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A Clinical Trial Assessing the Safety, Efficacy, and Delivery of Olive-Oil-Based Three-Chamber Bags for Parenteral Nutrition
Published on: September 20, 2019
[Multicenter study on incidence of total parenteral nutrition complications in the critically-ill patient. ICOMEP
Insights
Parenteral nutrition (PN) complications are common in ICU patients, with nutrient-related issues and infections being most frequent. While hyperglycemia and liver dysfunction require intervention, they do not necessitate PN withdrawal.
Area of Science:
- Intensive Care Medicine
- Clinical Nutrition
- Patient Safety
Background:
- Parenteral nutrition (PN) is crucial for critically ill patients but carries risks.
- Understanding PN-related complications is vital for optimizing patient outcomes in the ICU.
Purpose of the Study:
- To prospectively evaluate the incidence and types of complications associated with total parenteral nutrition (TPN) in intensive care unit (ICU) admissions.
- To identify specific complications requiring therapeutic interventions and assess their impact on TPN continuation.
Main Methods:
- A prospective, multicenter study involving ICU patients receiving TPN.
- Data collected included demographics, diagnoses, severity scores, TPN indications, and detailed complication tracking.
- Complications were categorized by route, administration, metabolic, infectious, and organ-specific issues.
Main Results:
- Of 3409 admissions, 370 patients received TPN. The main indication was paralytic ileus.
- High incidences of nutrient-related complications (94.3%) and catheter-induced sepsis (54.6%) were observed.
- Hyperglycemia and liver dysfunction were frequent, alongside electrolyte imbalances and catheter-related issues.
Conclusions:
- Hyperglycemia and liver dysfunction are common complications of TPN in the ICU.
- While requiring interventions, these complications, along with electrolyte imbalances and catheter issues, do not mandate TPN discontinuation.
Objective:
To assess parenteral nutrition complications in a prospective cohort of patients admitted to the ICU.
Material And Methods:
Prospective, multicenter study of patients admitted to the ICU and that received total parenteral nutrition (TPN). A 14-item questionnaire was done. Total number of admissions and TPN-treated patients were recorded. Demographical data, diagnosis, APACHE II, multiorgan dysfunction index and TPN indications were included. Each complication was previously defined and was related to the route, administration, serum electrolytes unbalances, active ingredients, liver dysfunction, and nosocomial infections. An independent group managed the databases. Data were expressed in absolute values or by their median and percentile (25-75). The rate and incidence density of complications are determined.
Results:
The number of admissions during the study period was 3409. Three hundred and seventy (11%) were valid cases that were treated with PN. Two hundred and thirty seven were men, 142 patients were admitted for medical causes, 195 for surgical causes and 33 for trauma. One hundred and twenty patients were moderately or severely underfed, 181 received PN for 7 days (3-11), and 189 received PN and EN. The main indication for PN was paralytic ileus, in 145 patients. TPN was withdrawn for switching to EN in 121 cases and for complications in 5 cases. PN summed up 3220 days. The incidence of complications was: access route 9.32%, maintenance 19.7% and 0.8 per 100 days. Administration, 5.6% and 6.4 per 100 days. Nutrients, 94.3% and 10.8 per 100 days. Catheter-induced sepsis, 54.6% and 0.44 bacteriemias per 100 days with catheter. Nosocomial infection, 54.6% and 6.27 per 100 days on TPN.
Conclusions:
hyperglycemia and liver dysfunction have a greater incidence. Hyperglycemia, electrolyte unbalances and catheter complications have a greater number of therapeutic interventions, but does not mean that TPN should be withdrawn.
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