Supplemental parenteral nutrition in critically ill patients

摘要

Undernutrition is an important risk factor for infections and poor outcome in the intensive-care unit (ICU). New guidelines recommend the addition of parenteral nutrition to enteral nutrition to supply patients in ICU: parenteral nutrition initiated after week or earlier (after 2-3 days in ICU). The study by Claudia Heidegger and colleagues3 seems to have ethical and methodological issues. First, the authors state that 25-30 kcal/kg per day is the ideal target in the ICU to offer patients an adequate energy intake. But the control group received only 20 kcal/ kg per day, leading to a higher risk for these patients to have complications, such as infections. Second, the intervention group, which received 28 kcal/kg per day through enteral nutrition plus 10 kcal/kg per day parenterally, has a significantly lower rate of infections compared with the control group receiving 20 kcal/kg per day. The' authors conclude in favour of the parenteral way. But the observed difference might be related only to the higher calories intake.