title: Combined enteral feeding and total parenteral nutritional support improves outcome in surgical intensive care unit patients.
abstract: BACKGROUND
  For intensive care unit (ICU) patients with gastrointestinal dysfunction and in need of total parenteral nutrition (TPN) support, the benefit of additional enteral feeding is not clear. This study aimed to investigate whether combined TPN with enteral feeding is associated with better outcomes in surgical intensive care unit (SICU) patients.
  
  
  METHODS
  Clinical data of 88 patients in SICU were retrospectively collected. Variables used for analysis included route and percentage of nutritional support, total caloric intake, age, gender, body weight, body mass index, admission diagnosis, surgical procedure, Acute Physiology and Chronic Health Evaluation (APACHE) II score, comorbidities, length of hospital stay, postoperative complications, blood glucose values and hospital mortality.
  
  
  RESULTS
  Wound dehiscence and central catheter infection were observed more frequently in the group of patients receiving TPN calories less than 90% of total calorie intake (p = 0.004 and 0.043, respectively). APACHE II scores were higher in nonsurvivors than in survivors (p = 0.001). More nonsurvivors received TPN calories exceeding 90% of total calorie intake and were in need of dialysis during ICU admission (p = 0.005 and 0.013, respectively). Multivariate analysis revealed that the percentage of TPN calories over total calories and APACHE II scores were independent predictors of ICU mortality in patients receiving supplementary TPN after surgery.
  
  
  CONCLUSIONS
  In SICU patients receiving TPN, patients who could be fed enterally more than 10% of total calories had better clinical outcomes than patients receiving less than 10% of total calorie intake from enteral feeding. Enteral feeding should be given whenever possible in severely ill patients.
authors.affiliation: Institute of Emergency and Critical Care Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC.
authors.forename: Min-Hui
authors.initials: MH
authors.lastname: Hsu
authors.forename: Ying E
authors.initials: YE
authors.lastname: Yu
authors.forename: Yueh-Miao
authors.initials: YM
authors.lastname: Tsai
authors.forename: Hui-Chen
authors.initials: HC
authors.lastname: Lee
authors.forename: Ying-Che
authors.initials: YC
authors.lastname: Huang
authors.forename: Han-Shui
authors.initials: HS
authors.lastname: Hsu
mesh_terms: D018806:APACHE; D000328:Adult; D000368:Aged; D004750:Enteral Nutrition; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010289:Parenteral Nutrition, Total; D011183:Postoperative Complications / Q000628:therapy*; D012189:Retrospective Studies