Parenteral Nutrition : Current Use, Complications, and Nutrition Delivery in Critically Ill Patients
López-Delgado, Juan Carlos (Institut d'Investigació Biomèdica de Bellvitge)
Grau-Carmona, Teodoro (Hospital 12 de Octubre (Madrid))
Mor-Marco, Esther (Institut Germans Trias i Pujol. Hospital Universitari Germans Trias i Pujol)
Bordeje, Mª Luisa (Institut Germans Trias i Pujol. Hospital Universitari Germans Trias i Pujol)
Portugal-Rodriguez, Esther (Hospital Clínico Universitario de Valladolid)
Lorencio-Cardenas, Carol (Hospital Universitari de Girona Doctor Josep Trueta)
Vera-Artazcoz, Paula (Institut d'Investigació Biomèdica Sant Pau)
Macaya-Redin, Laura (Complejo Hospitalario de Navarra)
Llorente-Ruiz, Beatriz (Hospital Universitario Príncipe de Asturias (Alcalá de Henares, Madrid))
Iglesias-Rodriguez, Rayden (Hospital General de Granollers)
Monge-Donaire, Diana (Hospital Virgen de la Concha (Zamora))
Martínez Carmona, JF. (Hospital Regional Universitario Carlos Haya (Málaga))
Sanchez-Ales, Laura (Consorci Sanitari de Terrassa. Hospital Universitari de Terrassa)
Sanchez-Miralles, Angel (Hospital Universitari Sant Joan d'Alacant)
Crespo-Gomez, Monica (Hospital Universitari Doctor Peset (València))
Leon-Cinto, Crisitna (Hospital Royo Villanova)
Flordelis-Lasierra, José Luis (Hospital 12 de Octubre (Madrid))
Servia-Goixart, Lluis (Hospital Universitari Arnau de Vilanova)
Universitat Autònoma de Barcelona

Data:	2023
Resum:	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). 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. 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. 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.
Drets:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, fins i tot amb finalitats comercials, sempre i quan es reconegui l'autoria de l'obra original.
Llengua:	Anglès
Document:	Article ; recerca ; Versió publicada
Matèria:	Complementary parenteral nutrition ; Critically ill patients ; Enteral nutrition ; Parenteral nutrition
Publicat a:	Nutrients, Vol. 15 Núm. 21 (november 2023) , p. 4665, ISSN 2072-6643

DOI: 10.3390/nu15214665
PMID: 37960318

15 p, 906.1 KB

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