Advertisement

Parenteral Nutrition

  • James J. Pomposelli

Abstract

The goals of nutritional support for patients in the surgical intensive care unit (SICU) differ from those for patients recovering on the surgical ward or at home (1). In malnourished patients who have no major metabolic stress, provision of adequate protein and calories above the patients’ energy expenditure results in a positive nitrogen balance and appropriate body mass gain. In the SICU, however, most patients are metabolically stressed and their hormonal milieu does not support anabolism regardless of intake (2). Attempts to replete the malnourished, metabolically stressed patient with substrate in excess of energy expenditures leads to the development of hyperglycemia and increased complications and nullifies any benefit from feeding (3,4). The goals of nutritional therapy in the SICU are to support the metabolic response to injury and infection by providing adequate protein and energy equivalent to or slightly less than energy expenditure (5,6).

Keywords

Parenteral Nutrition Ideal Body Weight Lipid Emulsion Surgical Intensive Care Unit Metabolic Alkalosis 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Ackerman MIL, Evans NJ, Ecklund MM. Systemic inflammatory response syndrome, sepsis, and nutritional support. Crit Care Nurs Clin North Am 1994; 6: 321–40.PubMedGoogle Scholar
  2. 2.
    Dahn MS, Lange P. Hormonal changes and their influence on metabolism and nutrition in the critically ill. Intensive Care Med 1982; 8: 209–13.PubMedCrossRefGoogle Scholar
  3. 3.
    Pomposelli JJ, Bistrian BR. Is total parenteral nutrition immunosuppressive? New Horiz 1994; 2: 224–9.PubMedGoogle Scholar
  4. 4.
    Pomposelli JJ, Baxter MC 3rd, Babineau TJ, Pomfret EA, Driscoll DF, Forse RA, Bistrian BR. Early postoperative glucose control predicts nosocomial infection rate in diabetic patients. WEN J Parenter Enteral Nutr 1998; 22: 77–81.CrossRefGoogle Scholar
  5. 5.
    Christman JW, McCain RW. A sensible approach to the nutritional support of mechanically ventilated critically ill patients. Intensive Care Med 1993; 19: 129–36.PubMedCrossRefGoogle Scholar
  6. 6.
    Tayek JA, Blackburn GL. Goals of nutritional support in acute infections. Am J Med 1984; 76: 81–90.PubMedCrossRefGoogle Scholar
  7. 7.
    Waddell LS, Michel ICE. Critical care nutrition: routes of feeding. Clin Tech Small Anim Pract 1998; 13: 197–203.PubMedCrossRefGoogle Scholar
  8. 8.
    Moore EE, Moore FA. Immediate enteral nutrition following multisystem trauma: a decade perspective. J Am Coll Nutr 1991; 10: 633–48.PubMedGoogle Scholar
  9. 9.
    Driscoll DF, Baptista RJ, Miltrano FP, Mascioli EA, Blackburn GL, Bistrian BR. Parenteral nutrient admixtures as drug vehicles: theory and practice in the critical care setting. DICP 1991; 25: 276–83.PubMedGoogle Scholar
  10. 10.
    Echenique MM, Bistrian BR, Blackburn GL. Theory and techniques of nutritional support in the ICU. Crit Care Med 1982; 10: 546–9.PubMedCrossRefGoogle Scholar
  11. 11.
    Bistrian BR. Dietary treatment in secondary wasting and cachexia. J Nutr 1999; 129 (1S suppl): 290S - 294S.PubMedGoogle Scholar
  12. 12.
    Lowell JA, Schifferdecker C, Driscoll DF, Benotti PN, Bistrian BR. Postoperative fluid overload: not a benign problem. Crit Care Med 1990; 18: 728–33.PubMedCrossRefGoogle Scholar
  13. 13.
