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Metabolism and Artificial Nutrition in the Critically Ill pp 115–122Cite as

Total parenteral nutrition vs total enteral nutrition in critically ill patients: Costs and benefits

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Part of the book series: Topics in Anaesthesia and Critical Care ((TIACC))

Abstract

Nutritional support can reduce morbidity and mortality associated with the hypermetabolic response and organ failure, avoiding calorie-protein malnutrition [1]. This symptom is extremely evident in the critically ill in whom protein catabolism is accelerated and the anabolic response altered. These patients have lost a large amount of lean mass with skeleton muscle depletion [2]. Artificial feeding deeply differs from enteral nutrition in supplying proteins, carbohydrates, lipids and nucleic acids. Parenteral nutrition often has a deficiency of dipeptides and amino acid substances that are important for protein synthesis and the immune response.

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References

  1. Cerra FB, Holman RT, Bankey PE, Mazuski JE (1990) Nutritional pharmacology: its role in the hypermetabolism-organ failure syndrome. Crit Care Med 18:S154–S158.

    Article  PubMed  CAS  Google Scholar 

  2. Wolfe RR, Jahoor F, Hard WH (1989) Protein and aminoacid metabolism after injury. Diab Metab Rev 5:149–155.

    Article  CAS  Google Scholar 

  3. Souba WW, Smith RJ, Wilmore DW (1985) Glutamine metabolism by the intestinal tract. JPEN 9:608–617.

    Article  CAS  Google Scholar 

  4. Barbul A (1990) Arginine and immune function. Nutrition 6:S53–S58.

    Google Scholar 

  5. Rombeau JL (1988) Colonic infusion of short-chain fatty acids. JPEN 12:S102–S103.

    Article  Google Scholar 

  6. Kinsella JE, Lokish B (1990) Dietary lipid, eicosanoids, and the immune functions. Crit Care Med 18:S94–S113.

    Article  PubMed  CAS  Google Scholar 

  7. Souba WW, Smith RJ, Wilmore DW (1985) Glutamine metabolism by the intestinal tract. JPEN 9:608–617.

    Article  CAS  Google Scholar 

  8. Hadfield RH, Sinclair DG, Houldsworth PE, Evans TW (1995) Effects of enteral and parenteral nutrition on gut mucosal permeability in the critically ill. Am J Resp Care Med 152:1545–1548.

    CAS  Google Scholar 

  9. Fong Y, Marano MA, Barber A (1989) Total parenteral nutrition and bowel rest modify the metabolic response to endotoxin in humans. Ann Surg 210:449–457.

    Article  PubMed  CAS  Google Scholar 

  10. Moore FA, Moore EE, Jones TN, McCroskey BL, Peterson VM (1989) TEN vs TPN following major abdominal trauma reduced septic morbidity. J Trauma 29(7):916–923.

    Article  PubMed  CAS  Google Scholar 

  11. Kudsk KA, Croce MA, Fabian TC, Minard G, et al (1992) Enterai vs parenteral feeding: effects on septic morbility after blunt and penetrating abdominal trauma. Ann Surg 215(5):503–513.

    Article  PubMed  CAS  Google Scholar 

  12. Adams S, Dellinger EP, Wertz MJ, Oreskovich MR, Simonowitz D, Johansen K (1986) Enterai vs parenteral nutrition support following laparotomy for trauma: a randomized prospective trial. J Trauma 26(10):882–891.

    Article  PubMed  CAS  Google Scholar 

  13. PetersonVM, Moore EE, Jones TN et al (1988) TEN vs TPN after major torso truma injury: attenuation of hepatic protein reprioritization. Surgery 104:199–207.

    PubMed  CAS  Google Scholar 

  14. Chiarelli AG, Ferrarello S, Picioli A, Abate A, Chini G, Berioli M B, Peris A, Lippi R (1996) La nutrizione enterale totale verso la nutrizione mista enterale e parenterale in pazienti ricoverati in una terapia intensiva polivalente. Min Anest 62:1–7.

