Is it now time to promote mixed enteral and parenteral nutrition for the critically ill patient?

Claudia Paula Heidegger, Jacques André Romand, Miriam Treggiari, Claude Pichard

Research output: Contribution to journalArticle

80 Citations (Scopus)

Abstract

Background: Intensive care outcome measured by morbidity and mortality is altered in the severely malnourished ICU patient, and nutritional support of the critically ill is accepted as a standard of care. Current recommendations suggest starting enteral feeding as soon as possible whenever the gastrointestinal tract is functioning. The disadvantage of enteral support is that inadequate energy and protein intake can occur. The present commentary focuses on some recent findings regarding the nutritional support of critically ill patients and proposes to promote mixed nutrition support by enteral nutrition (EN), and by parenteral nutrition (PN) whenever EN is insufficient. Recent findings: An increasing nutrition deficit during a long ICU stay is associated with increased morbidity (increased infection rate or impaired wound healing). Evidence shows that EN can result in underfeeding and that nutrition goals are reached only after 5-7 days. Contrary to former beliefs, recent meta-analyses of studies in the ICU showed that PN is not related to excess mortality but may even be associated with improved survival. Conclusions: Optimising the increased substrate requirement for the critically ill by initiating timely nutrition support and ensuring tight glycaemic control with insulin is now considered central for improved intensive care outcomes. Supplemental PN combined with EN could be an effective alternative to achieve 100% of energy and protein targets at day 4, when EN alone fails to achieve goals greater than 60% by day 3. Whether such combined nutrition support provides additional benefit on overall outcome has to be ascertained in further studies.

Original languageEnglish (US)
Pages (from-to)963-969
Number of pages7
JournalIntensive Care Medicine
Volume33
Issue number6
DOIs
StatePublished - Jun 2007
Externally publishedYes

Fingerprint

Parenteral Nutrition
Enteral Nutrition
Critical Illness
Nutritional Support
Critical Care
Morbidity
Mortality
Standard of Care
Energy Intake
Wound Healing
Small Intestine
Meta-Analysis
Gastrointestinal Tract
Proteins
Insulin
Survival
Infection

Keywords

  • Combined nutrition
  • Critical care
  • Enteral nutrition
  • Human
  • Nutritional support
  • Outcome
  • Parenteral nutrition
  • Practice guidelines
  • Standards

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

Cite this

Is it now time to promote mixed enteral and parenteral nutrition for the critically ill patient? / Heidegger, Claudia Paula; Romand, Jacques André; Treggiari, Miriam; Pichard, Claude.

In: Intensive Care Medicine, Vol. 33, No. 6, 06.2007, p. 963-969.

Research output: Contribution to journalArticle

Heidegger, Claudia Paula ; Romand, Jacques André ; Treggiari, Miriam ; Pichard, Claude. / Is it now time to promote mixed enteral and parenteral nutrition for the critically ill patient?. In: Intensive Care Medicine. 2007 ; Vol. 33, No. 6. pp. 963-969.
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