    Cerra, FB, Benitez MR, Blackburn GL, Irwin RS, Jeejeebhoy K, Katz DP, Pingleton SK, Pomposelli J, Rombeau JL, Shronts E, Wolfe RR, Zaloga GP. Applied nutrition in ICU patients. A consensus statement of the American College of Chest Physicians. Chest 1997; 111: 769–78.Google Scholar
  14. 14.
    Bistrian BR. Enteral nutrition: just a fuel or an immunity enhancer? Minerva Anestesiol 1999; 65: 471–4.PubMedGoogle Scholar
  15. 15.
    Cerra FB, Lehmann S, Konstantinides N, Dzik J, Fish J, Konstantinides F, LiCari JJ, Holman RT. Improvement in immune function in ICU patients by enteral nutrition supplemented with arginine, RNA, and menhaden oil is independent of nitrogen balance. Nutrition 1991; 7: 193–9.PubMedGoogle Scholar
  16. 16.
    Man-Fan Wan J, Kanders BS, Kowalchuk M, Knapp H, Szeluga DJ, Bagley J, Blackburn GL. Omega 3 fatty acids and cancer metastasis in humans. World Rev Nutr Diet 1991; 66: 477–87.Google Scholar
  17. 17.
    Kenler AS, Swails WS, Driscoll DF, DeMichele SJ, Daley B, Babineau TJ, Peterson MB, Bistrian BR. Early enteral feeding in postsurgical cancer patients. Fish oil structured lipid-based polymeric formula versus a standard polymeric formula. Ann Surg 1996; 223: 316–33.PubMedCrossRefGoogle Scholar
  18. 18.
    Benotti PN, Blackburn GL, Miller JD, Bistrian BR, FLatt J, Trerice M. Role of branched chain amino acids (BCAA) intake in preventing muscle proteolysis. Surg Forum 1976; 27: 7–10.PubMedGoogle Scholar
  19. 19.
    Wilmore DW. Postoperative protein sparing. World J Surg 1999; 23: 545–52.PubMedCrossRefGoogle Scholar
  20. 20.
    Driscoll DF, Blackburn GL. Total parenteral nutrition 1990. A review of its current status in hospitalised patients, and the need for patient-specific feeding. Drugs 1990; 40: 346–63.CrossRefGoogle Scholar
  21. 21.
    Kudsk KA, Mirtallo JM. Nutritional support of the critically ill patient. Drug Intell Clin Pharm 1983; 17: 501–6.PubMedGoogle Scholar
  22. 22.
    Moore F.A, Moore EE, Jones TN, McCroskey BL, Peterson VM. TEN versus TPN following major abdominal trauma-reduced septic morbidity. J Trauma 1989;29:916–22; discussion 922–3.Google Scholar
  23. 23.
    Frankenfield DC, Smith JS, Cooney RN. Accelerated nitrogen loss after traumatic injury is not attenuated by achievement of energy balance. WEN J Parenter Enteral Nutr 1997; 21: 324–9.CrossRefGoogle Scholar
  24. 24.
    Sobrado J, Moldawer LL, Pomposelli JJ, Mascioli EA, Babayan VK, Bistrian BR, Blackburn GL. Lipid emulsions and reticuloendothelial system function in healthy and burned guinea pigs. Am J Clin Nutr 1985; 42: 855–63.PubMedGoogle Scholar
  25. 25.
    Jensen GL, Mascioli EA, Seidner DL, Istfan NW, Domnitch AM, Seileck K, Babayan VK, Blackburn GL, Bistrian BR. Parenteral infusion of long-and medium-chain triglycerides and reticuloendothelial system function in man. WEN J Parenter Enteral Nutr 1990; 14: 467–71.CrossRefGoogle Scholar
  26. 26.
    Bistrian BR, Blackburn GL, Hallowell E, Heddle R. Protein status of general surgical patients. JAMA 1974; 230: 858–60.PubMedCrossRefGoogle Scholar
  27. 27.
    Tan YS, Nambiar R, Yo SL. Prevalence of protein calorie malnutrition in general surgical patients. Ann Acad Med Singapore 1992; 21: 334–8.PubMedGoogle Scholar
  28. 28.
    Wilmore DW. Catabolic illness. Strategies for enhancing recovery. N Engl J Med 1991; 325: 695–702.PubMedCrossRefGoogle Scholar
  29. 29.
    Dempsey DT, Buzby GP, Mullen JL. Nutritional assessment in the seriously ill patient. J Am Coll Nutr. 1983; 2: 15–22.PubMedGoogle Scholar
