36f146bfadb29d2b59d83eb697757c1b  296603.pdf
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Title:           Parenteral Nutrition: Current Use, Complications, and Nutrition Delivery in Critically Ill Patients
Subject:         Background: Parenteral nutrition (PN) is needed to avoid the development of malnutrition when enteral nutrition (EN) is not possible. Our main aim was to assess the current use, complications, and nutrition delivery associated with PN administration in adult critically ill patients, especially when used early and as the initial route. We also assessed the differences between patients who received only PN and those in whom EN was initiated after PN (PN-EN). Methods: A multicenter (n = 37) prospective observational study was performed. Patient clinical characteristics, outcomes, and nutrition-related variables were recorded. Statistical differences between subgroups were analyzed accordingly. Results: From the entire population (n = 629), 186 (29.6%) patients received PN as initial nutrition therapy. Of these, 74 patients (11.7%) also received EN during their ICU stay (i.e., PN-EN subgroup). PN was administered early (<48 h) in the majority of patients (75.3%; n = 140) and the mean caloric (19.94  6.72 Kcal/kg/day) and protein (1.01  0.41 g/kg/day) delivery was similar to other contemporary studies. PN showed similar nutritional delivery when compared with the enteral route. No significant complications were associated with the use of PN. Thirty-two patients (43.3%) presented with EN-related complications in the PN-EN subgroup but received a higher mean protein delivery (0.95  0.43 vs 1.17  0.36 g/kg/day; p = 0.03) compared with PN alone. Once adjusted for confounding factors, patients who received PN alone had a lower mean protein intake (hazard ratio (HR): 0.29; 95% confidence interval (CI): 0.18–0.47; p = 0.001), shorter ICU stay (HR: 0.96; 95% CI: 0.91–0.99; p = 0.008), and fewer days on mechanical ventilation (HR: 0.85; 95% CI: 0.81–0.89; p = 0.001) compared with the PN-EN subgroup. Conclusion: The parenteral route may be safe, even when administered early, and may provide adequate nutrition delivery. Additional EN, when possible, may optimize protein requirements, especially in more severe patients who received initial PN and are expected to have longer ICU stays. NCT Registry: 03634943.
Keywords:        parenteral nutrition; enteral nutrition; complementary parenteral nutrition; critically ill patients
Author:          Juan Carlos Lopez-Delgado, Teodoro Grau-Carmona, Esther Mor-Marco, Maria Luisa Bordeje-Laguna, Esther Portugal-Rodriguez, Carol Lorencio-Cardenas, Paula Vera-Artazcoz, Laura Macaya-Redin, Beatriz Llorente-Ruiz, Rayden Iglesias-Rodriguez, Diana Monge-Donaire, Juan Francisco Martinez-Carmona, Laura Sanchez-Ales, Angel Sanchez-Miralles, Monica Crespo-Gomez, Cristina Leon-Cinto, Jose Luis Flordelis-Lasierra, Lluis Servia-Goixart and on behalf of the ENPIC Study Group
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 Date: 2024-07-17 02:36:44 CEST
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     Item: 
      Title: Introduction 
      Destination: section.1
     Item: 
      Title: Materials and Methods 
      Destination: section.2
      Children: 
       Item: 
        Title: Design and Setting 
        Destination: subsection.2.1
       Item: 
        Title: Data Collection and Study Endpoints 
        Destination: subsection.2.2
       Item: 
        Title: Statistical Analysis 
        Destination: subsection.2.3
     Item: 
      Title: Results 
      Destination: section.3
      Children: 
       Item: 
        Title: Population Included in the Study 
        Destination: subsection.3.1
       Item: 
        Title: Current Use and Complications Associated with PN 
        Destination: subsection.3.2
       Item: 
        Title: Assessment of Nutrition Delivery 
        Destination: subsection.3.3
       Item: 
        Title: Differences between the PN and PN-EN Subgroups 
        Destination: subsection.3.4
     Item: 
      Title: Discussion 
      Destination: section.4
     Item: 
      Title: Conclusions 
      Destination: section.5
     Item: 
      Title: Appendix A
      Destination: section.A.
     Item: 
      Title: References
      Destination: section.B.
   Info: 
    Title: Parenteral Nutrition: Current Use, Complications, and Nutrition Delivery in Critically Ill Patients
    Author: Juan Carlos Lopez-Delgado, Teodoro Grau-Carmona, Esther Mor-Marco, Maria Luisa Bordeje-Laguna, Esther Portugal-Rodriguez, Carol Lorencio-Cardenas, Paula Vera-Artazcoz, Laura Macaya-Redin, Beatriz Llorente-Ruiz, Rayden Iglesias-Rodriguez, Diana Monge-Donaire, Juan Francisco Martinez-Carmona, Laura Sanchez-Ales, Angel Sanchez-Miralles, Monica Crespo-Gomez, Cristina Leon-Cinto, Jose Luis Flordelis-Lasierra, Lluis Servia-Goixart and on behalf of the ENPIC Study Group
    Subject: Background: Parenteral nutrition (PN) is needed to avoid the development of malnutrition when enteral nutrition (EN) is not possible. Our main aim was to assess the current use, complications, and nutrition delivery associated with PN administration in adult critically ill patients, especially when used early and as the initial route. We also assessed the differences between patients who received only PN and those in whom EN was initiated after PN (PN-EN). Methods: A multicenter (n = 37) prospective observational study was performed. Patient clinical characteristics, outcomes, and nutrition-related variables were recorded. Statistical differences between subgroups were analyzed accordingly. Results: From the entire population (n = 629), 186 (29.6%) patients received PN as initial nutrition therapy. Of these, 74 patients (11.7%) also received EN during their ICU stay (i.e., PN-EN subgroup). PN was administered early (<48 h) in the majority of patients (75.3%; n = 140) and the mean caloric (19.94  6.72 Kcal/kg/day) and protein (1.01  0.41 g/kg/day) delivery was similar to other contemporary studies. PN showed similar nutritional delivery when compared with the enteral route. No significant complications were associated with the use of PN. Thirty-two patients (43.3%) presented with EN-related complications in the PN-EN subgroup but received a higher mean protein delivery (0.95  0.43 vs 1.17  0.36 g/kg/day; p = 0.03) compared with PN alone. Once adjusted for confounding factors, patients who received PN alone had a lower mean protein intake (hazard ratio (HR): 0.29; 95% confidence interval (CI): 0.18 0.47; p = 0.001), shorter ICU stay (HR: 0.96; 95% CI: 0.91 0.99; p = 0.008), and fewer days on mechanical ventilation (HR: 0.85; 95% CI: 0.81 0.89; p = 0.001) compared with the PN-EN subgroup. Conclusion: The parenteral route may be safe, even when administered early, and may provide adequate nutrition delivery. Additional EN, when possible, may optimize protein requirements, especially in more severe patients who received initial PN and are expected to have longer ICU stays. NCT Registry: 03634943.
    Keywords: parenteral nutrition; enteral nutrition; complementary parenteral nutrition; critically ill patients
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