title: Does delaying early intravenous fat emulsion during parenteral nutrition reduce infections during critical illness?
abstract: BACKGROUND
  Because early administration of intravenous fat emulsions (IVFEs) has been linked to infectious complications in trauma patients, we began withholding IVFE for the first seven to ten days of parenteral nutrition (PN) in all surgical intensive care unit (SICU) patients. Prior to this, IVFE had been infused from the start of PN.
  
  
  OBJECTIVE
  To evaluate the influence of delaying IVFE on infectious complications in SICU patients.
  
  
  METHODS
  Retrospective review from October 2006 to June 2009 of SICU patients before and after a change in IVFE practice patterns in a 44-bed SICU at an academic medical center. Adult patients who received PN for more than six days were included. Patients receiving PN with IVFE prior to SICU admission or being given other lipid emulsion therapy were excluded. The data collected included demographics, transfusion requirements, nutritional assessments, and laboratory and microbiology results. The infectious complications studied were pneumonia, urinary tract infections (UTIs), blood stream infections (BSIs), and catheter-related blood stream infections (CRBSIs).
  
  
  RESULTS
  Sixty-four patients received IVFE; 30 at initiation of PN and 34 starting after seven to ten days. The two groups had similar demographics, severity of illness, transfusion requirements, and duration of PN. Infectious complications occurred in 65.6% of patients (63.3% having immediate IVFE vs. 67.6% having delayed IVFE; p = 0.79). Seventeen patients developed BSI or CRBSI while receiving PN (26.7% immediate IVFE vs. 26.5% delayed IVFE; p > 0.99). The mortality rates were 63.3% and 55.9%, respectively (p = 0.63).
  
  
  CONCLUSIONS
  Withholding IVFE therapy during the first seven to ten days of PN did not influence infectious complications or the mortality rate in SICU patients. The benefits of delaying IVFE therefore may not be generalizable to all critically ill patients.
authors.affiliation: Department of Pharmacy, The Ohio State University Medical Center, 410 West Tenth Avenue, Columbus, OH, USA. Gerlach.6@osu.edu
authors.forename: Anthony T
authors.initials: AT
authors.lastname: Gerlach
authors.forename: Sheela
authors.initials: S
authors.lastname: Thomas
authors.forename: Claire V
authors.initials: CV
authors.lastname: Murphy
authors.forename: P Stanislaw P
authors.initials: PS
authors.lastname: Stawicki
authors.forename: Melissa L
authors.initials: ML
authors.lastname: Whitmill
authors.forename: Lydia
authors.initials: L
authors.lastname: Pourzanjani
authors.forename: Steven M
authors.initials: SM
authors.lastname: Steinberg
authors.forename: Charles H
authors.initials: CH
authors.lastname: Cook
mesh_terms: D000328:Adult; D000368:Aged; D055499:Catheter-Related Infections / Q000453:epidemiology / Q000401:mortality / Q000517:prevention & control; D016638:Critical Illness / Q000628:therapy*; D003428:Cross Infection / Q000453:epidemiology* / Q000401:mortality / Q000517:prevention & control; D005217:Fat Emulsions, Intravenous / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010288:Parenteral Nutrition / Q000379:methods*; D011014:Pneumonia / Q000453:epidemiology / Q000401:mortality / Q000517:prevention & control; D012189:Retrospective Studies; D013997:Time Factors; D014552:Urinary Tract Infections / Q000453:epidemiology / Q000401:mortality / Q000517:prevention & control; D014947:Wounds and Injuries / Q000150:complications* / Q000628:therapy*
chemical_list: D005217:Fat Emulsions, Intravenous