  30. 30.
    Hirsch S, deObaldia N, Petermann M, Rojo P, Barrientos C, Iturriaga H, Bunout D. Subjective global assessment of nutritional status: further validation. Nutrition 1991;7:35–7; discussion 37–8.Google Scholar
  31. 31.
    Boyes RJ, Kruse JA. Nasogastric and nasoenteric intubation. Crit Care Clin 1992; 8: 865–78.PubMedGoogle Scholar
  32. 32.
    DeBiasse MA, Wilmore DW. What is optimal nutritional support? New Horiz 1994; 2: 122–30.PubMedGoogle Scholar
  33. 33.
    Wemerman J. Enteral or parenteral nutrition? Pro-parenteral. Acta Anaesthesiol Scand Suppl 1997; 110: 148–50.CrossRefGoogle Scholar
  34. 34.
    Hunter DC, Jaksic T, Lewis D, Benotti PN, Blackburn GL, Bistrian BR Resting energy expenditure in the critically ill: estimations versus measurement. Br J Surg 1988; 75: 875–8.PubMedCrossRefGoogle Scholar
  35. 35.
    Lewis WD, Chwals W, Benotti PN, Lakshman K, O’Donnell C, Blackburn GL, Bistrian BR Bedside assessment of the work of breathing. Crit Care Med 1988; 16: 117–22.PubMedCrossRefGoogle Scholar
  36. 36.
    Ireton-Jones CS, Francis C. Obesity: nutrition support practice and application to critical care. Nutr Clin Pract 1995; 10: 144–9.PubMedCrossRefGoogle Scholar
  37. 37.
    Palombo JD, Blackburn GL. Human protein requirements. ASDC J Dent Child 1980; 47: 277–80.PubMedGoogle Scholar
  38. 38.
    Cutts ME, Dowdy RP, Ellersieck MR, Edes TE. Predicting energy needs in ventilator-dependent critically ill patients: effect of adjusting weight for edema or adiposity. Am J Clin Nutr 1997; 66: 1250–6.PubMedGoogle Scholar
  39. 39.
    Guenst JM, Nelson LD. Predictors of total parenteral nutrition-induced lipogenesis. Chest 1994; 105: 553–9.PubMedCrossRefGoogle Scholar
  40. 40.
    Nygren J, Thorell A, Efendic S, Nair KS, Lungqvist O Site of insulin resistance after surgery: the contribution of hypocaloric nutrition and bed rest. Clin Sci (Colch)1997; 93: 137–46.Google Scholar
  41. 41.
    Yamamoto T. Metabolic response to glucose overload in surgical stress: energy disposal in brown adipose tissue. Surg Today 1996; 26: 151–7.PubMedCrossRefGoogle Scholar
  42. 42.
    Moro M.L, Maffei C, Manso E, Morace G, Polonelli L, Bivasco F. Nosocomial outbreak of systemic candidosis associated with parenteral nutrition. Infect Control Hosp Epidemiol 1990; 11: 27–35.PubMedCrossRefGoogle Scholar
  43. 43.
    Driscoll DF, Baptista RJ, Bistrian BR, Blackburn GL. Practical considerations regarding the use of total nutrient admixtures. Am J Hosp Pharm 1986; 43: 416–9.PubMedGoogle Scholar
  44. 44.
    Watanabe Y, Sato M, Abe Y, Nakata Y, Lee T, Kimura S. Fat emulsions as an ideal nonprotein energy source under surgical stress for diabetic patients. Nutrition 1995; 11: 734–8.PubMedGoogle Scholar
  45. 45.
    Ball MJ, White K. Metabolic effects of intravenous medium-and long-chain triacylglycerols in critically ill patients. Clin Sci (Colch) 1989; 76: 165–70.Google Scholar
  46. 46.
    Pomposelli JJ, Flores E, Hirschberg Y, Teo TC, Blackburn GL, Zeisel SH, Bistrian BR. Short-term TPN containing n-3 fatty acids ameliorate lactic acidosis induced by endotoxin in guinea pigs. Am J Clin Nutr 1990; 52: 548–52.Google Scholar
  47. 47.
    Pomposelli JJ, Flores EA, Blackburn GL, Zeisel SH, Bistrian BR. Diets enriched with N-3 fatty acids ameliorate lactic acidosis by improving endotoxin-induced tissue hypoperfusion in guinea pigs. Ann Surg 1991; 213: 166–76.PubMedCrossRefGoogle Scholar
