Parenteral Nutrition: Current Use, Complications, and Nutrition Delivery in Critically Ill Patients
Por:
Lopez-Delgado, JC, Grau-Carmona, T, Mor-Marco, E, Bordeje-Laguna, ML, Portugal-Rodriguez, E, Lorencio-Cardenas, C, Vera-Artazcoz, P, Macaya-Redin, L, Llorente-Ruiz, B, Iglesias-Rodriguez, R, Monge-Donaire, D, Martinez-Carmona, JF, Sanchez-Ales, L, Sanchez-Miralles, A, Crespo-Gomez, M, Leon-Cinto, C, Flordelis-Lasierra, JL, Servia-Goixart, L
Publicada:
1 nov 2023
Resumen:
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., PNEN 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.
Filiaciones:
Lopez-Delgado, JC:
Hosp Clin Barcelona, Clin Inst Internal Med & Dermatol ICMiD, Med ICU, C-Villarroel,170, Barcelona 08036, Spain
Hosp Llobregat, IDIBELL, Biomed Invest Inst Bellvitge, Ave Gran Via,199, Barcelona 08908, Spain
Grau-Carmona, T:
Hosp 12 Octubre, Intens Care Dept, Ave Cordoba S-N, Madrid 28041, Spain
Hosp 12 Octubre, i 12 Res Inst, Ave Cordoba S-N, Madrid 28041, Spain
Mor-Marco, E:
Hosp Badalona Germans Trias & Pujol, Intens Care Dept, Carretera Canyet,S-N, Badalona 08916, Barcelona, Spain
Bordeje-Laguna, ML:
Hosp Badalona Germans Trias & Pujol, Intens Care Dept, Carretera Canyet,S-N, Badalona 08916, Barcelona, Spain
Portugal-Rodriguez, E:
Hosp Clin Univ Valladolid, Intens Care Dept, Ave Ramon & Cajal,3, Valladolid 47003, Spain
Lorencio-Cardenas, C:
Hosp Univ Josep Trueta, Intens Care Dept, Ave Franca,S-N, Girona 17007, Spain
Vera-Artazcoz, P:
Hosp Santa Creu & Sant Pau, Intens Care Dept, C-St Quinti,89, Barcelona 08041, Spain
Macaya-Redin, L:
Complejo Hosp Navarra, Intens Care Dept, C-Irunlarrea,E, Pamplona 31008, Navarra, Spain
Llorente-Ruiz, B:
Hosp Univ Principe Asturias, Intens Care Dept, Ave Principal Univ,S-N, Alcala De Henares 28805, Madrid, Spain
Iglesias-Rodriguez, R:
Hosp Gen Granollers, Intens Care Dept, C-Francesc Ribas,S-N, Granollers 08402, Barcelona, Spain
Monge-Donaire, D:
Hosp Virgen Concha, Intens Care Dept, Ave Requejo,35, Zamora 49022, Spain
Martinez-Carmona, JF:
Hosp Reg Univ Carlos Haya, Intens Care Dept, Ave Carlos Haya,84, Malaga 29010, Spain
Sanchez-Ales, L:
Hosp Terrassa, Intens Care Dept, C-Torrebon,S-N, Terrassa 08227, Barcelona, Spain
Sanchez-Miralles, A:
Hosp Univ St Joan Alacant, Intens Care Dept, N 332,S-N, Sant Joan dAlacant 03550, Alicante, Spain
Crespo-Gomez, M:
Hosp Doctor Peset, Intens Care Dept, Ave Gaspar Aguilar,90, Valecia 46017, Spain
Leon-Cinto, C:
Hosp Royo Villanova, Intens Care Dept, Ave San Gregorio,S-N, Zaragoza 50015, Spain
Flordelis-Lasierra, JL:
Hosp 12 Octubre, Intens Care Dept, Ave Cordoba S-N, Madrid 28041, Spain
Hosp 12 Octubre, i 12 Res Inst, Ave Cordoba S-N, Madrid 28041, Spain
Servia-Goixart, L:
Hosp Arnau Vilanova, Intens Care Dept, Ave Alcalde Rovira Roure,80, Lleida 25198, Spain
IRBLLeida, Lleida Biomed Res Inst Dr Pifarre Fdn, Ave Alcalde Rovira Roure,80, Lleida 25198, Spain
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