[Effectiveness of total parenteral nutrition in critically ill patients]

Stress metabolism that develops in critically ill patients leads to acute malnutrition in approximately 40% of intensive care patients. Many of them cannot be fed enterally, and total parenteral nutrition (TPN) is necessary. On the other hand, TPN is often not fully effective, and may be associated with various side effects and complications. We have assessed our practice by seeking the answers to three questions: (1) Was the TPN sufficient and adequate? (2) Did the TPN improve the nutritional status of patients? and (3) Were there any disease-dependent differences?

Seventy-one adult patients receiving TPN for at least 2 weeks, were allocated to five groups according to their underlying disease: A--patients after cardiovascular surgery, B--patients with acute pancreatitis, C--multiple trauma victims, D--patients after abdominal surgery; and E--septic or leukemic patients.The following parameters were assessed twice a week, in all cases: serum total protein, albumin, glucose, triglycerides, total cholesterol, and C-reactive protein, as well as nitrogen daily excretion and nitrogen balance. All patients were receiving "all-in-one" nutritional mixtures, consisting of amino acids, glucose, electrolytes, fat emulsion, vitamins and microelements.

TPN increased serum total protein and serum albumin concentrations and improved nitrogen balance in all patients. Nutritional status also improved, regardless of underlying disease. Hyperglycemia was common, but glucose concentrations did not differ among the groups. There were no TPN-related complications.

We conclude that, in the categories of patients studied, standard TPN is sufficient for improvement of nutritional status during life-threatening illness.