    CAS  Google Scholar 

  15. Bower RH, Talamini MA, Sax HC, Hamilton F, Fischer JE (1986) Postoperative enteral vs parenteral nutrition. Arch surg 121:1040–1045.

    Article  PubMed  CAS  Google Scholar 

  16. Hamaoui E, Lefkowitz R, Olender L et al (1990) Enterai nutrition in the early postoperative period: a new semi-elemental formula vs total parenteral nutrition. JPEN 14(5):501–507.

    Article  CAS  Google Scholar 

  17. Kudsk KA, Minard G, Wojisiak SL, Croce M, Fabian T, Brown RO (1994) Visceral protein response to enteral versus parenteral and sepsis in patients with trauma. Surgery 116:516–523.

    PubMed  CAS  Google Scholar 

  18. Braga M, Gianotti L, Vignali A, Cestari A, Bisagni P, Di Carlo V (1998) Artificial nutrition after abdominal surgery: impact of route of administration and composition of the diet. Crit Care Med 26:24–30.

    Article  PubMed  CAS  Google Scholar 

  19. Mendez C, Jurkovic GJ, Garcia I, Davis D, Parker A, Maier RV (1997) Effects of an immune-enhancing diet in critically injured patients. J Trauma 42(5):933–941.

    Article  PubMed  CAS  Google Scholar 

  20. Eyer SD, Micon LT, Kostantinides FN et al (1993) Early enteral feeding does not attenuate metabolic response after blunt trauma. J Trauma 34(5):639–644.

    Article  PubMed  CAS  Google Scholar 

  21. Moore FA, Feliciano DV, Andrassy RJ et al (1992) Early enteral feeding, compared with parenteral, reduces postoperative septic complications. The results of a meta-analysis. Ann Surg 216(2):172–183.

    Article  PubMed  CAS  Google Scholar 

  22. Zaloga GP (1993) Parenteral vs enteral nutrition. In: Wilmore DW, Carpentier YA (eds) Metabolic support of the critically ill patient. Springer-Verlag, Berlin Heidelberg New York, pp 267–293.

    Chapter  Google Scholar 

  23. Moore FA, Moore EE (1996) Gut dysfunction in trauma patients. In: Rombeau JL, Takala J (eds) Gut dysfunction in critical illness. Springer-Verlag, Berlin Heidelberg New York, pp 217–229.

    Chapter  Google Scholar 

  24. Moore FA, Moore EE, Poggetti R et al (1991) Gut bacterial traslocation via the portal vein: a clinical perspective with major torso trauma. J Trauma 31:629–635.

    Article  PubMed  CAS  Google Scholar 

  25. Reed L, Martin M, Manglano M, Newson Barett J (1990) Bacterial traslocation following abdominal trauma in humans. Crit Care Med 19:S95.

    Google Scholar 

  26. Leibovici L, Samra Z, Konisberger H, Drucker M, Ashkenazi S, Pitlik SD (1995) Longterm survival following bacteremia or fungemia. JAMA 247:807–812.

    Article  Google Scholar 

  27. Fagon JY, Chastre J, Vuagnat A, Trouillet JL, Novara A, Gibert C (1996) Nosocomial pneumonia and mortality among patients in intensive care units. JAMA 275:866–869.

    Article  PubMed  CAS  Google Scholar 

  28. Heyland DK, Cook DJ, Guyatt GH (1993) Enterai nutrition in the critically ill patient: a critical review of the evidence. Int Care Med 19:435–442.

    Article  CAS  Google Scholar 

  29. Jacobs S, Chang RW, Lee B, Bartlett FW (1990) Continous enteral feeding: a major cause of pneumonia among ventilated care unit patients. JPEN 14(4):353–356.

    Article  CAS  Google Scholar 

  30. Lee B, Chang RWS, Jacobs S (1990) Intermittent nasogastric feeding: a simple and effective method to reduce pneumonia among ventilated ICU patients. Clin Intesiv Care 1:100–102.

