title: Parenteral nutrition in the ICU setting: need for a shift in utilization.
abstract: OBJECTIVE
  The difficulties to feed the patients adequately with enteral nutrition alone have drawn the attention of the clinicians toward the use of parenteral nutrition, although recommendations by the recent guidelines are conflicting. This review focuses on the intrinsic role of parenteral nutrition, its new indication, and modalities of use for the critically ill patients.
  
  
  RESULTS
  A recent trial demonstrated that selecting either parenteral nutrition or enteral nutrition for early nutrition has no impact on clinical outcomes. However, it must be acknowledged that the risk of relative overfeeding is greater when using parenteral nutrition and the risk of underfeeding is greater when using enteral nutrition because of gastrointestinal intolerance. Both overfeeding and underfeeding in the critically ill patients are associated with deleterious outcomes. Thus, early and adequate feeding according to the specific energy needs can be recommended as the optimal feeding strategy.
  
  
  CONCLUSIONS
  Parenteral nutrition can be used to substitute or supplement enteral nutrition, if adequately prescribed. Testing for enteral nutrition tolerance during 2-3 days after ICU admission provides the perfect timing to start parenteral nutrition, if needed. In case of absolute contraindication for enteral nutrition, consider starting parenteral nutrition carefully to avoid overfeeding.
authors.affiliation: aDepartment of Emergency and Critical Care Medicine, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuou-ku, Chiba City, Chiba, Japan bDepartment of Anaesthesiology, General Intensive Care and Pain Control, Division of Cardiac, Thoracic, Vascular Anaesthesia and Intensive Care, Medical University Vienna, Vienna, Austria cNutrition Unit, Geneva University Hospital, Geneva, Switzerland.
authors.forename: Taku
authors.initials: T
authors.lastname: Oshima
authors.forename: Michael
authors.initials: M
authors.lastname: Hiesmayr
authors.forename: Claude
authors.initials: C
authors.lastname: Pichard
mesh_terms: D016638:Critical Illness / Q000628:therapy*; D002149:Energy Intake; D004750:Enteral Nutrition / Q000379:methods; D006801:Humans; D007362:Intensive Care Units; D010288:Parenteral Nutrition / Q000379:methods*; D016896:Treatment Outcome