Parenteral nutrition: How do patients initiated in the intensive care unit differ from those on the ward?

Abstract

Summary: Background: Parenteral nutrition (PN) is important to maintain adequate nutrition in patients who have a non-functioning gastrointestinal tract. Our aim was to characterise patients receiving PN initiated in the intensive care unit (ICU) or the general wards. Methods: Data from patients who received PN in two Australian hospital sites within a single health service between June and December 2016 (inclusive) was retrospectively collected. Demographics, cause for admission, indication and duration, and complications of PN were recorded. The latter included time to PN commencement, refeeding hypophosphataemia, biochemical liver dysfunction, hypoglycaemia and line sepsis. Results: Sixty-one patients received PN during this period. There was no delay between referral and commencing PN in ICU whilst seven (21.2%) ward patients were delayed by an average of 2.0 days (p = 0.01). Ward patients averaged 8.1 days of negligible oral intake compared with 4.3 days in ICU (p = 0.002). Complications were recorded in 19 (67.9%) ICU PN patients and 13 (39.4%) ward PN patients (p = 0.04). Refeeding hypophosphataemia was detected in three (9.1%) ward patients and six (21.4%) in ICU. There were eight (24.2%) cases of liver biochemical abnormality post commencing PN on the ward compared with 14 (50%) in ICU. There was no difference in hospital length of stay or survival between the groups. Conclusions: Patients receiving nutritional support initiated in the ICU were commenced on PN sooner than patients on the ward but experienced more complications. Ward patients experienced negligible oral intake for almost twice as long as ICU patients. Keywords: Parenteral nutrition, Intensive care unit, Ward, Malnutrition, Refeeding syndrome