Combined enteral-parenteral nutrition versus total parenteral nutrition in brain-injured patients

Abstract

A comparative nutritional study in brain-injured patients (BIP) was performed to assess the influence of a combined enteral-parenteral nutrition (CN) and a total parenteral nutrition (TPN) on protein catabolism in the early posttraumatic period. 20 male BIP (Glasgow coma scale 5-7) were randomized to one of the two feeding regimes. Nutritional support was based on 150-175% basic energy expenditure. Amino acid intake was 1.4 g/kg/day in the TPN and 2.4 g/kg/day in the CN group. Negative nitrogen balance (NNB) averaged means = 11.3 g/m2/day (SEM = 3.06 g/m2/day) in the TPN group and means = 10.2 g/m2/day (SEM = 2.33 g/m2/day) in the CN group. Between both feeding regimes not statistically significant differences could be observed concerning mortality, N-balance, creatinine and 3-methylhistidine excretions. Protein concentration of the regurgitated gastric fluid was significantly higher in the CN than in the TPN study group. Data imply that both alimentary regimes are of similar value, but BIP with impaired gastric function, such as high tube reflux, are better treated by TPN.

Nutritional Support for Patients Sustaining Traumatic Brain Injury: A Systematic Review and Meta-Analysis of Prospective Studies

“…Further, 10 studies were excluded, with 5 of non-English language, 1 comparing combined EN and PN with PN [14], 1 comparing two different fat emulsions [15], 1 comparing essential amino acid with placebo [16], 1 comparing intermittent EN with continuous EN [17], and 1 compared different infusion speed of EN [18]. In the remaining 24 studies included in qualitative synthesis, 8 articles lacked sufficient data relating to our outcomes [19]–[25].…”

Early Supplemental Parenteral Nutrition Is Associated with Increased Infectious Complications in Critically Ill Trauma Patients

“…One explanation for our observations is that the PN itself is harmful. Studies in elective surgical, acute burn, trauma, and critically ill patients have failed to demonstrate a beneficial effect of PN on patient outcome 18,[21][22][23][24] . Given that the majority of these studies were performed prior to the widespread use of protocols for tight glycemic control, it is possible and has been posited, that poorly controlled hyperglycemia contributes to the increased morbidity seen with PN use.…”

Nutritional support for critically ill children

“…Following screening, we identified 17 studies as potentially relevant (see Figure 1). Upon closer review we excluded all but one of the studies (as well as one ongoing study), for the following reasons: di erent routes of delivering enteral nutrition compared (gastric versus small bowel feeding (Meert 2004); continuous versus intermittent gastric feeding (Horn 2003); immune-enhancing formula versus standard formula (Alberda 2005;Albers 2005;Barbosa 1999;Briassoulis 2005b;Briassoulis 2006;Gottschlich 1990;Marin 2006;Papadopoulou 2000); two regimens of early combined enteral and parenteral nutrition compared (Alexander 1980); only surrogate nutritional markers as outcomes (Chaloupecky 1994); study population was primarily adult (Hadley 1986;Hausmann 1985;Justo Meirelles 2011;Kolacinski 1993;Peng 2001;Suchner 1996;Young 1987); study population was premature neonates or newborn infants in the neonatal intensive care unit (Black 1981; Morgan 2013); and study population was not critically ill children (that is, children not cared for in a PICU) (Khorasani 2010; Marín 1999; Pillo-Blocka 2004). See 'Characteristics of excluded studies'.…”