduce the risk of infection and to improve glycemic control.
Marik
Paul E
PE
Pulmonary and Critical Care Medicine, Thomas Jefferson University, 834 Walnut Street, Suite 650, Philadelphia, PA, 19107, USA. Paul.marik@jefferson.edu
D001786:Blood Glucose / Q000378:metabolism*; D003422:Critical Care / Q000379:methods*; D016638:Critical Illness / Q000628:therapy*; D004041:Dietary Fats / Q000627:therapeutic use*; D005973:Glutamine / Q000627:therapeutic use*; D006801:Humans; D010288:Parenteral Nutrition / Q000379:methods* / Q000639:trends; D018579:Patient Selection; D016896:Treatment Outcome
D001786:Blood Glucose; D004041:Dietary Fats; D005973:Glutamine