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Parenteral nutrition: a clear and present danger unabated by tight glucose control

Kazuhide Matsushima1, Alan Cook, Tracy Tyner

  • 1Department of Surgery, University of Texas Southwestern Medical Center, Dallas, USA. kmatsushima@hmc.psu.edu

American Journal of Surgery
|August 31, 2010
PubMed

Insights

Parenteral nutrition (PN) in critical illness increases infectious risks, even with tight glucose control (TGC). PN use was significantly associated with higher rates of bloodstream infections compared to enteral nutrition (EN).

Area of Science:

  • Critical care medicine
  • Infectious disease epidemiology
  • Nutritional support

Background:

  • Parenteral nutrition (PN) is associated with infectious risks in critical illness.
  • Previous studies on PN complications predate current tight glucose control (TGC) practices.
  • The study investigates if TGC mitigates PN-related infectious risks.

Purpose of the Study:

  • To evaluate the impact of tight glucose control (TGC) on infectious complications in patients receiving parenteral nutrition (PN).
  • To compare infectious outcomes between patients receiving PN and those receiving enteral nutrition (EN) under TGC.
  • To determine if PN remains an independent risk factor for infections despite TGC.

Main Methods:

  • Prospective cohort study in a surgical intensive care unit.
  • Comparison of patients receiving PN versus EN.
  • Target glucose range of 80 to 110 mg/dL for TGC.
  • Univariate and multivariate logistic regression analysis to assess PN's association with infectious outcomes.

Main Results:

  • 155 patients were included in the study.
  • Mean daily glucose levels were lower in the PN group (118.2 mg/dL) compared to the EN group (125.6 mg/dL).
  • PN was significantly associated with a >4-fold increased odds of catheter-related bloodstream infection (OR, 4.48; P = .03).

Conclusions:

  • Tight glucose control (TGC) did not eliminate the increased infectious risk associated with parenteral nutrition (PN).
  • PN remains a significant risk factor for infectious complications in surgical intensive care unit patients.
  • Further strategies are needed to reduce PN-associated infections.
Abstract

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