Fighting Caloric Deficit with Supplemental Parenteral Nutrition | Clinical Nutrition LAM Initiative

Fighting Caloric Deficit with Supplemental Parenteral Nutrition

How adequate nutrition can improve patients’ hospital outcome

Clinical nutrition (CN) needs to be adequate to effectively fight caloric deficit. This is challenging, especially in critically ill patients. Rigorous nutrition control is important to prevent underfeeding, overfeeding and refeeding syndrome.

Insufficient enteral nutrition (EN) in critically ill patients

In the critical care setting sufficient EN is often not feasible1,2 due to limited gastrointestinal tolerance or frequent interruptions e.g. from treatment related procedures or surgeries.3,4,5 Inadequate clinical nutrition can lead to nutritional deficits. If acquired early on, these nutritional deficits are associated with the occurrence of (infectious) complications, increased antibiotic use, mechanical ventilation, extended intensive care unit (ICU) stay and increased mortality.6.7,8,9,10,11

Click here to read more about the risks arising from caloric deficits.

Supplemental parenteral nutrition (SPN) can help to improve outcome in critically ill patients

Whenever EN is insufficient early SPN is an effective and safe strategy to fulfill nutritional needs and prevent nutritional deficits.1,2,12,13 Early SPN can improve patient outcomes in the critical care setting.2,12,13

Heidegger et al. showed that SPN introduced after 3 days of insufficient EN resulted in significantly improved energy and protein delivery in ICU patients between day 4 and 8 compared to EN alone. The same study also detected a significantly reduced mean number of days with antibiotic use as well as a decreased rate of hospital-acquired infections between days 9 and 28. Individual energy supplementation with SPN at day 4 after ICU admission should be considered to improve clinical outcomes of ICU patients in the case of insufficient EN.2

: Hospital-aquired infections in nutritionally supported patients

SPN is a safe choice when fighting caloric deficits in critically ill patients:

  • SPN is an effective and safe strategy to prevent nutritional deficits and meet nutritional needs.1,2,12,13
  • SPN significantly increases mean energy and protein delivery2
  • SPN enables filling the gap between feasible enteral intake and actual needs12
  • SPN leads to a significantly reduced mean number of days with antibiotic use and decreased number of hospital-acquired infections in the ICU2
  • Early SPN is safe and well-tolerated when administered adequately2,12,13
  • 1. a. b. c. Berger M, Pichard C. Development and current use of parenteral nutrition in critical care - an opinion paper. Crit Care 2014;18(4):478.
  • 2. a. b. c. d. e. f. g. h. Heidegger CP, Berger MM, Graf S et al. Optimisation of energy provision with supplemental parenteral nutrition in critically ill patients: a randomized controlled clinical trial. Lancet 2013;381(9864):385-393.
  • 3. Adam S, Batson S. A study of problems associated with the delivery of enteral feed in critically ill patients in five ICUs in the UK. Intensive Care Med 1997;23:261–266.
  • 4. De Jonghe B, Appere-De-Vechi C, Fournier M et al. A prospective survey of nutritional support practices in intensive care unit patients: what is prescribed? What is delivered? Crit Care Med 2001;29:8-12.
  • 5. O´Meara D, Mireles-Cabodevila E, Frame F et al. Evaluation of delivery of enteral nutrition in critically ill patients receiving mechanical ventilation. Am J Crit Care 2008;17(1):53-61.
  • 6. Alberda C, Gramlich L, Jones N et al. The relationship between nutritional intake and clinical outcomes in critically ill patients: results of an international multicenter observational study. Intensive Care Med 2009;35:1728–1737.
  • 7. Dvir D, Cohen J, Singer P. Computerized energy balance and complications in critically ill patients: an observational study. Clin Nutr 2006;25(1):37-44.
  • 8. Faisy C, Candela LM, Savalle M et al. Early ICU energy deficit is a risk factor for Staphylococcus aureus ventilator-associated pneumonia. Chest 2011;140(5):1254-1260.
  • 9. Rubinson L, Diette GB, Song X et al. Low caloric intake is associated with nosocomial bloodstream infections in patients in the medical intensive care unit. Crit Care Med 2004;32:350-357.
  • 10. Petros S, Horbach M, Seidel F et al. Hypocaloric vs Normocaloric Nutrition in Critically Ill Patients: A Prospective Randomized Pilot Trial. JPEN 2014.
  • 11. Villet S, Chiolero RL, Bollmann MD et al. Negative impact of hypocaloric feeding and energy balance on clinical outcome in ICU patients. Clin Nutr 2005;34:502-509.
  • 12. a. b. c. d. e. Singer P, Anbar R, Cohen J et al. The tight calorie control study (TICACOS): a prospective, randomized, controlled pilot study of nutritional support in critically ill patients. Intensive Care Med 2011;37:601-609.
  • 13. a. b. c. d. 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.

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