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Postoperative total parenteral nutrition.

D L Waitzberg1, C Plopper, R M Terra

  • 1Department of Surgery, University of São Paulo Medical School, Av. Dr. Arnaldo 455, São Paulo, SP 01246.903, Brazil. waitzber@virtual-net.com.br

World Journal of Surgery
|May 5, 1999
PubMed
Summary

Postoperative nutritional therapy, including total parenteral nutrition (TPN), is crucial for surgical patients experiencing catabolism. Optimal TPN strategies involve specific energy, macronutrient, and nitrogen targets to prevent metabolic distress.

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Area of Science:

  • Metabolic Surgery
  • Surgical Nutrition
  • Intensive Care Medicine

Background:

  • Surgical trauma triggers catabolism and body cell mass loss, potentially severe in malnourished patients or those with complications.
  • Enteral nutrition is preferred, but total parenteral nutrition (TPN) becomes necessary in specific postoperative scenarios.
  • Severe metabolic distress can arise from exacerbated catabolic responses post-surgery.

Purpose of the Study:

  • To outline indications and optimal parameters for postoperative total parenteral nutrition (TPN).
  • To guide nutritional management in surgical patients at risk of metabolic complications.
  • To highlight the need for further research in TPN for postoperative care.

Main Methods:

  • Review of current literature and clinical guidelines on postoperative nutritional support.

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  • Analysis of metabolic changes induced by surgical trauma.
  • Identification of key nutritional requirements and administration strategies for TPN.

    • Main Results:

    • Postoperative TPN is indicated for patients on preoperative TPN, severely malnourished, unable to eat for 7 days, or with severe complications.
    • Recommended TPN duration is at least 7 days, with energy targets of 30-35 kcal/kg/day.
    • Optimal macronutrient distribution includes 50-70% carbohydrates, 20-30% lipids, with specific glucose, lipid, and nitrogen rates provided.

    Conclusions:

    • Postoperative TPN requires careful patient selection and adherence to specific metabolic and nutritional guidelines.
    • Optimal TPN administration involves precise energy, macronutrient, and nitrogen delivery.
    • Further high-quality clinical trials are essential to refine TPN protocols and address remaining questions in postoperative care.