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Is total parenteral nutrition immunosuppressive?
1New England Deaconess Hospital, Harvard Medical School, Boston, MA.
New Horizons (Baltimore, Md.)
|May 1, 1994
Summary
Overfeeding critically ill patients with total parenteral nutrition (TPN) increases infection risk. Limiting calories to resting energy expenditure is crucial for optimal outcomes in nutritional support.
Area of Science:
- Clinical Nutrition
- Critical Care Medicine
- Metabolic Support
Background:
- Total parenteral nutrition (TPN) is vital for critically ill patients.
- Incorrect TPN administration, especially excess energy (dextrose or lipid), poses significant risks.
- Uncontrolled hyperglycemia from TPN elevates infection risk, potentially negating benefits.
Purpose of the Study:
- To highlight the risks of excessive energy administration in TPN.
- To define optimal caloric and protein targets for critically ill patients.
- To emphasize the adverse outcomes associated with overfeeding.
Main Methods:
- Review of existing literature on TPN complications.
- Analysis of metabolic responses to injury and nutritional support.
- Evaluation of recommended protein and calorie delivery strategies.
Main Results:
- Excessive dextrose or lipid in TPN can lead to hyperglycemia and impaired immune function.
- Hyperglycemia significantly increases infection risk in TPN patients.
- Excessive caloric delivery beyond resting energy expenditure is ineffective and harmful.
Conclusions:
- Optimal TPN involves adequate protein (1.5-2.0 g/kg/day) and calories near resting energy expenditure.
- Avoiding excessive energy, particularly lipids and dextrose, is key to preventing TPN-related complications.
- Careful administration of TPN is essential to improve patient outcomes and reduce adverse events.