Fighting Caloric Deficit with Supplemental Parenteral Nutrition
How adequate nutrition can improve patients’ hospital outcome
Clinical nutrition (CN) needs to be adequate to effectively fight caloric deficit. This is challenging, especially in critically ill patients. Rigorous nutrition control is important to prevent underfeeding, overfeeding and refeeding syndrome.
Insufficient enteral nutrition (EN) in critically ill patients
In the critical care setting sufficient EN is often not feasible1‘2 due to limited gastrointestinal tolerance or frequent interruptions e.g. from treatment related procedures or surgeries.3‘4‘5 Inadequate clinical nutrition can lead to nutritional deficits. If acquired early on, these nutritional deficits are associated with the occurrence of (infectious) complications, increased antibiotic use, mechanical ventilation, extended intensive care unit (ICU) stay and increased mortality.6‘7‘8‘9‘10‘11
Click here to read more about the risks arising from caloric deficits.
Supplemental parenteral nutrition (SPN) can help to improve outcome in critically ill patients
Whenever EN is insufficient early SPN is an effective and safe strategy to fulfill nutritional needs and prevent nutritional deficits.1‘2‘12‘13 Early SPN can improve patient outcomes in the critical care setting.2‘12‘13
Heidegger et al. showed that SPN introduced after 3 days of insufficient EN resulted in significantly improved energy and protein delivery in ICU patients between day 4 and 8 compared to EN alone. The same study also detected a significantly reduced mean number of days with antibiotic use as well as a decreased rate of hospital-acquired infections between days 9 and 28. Individual energy supplementation with SPN at day 4 after ICU admission should be considered to improve clinical outcomes of ICU patients in the case of insufficient EN.2
SPN is a safe choice when fighting caloric deficits in critically ill patients:
- SPN is an effective and safe strategy to prevent nutritional deficits and meet nutritional needs.1‘2‘12‘13
- SPN significantly increases mean energy and protein delivery2
- SPN enables filling the gap between feasible enteral intake and actual needs12
- SPN leads to a significantly reduced mean number of days with antibiotic use and decreased number of hospital-acquired infections in the ICU2
- Early SPN is safe and well-tolerated when administered adequately2‘12‘13