P019 Nutritional Support in Critically Ill Patients Decreases the Length of Stay and the Mortality Rate in the Icu

Fuentes-Carrasco, M.; Anda, G Vazquez de; Denova‐Gutiérrez, Edgar

doi:10.1016/s1744-1161(08)70081-4

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“…This is mechanistically plausible as PN may arrest the catabolic phase and provide calories avoiding cellular exhaustion [33]. Our finding of a potentially reduced LOS is at odds with some reviews [34], although studies of patients in intensive care have shown benefit in PN reducing LOS [35]. Preoperative PN has a known association with shorter postoperative LOS in elective patients [36].…”

Section: Discussionmentioning

confidence: 83%

What is the evidence for the use of parenteral nutrition (PN) in critically ill surgical patients: a systematic review and meta-analysis

et al. 2018

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Background Malnutrition is associated with poor outcomes in surgical patients and corrective enteral feeding may not be possible. This is a particular problem in the acute setting where malnutrition is prevalent. The aim of this systematic review was to evaluate the use of parenteral nutrition (PN) in critically ill surgical patients. Methods This review was registered with PROSPERO (CRD42017079567). Searches of the CENTRAL, EMBASE, and MEDLINE databases were performed using a predefined strategy. Randomised trials published in English since 1995, reporting a comparison of PN vs any comparator in a critically ill surgical population were included. The primary outcome was mortality. Risk of bias was assessed using the Cochrane risk of bias tool and the Grading of Recommendations Assessment, Development and Evaluation assessment. Meta-analysis was performed using a random effects model to assess variation in mortality and length of stay. Results Fourteen RCTs were identified; standard PN was compared vs other forms of PN in ten studies, to PN with variable dose amino acids in one, and to enteral nutrition (EN) in three. In trials comparing glutamine-supplemented PN (PN-GLN) to PN, a non-significant reduction in mortality was noted (risk difference − 0.08. 95% CI − 0.17, 0.01, p = 0.08). A trend for a reduction in length of stay was seen in PN-GLN to PN comparator (mean reduction − 2.4, 95% CI − 7.19 to 2.32 days, I 2 = 92%). Impact on other outcome measures varied in direction of effect. Conclusions PN may offer benefit in critically ill surgical patients. The size and quality of studies lead to uncertainty around the estimates of clinical effect, meaning a robust trial is required.

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