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

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...

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Autores: 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, On Behalf Of The Enpic Study Group
Tipo de recurso: artículo
Estado:Versión publicada
Fecha de publicación:2023
País:España
Institución:Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana (FISABIO)
Repositorio:r-FISABIO. Repositorio Institucional de Producción Científica
OAI Identifier:oai:fisabio.fundanetsuite.com:p15925
Acceso en línea:https://fisabio.portalinvestigacion.com/publicaciones/15925
Access Level:acceso abierto
Palabra clave:parenteral nutrition
enteral nutrition
complementary parenteral nutrition
critically ill patients
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spelling Parenteral Nutrition: Current Use, Complications, and Nutrition Delivery in Critically Ill PatientsLopez-Delgado JCGrau-Carmona TMor-Marco EBordeje-Laguna MLPortugal-Rodriguez ELorencio-Cardenas CVera-Artazcoz PMacaya-Redin LLlorente-Ruiz BIglesias-Rodriguez RMonge-Donaire DMartinez-Carmona JFSanchez-Ales LSanchez-Miralles ACrespo-Gomez MLeon-Cinto CFlordelis-Lasierra JLServia-Goixart LOn Behalf Of The Enpic Study Groupparenteral nutritionenteral nutritioncomplementary parenteral nutritioncritically ill patientsBackground: 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.MDPI2023info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersionhttps://fisabio.portalinvestigacion.com/publicaciones/15925NutrientsISSN: 20726643reponame:r-FISABIO. Repositorio Institucional de Producción Científicainstname:Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana (FISABIO)Inglésinfo:eu-repo/semantics/openAccessoai:fisabio.fundanetsuite.com:p159252026-06-11T12:45:17Z
dc.title.none.fl_str_mv Parenteral Nutrition: Current Use, Complications, and Nutrition Delivery in Critically Ill Patients
title Parenteral Nutrition: Current Use, Complications, and Nutrition Delivery in Critically Ill Patients
spellingShingle Parenteral Nutrition: Current Use, Complications, and Nutrition Delivery in Critically Ill Patients
Lopez-Delgado JC
parenteral nutrition
enteral nutrition
complementary parenteral nutrition
critically ill patients
title_short Parenteral Nutrition: Current Use, Complications, and Nutrition Delivery in Critically Ill Patients
title_full Parenteral Nutrition: Current Use, Complications, and Nutrition Delivery in Critically Ill Patients
title_fullStr Parenteral Nutrition: Current Use, Complications, and Nutrition Delivery in Critically Ill Patients
title_full_unstemmed Parenteral Nutrition: Current Use, Complications, and Nutrition Delivery in Critically Ill Patients
title_sort Parenteral Nutrition: Current Use, Complications, and Nutrition Delivery in Critically Ill Patients
dc.creator.none.fl_str_mv 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
On Behalf Of The Enpic Study Group
author Lopez-Delgado JC
author_facet 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
On Behalf Of The Enpic Study Group
author_role author
author2 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
On Behalf Of The Enpic Study Group
author2_role author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
dc.subject.none.fl_str_mv parenteral nutrition
enteral nutrition
complementary parenteral nutrition
critically ill patients
topic parenteral nutrition
enteral nutrition
complementary parenteral nutrition
critically ill patients
description 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.
publishDate 2023
dc.date.none.fl_str_mv 2023
dc.type.none.fl_str_mv info:eu-repo/semantics/article
info:eu-repo/semantics/publishedVersion
format article
status_str publishedVersion
dc.identifier.none.fl_str_mv https://fisabio.portalinvestigacion.com/publicaciones/15925
url https://fisabio.portalinvestigacion.com/publicaciones/15925
dc.language.none.fl_str_mv Inglés
language_invalid_str_mv Inglés
dc.rights.none.fl_str_mv info:eu-repo/semantics/openAccess
eu_rights_str_mv openAccess
dc.publisher.none.fl_str_mv MDPI
publisher.none.fl_str_mv MDPI
dc.source.none.fl_str_mv Nutrients
ISSN: 20726643
reponame:r-FISABIO. Repositorio Institucional de Producción Científica
instname:Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana (FISABIO)
instname_str Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana (FISABIO)
reponame_str r-FISABIO. Repositorio Institucional de Producción Científica
collection r-FISABIO. Repositorio Institucional de Producción Científica
repository.name.fl_str_mv
repository.mail.fl_str_mv
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score 15,81155

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