Adapting Parenteral Nutrition for Clinical Circumstances | Clinical Nutrition LAM Initiative

Adapting Parenteral Nutrition for Clinical Circumstances

Total Versus Supplemental Parenteral Nutrition

Ideally for the majority of patients, an adequate dietary intake can be ensured by providing normal, good quality hospital food. However, when patients are unable to eat or when their nutrient intake is insufficient to meet clinical nutrition needs, enteral nutrition (EN) is required.1

In those cases where EN intake is insufficient or inadequate to provide the patient’s nutritional requirements, parenteral nutrition (PN) should be started to avoid disease-related malnutrition.1,2

When Is Supplemental PN Indicated?

By this approach, PN supplements EN intake and supplies parts of the daily nutritional requirements. EN complemented by early supplemental PN improves patients’ outcomes.3,4 ESPEN states that all supplemental PN is generally preferred over exclusive EN, and all patients receiving less than their targeted enteral feeding after two days should be considered for supplemental PN.5

When Is Total PN Indicated?

Total PN can supply the patient with all of their daily nutritional requirements, in cases where EN is contraindicated.

  • 1. a. b. National Collaborating Centre for Acute Care (UK). Nutrition Support for Adults Oral Nutrition Support, Enteral Tube Feeding and Parenteral Nutrition. NICE Clinical Guidelines, No. 32 London 2006.
  • 2. Kreymann KG. Early nutrition support in critical care: A European perspective. Curr Opin Clin Nutr Metab Care 2008;11:156-159.
  • 3. Heidegger CP, Berger MM, Graf S et al. Optimisation of energy provision with supplemental parenteral nutrition in critically ill patients: a randomised controlled clinical trial. Lancet 2013;381(9864):385-393.
  • 4. Thibault R, Heidegger CP, Berger MM et al. Parenteral nutrition in the intensive care unit: cautious use improves outcome. Swiss Med Wkly 2014;144:w13997.
  • 5. Singer P, Berger MM, Van den Berghe G et al. ESPEN Guidelines on Parenteral Nutrition: intensive care. Clin Nutr 2009;28(4):387-400.

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