Enteral and parenteral nutrition for critically ill patients: A logical combination to optimize nutritional support

Malnutrition is a common and serious problem in intensive care units. Negative energy balance has been associated with increased morbidity and mortality in critically ill patients. The increased incidence of complications attributable to malnutrition correlates with increased length of hospital stay and overall health care costs. Although early enteral nutrition is the preferred method of feeding critically ill patients, enteral nutrition alone often fails to supply adequate calories and nutrients to critically ill patients, who are frequently hypermetabolic. Supplementation of insufficient enteral nutrition with parenteral nutrition may optimize nutritional support and avert negative energy balance in critically ill patients, thereby improving outcomes.

[1]  C. Pichard,et al.  Does nutritional risk, as assessed by Nutritional Risk Index, increase during hospital stay? A multinational population-based study. , 2005, Clinical nutrition.

[2]  L. Neumayer,et al.  Early and sufficient feeding reduces length of stay and charges in surgical patients. , 2001, The Journal of surgical research.

[3]  A. Forbes,et al.  ESPEN Guidelines on Parenteral Nutrition: intensive care. , 2006, Clinical nutrition.

[4]  D. Heyland,et al.  Does enteral nutrition compared to parenteral nutrition result in better outcomes in critically ill adult patients? A systematic review of the literature. , 2004, Nutrition.

[5]  J P McWhirter,et al.  Incidence and recognition of malnutrition in hospital , 1994, BMJ.

[6]  M. Correia,et al.  The impact of malnutrition on morbidity, mortality, length of hospital stay and costs evaluated through a multivariate model analysis. , 2003, Clinical nutrition.

[7]  S. Hameed,et al.  Enteral nutrition and mucosal immunity: implications for feeding strategies in surgery and trauma. , 2004, Canadian journal of surgery. Journal canadien de chirurgie.

[8]  C. Hinds,et al.  Anabolic strategies in critical illness. , 2002, Current opinion in pharmacology.

[9]  C. Hill,et al.  Prevalence of malnutrition on admission to four hospitals in England. The Malnutrition Prevalence Group. , 2000, Clinical nutrition.

[10]  C. Pichard,et al.  Nutritional assessment: lean body mass depletion at hospital admission is associated with an increased length of stay. , 2004, The American journal of clinical nutrition.

[11]  R. Price,et al.  Protein-calorie malnutrition in a community hospital. , 1980, JAMA.

[12]  J. Jakobsson,et al.  Is enteral nutrition optimally used in hospitalized patients? A study of the practice of nutrition in a Swedish hospital. , 1996, Clinical nutrition.

[13]  Sirak Petros,et al.  Enteral nutrition delivery and energy expenditure in medical intensive care patients. , 2006, Clinical nutrition.

[14]  C. Pichard,et al.  Clinical relevance of parenteral nutrition prescription and administration in 200 hospitalized patients: a quality control study. , 2008, Clinical nutrition.

[15]  W. Caiaffa,et al.  Hospital malnutrition: the Brazilian national survey (IBRANUTRI): a study of 4000 patients. , 2001, Nutrition.

[16]  C. Scurlock,et al.  Early nutrition support in the intensive care unit: a US perspective , 2008, Current opinion in clinical nutrition and metabolic care.

[17]  G. Hill,et al.  Components of energy expenditure in patients with severe sepsis and major trauma: a basis for clinical care. , 1999, Critical care medicine.

[18]  J. Macfie,et al.  Enteral versus parenteral nutrition: a pragmatic study. , 2001, Nutrition.

[19]  M Schetz,et al.  Intensive insulin therapy in critically ill patients. , 2001, The New England journal of medicine.

[20]  T. Amaral,et al.  The economic impact of disease-related malnutrition at hospital admission. , 2007, Clinical nutrition.

[21]  H. Dupont,et al.  Upper digestive intolerance during enteral nutrition in critically ill patients: Frequency, risk factors, and complications , 2001, Critical care medicine.

[22]  Dorothee Volkert,et al.  The German hospital malnutrition study. , 2006, Clinical nutrition.

[23]  G. Frost,et al.  The prevalence of malnutrition in hospitals can be reduced: results from three consecutive cross-sectional studies. , 2005, Clinical nutrition.

[24]  R. Griffiths,et al.  Nutrition support for patients in the intensive care unit , 2005, Postgraduate Medical Journal.

[25]  B. Digiovine,et al.  Effects of Early Enteral Feeding on the Outcome of Critically Ill Mechanically Ventilated Medical Patients , 2006 .

[26]  K. Jeejeebhoy Total parenteral nutrition: potion or poison? , 2001, The American journal of clinical nutrition.

[27]  A. Laviano,et al.  In 1995 a correlation between malnutrition and poor outcome in critically ill patients still exists. , 1996, Nutrition.

[28]  B. de Jonghe,et al.  A prospective survey of nutritional support practices in intensive care unit patients: What is prescribed? What is delivered? , 2001, Critical care medicine.

[29]  C. Yen,et al.  Nutritional status of mechanically ventilated critically ill patients: comparison of different types of nutritional support. , 2000, Clinical nutrition.

[30]  M. Perman,et al.  Prevalence of hospital malnutrition in Argentina: preliminary results of a population-based study. , 2003, Nutrition.

[31]  D. Spain,et al.  Infusion protocol improves delivery of enteral tube feeding in the critical care unit. , 1999, JPEN. Journal of parenteral and enteral nutrition.

[32]  Yi-Chia Huang,et al.  Estimation of energy requirements for mechanically ventilated, critically ill patients using nutritional status , 2003, Critical care.

[33]  C. Pichard,et al.  Is it now time to promote mixed enteral and parenteral nutrition for the critically ill patient? , 2007, Intensive Care Medicine.

[34]  Jonathan Cohen,et al.  Computerized energy balance and complications in critically ill patients: an observational study. , 2006, Clinical nutrition.

[35]  L. Dominioni,et al.  The rationale of early enteral nutrition. , 2003, Acta bio-medica : Atenei Parmensis.

[36]  L. Aday,et al.  Economic implications of an early postoperative enteral feeding protocol. , 1997, Journal of the American Dietetic Association.

[37]  M. Berger,et al.  Negative impact of hypocaloric feeding and energy balance on clinical outcome in ICU patients. , 2005, Clinical nutrition.

[38]  G. Hill Implications of critical illness, injury, and sepsis on lean body mass and nutritional needs. , 1998, Nutrition.

[39]  K. Kudsk,et al.  Early nutritional therapy: the role of enteral and parenteral routes , 2008, Current opinion in clinical nutrition and metabolic care.

[40]  Fiona Simpson,et al.  Parenteral vs. enteral nutrition in the critically ill patient: a meta-analysis of trials using the intention to treat principle , 2004, Intensive Care Medicine.

[41]  A. V. van Bodegraven,et al.  Diagnosis and treatment of (disease-related) in-hospital malnutrition: the performance of medical and nursing staff. , 2008, Clinical nutrition.

[42]  Harminder Singh,et al.  Malnutrition is prevalent in hospitalized medical patients: are housestaff identifying the malnourished patient? , 2006, Nutrition.