Parenteral nutrition: a clear and present danger unabated by tight glucose control.
BACKGROUND
The infectious risks of parenteral nutrition (PN) in critical illness are well described, although most literature predates tight glucose control (TGC) practice. The authors hypothesized that PN-related complications are ameliorated by TGC and are equivalent to those in enteral nutrition (EN) patients.


METHODS
A prospective cohort study of patients admitted to the surgical intensive care unit was conducted, comparing PN and EN patients. TGC target was 80 to 110 mg/dL. Univariate and multivariate logistic regression was used to explore the association between infectious outcomes and PN use.


RESULTS
One hundred fifty-five patients were studied. Mean daily glucose values were lower for the PN group than for the EN patients (118.2 vs 125.6 mg/dL, P = .002). Nonetheless, the incidence of bloodstream infection and catheter-related bloodstream infection was significantly associated with the administration of PN. In a multivariate logistic regression model, PN was associated with a >4-fold increase in the odds of having a catheter-related bloodstream infection (odds ratio, 4.48; 95% confidence interval, 1.14-17.49; P = .03).


CONCLUSIONS
Despite the successful implementation of TGC, PN is still a significant risk factor for infectious complications among surgical intensive care unit patients.
Matsushima
Kazuhide
K
Department of Surgery, University of Texas Southwestern Medical Center, Dallas, USA. kmatsushima@hmc.psu.edu
Cook
Alan
A
Tyner
Tracy
T
Tollack
Lauren
L
Williams
Richard
R
Lemaire
Susan
S
Friese
Randall
R
Frankel
Heidi
H
D016470:Bacteremia / Q000209:etiology*; D001786:Blood Glucose / Q000378:metabolism*; D002408:Catheters, Indwelling / Q000009:adverse effects*; D016638:Critical Illness; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010288:Parenteral Nutrition / Q000009:adverse effects*; D011446:Prospective Studies
D001786:Blood Glucose