When is parenteral nutrition indicated in the hospitalized, acutely ill patient?

Abstract

Purpose of review: This review discusses current practices regarding appropriate indications for parenteral nutrition (PN) in acutely ill hospitalized patients. We address specific indications for PN in the peri-operative period, and in inflammatory bowel disease, oncology, hepatobiliary, critical care and end-stage renal disease patients. Recent findings: Acutely ill hospitalized patients can develop intestinal failure requiring PN. Recent studies have provided insight into the main indications. The most common indications for inpatient PN include post-surgical complications, including prolonged ileus sepsis, fistula and leaks, and bowel obstruction, predominantly malignant. Severe or complicated inflammatory bowel disease and cancer treatment-related mucosal enteropathies (mucositis, enterocolitis, gut graft-versus-host disease) are the next commonest indications. Less frequent indications are primary motility disorders and inability to secure enteral access for enteral nutrition. Gastrointestinal failure of the intensive care patient is a separate entity resulting from multiple mechanisms, including an enteropathy and dysmotility. Summary: Despite the wider availability of nutrition support teams, use of PN is not without risk. The risks and benefits of PN in the acute setting need to be carefully considered even when it is indicated.

Effects of fish oil-containing nutrition supplementation in adult sepsis patients: a systematic review and meta-analysis

“…Fish oil-containing nutrition makes sense at the initial hyperinflammatory stage, but may be harmful during the hypo-inflammatory phase [ 62 ]. Therefore, apart from the administration route, timing is a key point, when to start, by which route and for how long [ 7 , 9 ]. Parenteral provision of nutrition shows its advantageous efficacy in patients if the prepared PN is well-indicated and provided for patients with the assistance of a professional nutrition team, which is, however, more challenging and expensive than EN [ 63 ].…”

“…On the one hand, conventional nutrition therapy provides the body with the necessary energy and metabolic substrates [ 9 ]. On the other hand, the addition of pharmaco-nutrients such as glutamine, arginine, omega-3 (ω-3) fatty acids, vitamin C and selenium can invigorate systemic immune defense.…”

Management of the Hostile Abdomen

“…Individuals who have a prolonged recovery and do not tolerate an adequate oral intake should be considered for home PN if they are otherwise appropriate for discharge, so that an enteral diet can be restored without pressure. 31 Electrolyte and fluid status should be closely monitored in those with proximal or high output ostomy. Immediate consultation with ET is of extreme importance, for pouching and wound care, and to avoid developing skin excoriation around the ostomy or new wounds.…”

“…Individuals who have a prolonged recovery and do not tolerate an adequate oral intake should be considered for home PN if they are otherwise appropriate for discharge, so that an enteral diet can be restored without pressure. 31…”