  48. 48.
    Ling PR, Istfan NW, Lopes SM, Babayan VK, Blackburn GL, Bistrian BR. Structured lipid made from fish oil and medium-chain triglycerides alters tumor and host metabolism in Yoshidasarcoma-bearing rats. Am J Clin Nutr 1991; 53: 1177–84.PubMedGoogle Scholar
  49. 49.
    Bellantone R, Bossola M, Carrier° C, Malerba M, Nucera P, Ratto C, Crucitti P, Pacelli F, Doglietto GB, Crucitti F. Structured versus long-chain triglycerides: a safety, tolerance, and efficacy randomized study in colorectal surgical patients. WEN J Parenter Enteral Nutr 1999; 23: 123–7.CrossRefGoogle Scholar
  50. 50.
    Sierra P, Ling PR, Istfan NW, Bistrian BR. Fish oil feeding improves muscle glucose uptake in tumor necrosis factor-treated rats. Metabolism 1995; 44: 1365–70.PubMedCrossRefGoogle Scholar
  51. 51.
    DeMichele SJ, Karlstad MD, Bistrian BR, Istfan N, Babayan VK, Blackburn GL. Enteral nutrition with structured lipid: effect on protein metabolism in thermal injury. Am J Clin Nutr 1989; 50: 1295–302.PubMedGoogle Scholar
  52. 52.
    Hamawy KJ, Moldawer LL, GeorgieffM, Valicenti Al, Babayan VK, Bistrian BR, Blackburn GL. The Henry M. Vars Award. The effect of lipid emulsions on reticuloendothelial system function in the injured animal. WEN J Parenter Enteral Nutr 1985; 9: 559–65.CrossRefGoogle Scholar
  53. 53.
    Mascioli EA, Babayan VK, Bistrian BR, Blackburn GL. Novel triglycerides for special medical purposes. WEN J Parenter Enteral Nutr 1988; 12 (6 suppl): 127S - 132S.CrossRefGoogle Scholar
  54. 54.
    Driscoll DF, Newton DW, Bistrian BR. Precipitation of calcium phosphate from parenteral nutrient fluids. Am J Hosp Phann 1994; 51: 2834–6.Google Scholar
  55. 55.
    Apovian CM, McMahon MM, Bistrian BR. Guidelines for refeeding the marasmic patient. Crit Care Med 1990; 18: 1030–3.PubMedCrossRefGoogle Scholar
  56. 56.
    Hamill-Ruth RI, McGory R. Magnesium repletion and its effect on potassium homeostasis in critically ill adults: results of a double-blind, randomized, controlled trial. Crit Care Med 1996; 24: 38–45.PubMedCrossRefGoogle Scholar
  57. 57.
    McMahon M., Manji N, Driscoll DF, Bistrian BR. Parenteral nutrition in patients with diabetes mellitus: theoretical and practical considerations. WEN J Parenter Enteral Nutr 1989; 13: 545–53.CrossRefGoogle Scholar
  58. 58.
    Hongsermeier T, Bistrian BR. Evaluation of a practical technique for determining insulin requirements in diabetic patients receiving total parenteral nutrition. WEN J Parenter Enteral Nutr 1993; 17: 16–9.CrossRefGoogle Scholar
  59. 59.
    Driscoll DF, Bistrian BR, Jenkins RL, Randall S, Dzik WH, Gerson B, Blackburn GL. Development of metabolic alkalosis after massive transfusion during orthotopic liver transplantation. Crit Care Med 1987; 15: 905–8.PubMedCrossRefGoogle Scholar
  60. 60.
    Lumpkin MM._ Safety alert:hazards of precipitation associated with parenteral nutrition. Am J Hosp Pharm 1994;51:1427–8.Google Scholar
  61. 61.
    Driscoll DF, Bacon MN, Bistrian BR. Physicochemical stability of two types of intravenous lipid emulsion as total nutrient admixtures. WEN J Parenter Enteral Nutr 2000; 24: 15–22.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2001

Authors and Affiliations

  • James J. Pomposelli
    • 1
  1. 1.Lahey Clinic Medical CenterBurlingtonUSA

Personalised recommendations