    Google Scholar 

  31. Bonten MJM, Gaillard CA, van der Hulst R et al (1996) Intermittent enteral feeding: the influence on respiratory and digestive tract colonization in mechanically ventilated ICU patients. Am J Respir Crit Care Med 154:394–399.

    PubMed  CAS  Google Scholar 

  32. Heyland DK, Bradley C, Mandell LA (1992) Acidified enteral feeds: effects on gastric colonization. Crit Care Med 20:1388–1394.

    Article  PubMed  CAS  Google Scholar 

  33. Tryba M, Cook DJ (1995) Gastric alkalinization, pneumonia and systemic infections: the controversy. Scand J Gastroenterol 30(Suppl 210):53–59.

    Article  Google Scholar 

  34. Cook D, Guyatt G, Marshall J et al (1998) A comparison of sucralfate and ranitidine for the prevention of upper gastrointestinal bleeding in patients requiring mechanical ventilation. N Engl J Med 338(12):791–797.

    Article  PubMed  CAS  Google Scholar 

  35. Takala J (1996) Determinants of splanchnic blood flow. Br J Anaesthesia 77:50–58.

    Article  CAS  Google Scholar 

  36. Vincent JL (1996) MOF and gut. Dig Surg 13:245–249.

    Article  Google Scholar 

  37. Bower RH, Cerra FB, Bershadsky B et al (1995) Early enteral administration of a formula (Impact) supplemented with arginina, nucleotides and fish oil in intensive care unit patients: Results of a multicenter, prospective, randomized, clinical trial. Crit Care Med 23:436–449.

    Article  PubMed  CAS  Google Scholar 

  38. Senkal M, Mumme A, Eickhoff U et al (1997) Early postoperative enteral immunonutrition: clinical outcome and cost-coparison analysis in surgical patients. Crit Care Med 25:1489–1496.

    Article  PubMed  CAS  Google Scholar 

  39. Daly JM, Weintrub FM, Shou J, Rosato EF, Lucia M (1995) Enterai nutrition during multimodality therapy in upper gastrointestinal cancer patients. Ann Surg 221:327–338.

    Article  PubMed  CAS  Google Scholar 

  40. Nelson LD (1998) Death knell for parenteral nutrion? Crit Care Med 26(1):4.

    Article  PubMed  CAS  Google Scholar 

  41. Griffiths RD, Jones C, Palmer TE (1997) Six-month outcome of critically ill patients given glutamine-supplemented parenteral nutrition. Nutrition 13:295–302.

    PubMed  CAS  Google Scholar 

  42. Tremel H, Kienle B, Weilmann LS, Stehle P, Furst P (1994) Glutamine dipeptide-sup-plemented parenteral nutrition maintains function in the critically ill. Gastroenterology 107:1595–1601.

    PubMed  CAS  Google Scholar 

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Authors
  1. F. Iscra
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  2. A. Randino
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  3. G. Sermann
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Editor information

Editors and Affiliations

  1. Institute of General Clinical Medicine, Cattinara Hospital, Trieste, Italy

    G. Guarnieri MD

  2. Department of Anaesthesia, Intensive Care and Pain Therapy, Cattinara Hospital, Trieste, Italy

    F. Iscra MD

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© 1999 Springer-Verlag Italia, Milano

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Iscra, F., Randino, A., Sermann, G. (1999). Total parenteral nutrition vs total enteral nutrition in critically ill patients: Costs and benefits. In: Guarnieri, G., Iscra, F. (eds) Metabolism and Artificial Nutrition in the Critically Ill. Topics in Anaesthesia and Critical Care. Springer, Milano. https://doi.org/10.1007/978-88-470-2901-9_11

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  • DOI: https://doi.org/10.1007/978-88-470-2901-9_11

  • Publisher Name: Springer, Milano

  • Print ISBN: 978-88-470-0042-1

  • Online ISBN: 978-88-470-2901-9

  • eBook Packages: Springer Book Archive

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