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World J Crit Care Med. Feb 4, 2017; 6(1): 13-20
Published online Feb 4, 2017. doi: 10.5492/wjccm.v6.i1.13
Management of parenteral nutrition in critically ill patients
Paolo Cotogni
Paolo Cotogni, Department of Anesthesia and Intensive Care, Pain Management and Palliative Care, S. Giovanni Battista Hospital, University of Turin, 10123 Turin, Italy
Author contributions: Cotogni P developed the research question and review design, drafted and finalized the manuscript.
Conflict-of-interest statement: The author declares no conflict of interests for this article.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Paolo Cotogni, MD, MSc, Department of Anesthesia and Intensive Care, Pain Management and Palliative Care, S. Giovanni Battista Hospital, University of Turin, Via Giovanni Giolitti 9, 10123 Turin, Italy. paolo.cotogni@unito.it
Telephone: +39-011-5171634 Fax: +39-011-5171634
Received: September 3, 2016
Peer-review started: September 7, 2016
First decision: September 29, 2016
Revised: October 30, 2016
Accepted: December 7, 2016
Article in press: December 9, 2016
Published online: February 4, 2017
Processing time: 141 Days and 14.9 Hours
Abstract

Artificial nutrition (AN) is necessary to meet the nutritional requirements of critically ill patients at nutrition risk because undernutrition determines a poorer prognosis in these patients. There is debate over which route of delivery of AN provides better outcomes and lesser complications. This review describes the management of parenteral nutrition (PN) in critically ill patients. The first aim is to discuss what should be done in order that the PN is safe. The second aim is to dispel “myths” about PN-related complications and show how prevention and monitoring are able to reach the goal of “near zero” PN complications. Finally, in this review is discussed the controversial issue of the route for delivering AN in critically ill patients. The fighting against PN complications should consider: (1) an appropriate blood glucose control; (2) the use of olive oil- and fish oil-based lipid emulsions alternative to soybean oil-based ones; (3) the adoption of insertion and care bundles for central venous access devices; and (4) the implementation of a policy of targeting “near zero” catheter-related bloodstream infections. Adopting all these strategies, the goal of “near zero” PN complications is achievable. If accurately managed, PN can be safely provided for most critically ill patients without expecting a relevant incidence of PN-related complications. Moreover, the use of protocols for the management of nutritional support and the presence of nutrition support teams may decrease PN-related complications. In conclusion, the key messages about the management of PN in critically ill patients are two. First, the dangers of PN-related complications have been exaggerated because complications are uncommon; moreover, infectious complications, as mechanical complications, are more properly catheter-related and not PN-related complications. Second, when enteral nutrition is not feasible or tolerated, PN is as effective and safe as enteral nutrition.

Keywords: Enteral nutrition; Intensive care; Nutritional support; Vascular access; Artificial nutrition

Core tip: The goal of parenteral nutrition (PN) is to complete the therapy without complications. But the goal of “near zero” PN-related complications is achievable if appropriate prevention and monitoring procedures for reducing PN complications are instituted. The key message of this review is the strong recommendation for the development and implementation of protocols for the safe management of PN in critically ill patients, in which each healthcare professional will be actively engaged. If accurately managed, PN can be safely provided for most critically ill patients without expecting a relevant incidence of PN-related complications.