Wait to start TPN in most critically ill adults

Recommend starting ENTERAL feeding right away in critical patients when possible, even in those without bowel sounds...
Mahitab Hany, BS Pharm, PGDipClinPharm, PGDipClinNutrition

There's now stronger evidence for waiting to start parenteral nutrition in most critically ill adults. Waiting one week (7 days) to start parenteral nutrition instead of starting it right away reduces ICU stays by one day and hospital stays by two days.

Patients who start parenteral nutrition later also have a lower risk for infections, less time on a ventilator and lower health care costs. The downside of late initiation is a higher risk of hypoglycemia. Researchers think that starting parenteral nutrition earlier might reduce the body's ability to clear damaged cells and microbes.

Recommend starting ENTERAL feeding right away in critical patients when possible, even in those without bowel sounds. Hold off on PARENTERAL nutrition for about seven days as long as patients aren't malnourished before admission to ICU. In the meantime, give IV fluids, electrolytes, trace elements, and vitamins.

Start parenteral nutrition right away if needed in malnourished patients. Remember that glycemic control during hospitalization reduces infections, length of stay and mortality in critically ill patients. Recommend keeping blood glucose around 140 mg/dL (7.8 mmol/L).

References

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