Nutrients (Nov 2023)

Parenteral Nutrition: Current Use, Complications, and Nutrition Delivery in Critically Ill Patients

  • 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,
  • on behalf of the ENPIC Study Group

DOI
https://doi.org/10.3390/nu15214665
Journal volume & issue
Vol. 15, no. 21
p. 4665

Abstract

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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 (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.

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