Early administration of early supplemental parenteral feeding is proven to be harmful in patients admitted to intensive care units. A study published in The Lancet explored which macronutrient component of early parenteral feeding is responsible for causing harm.
Critically ill children who are admitted to the pediatric intensive care unit (PICU) often receive supplemental nutrition via parenteral route if they are unable to tolerate oral or nasogastric routes. However, earlier randomized controlled trials show that early administration of supplemental parenteral nutrition causes harm.
An article published in The Lancet investigated which component of supplemental parenteral feeding given to PICU patients is responsible for increased rates of infection, longer weaning time from the mechanical ventilation, and longer stays in the PICU. A total of 1440 children aged 0 to 17 years who were admitted to the PICU and had a central venous line in place from June 18, 2012 to July 15, 2015 were included in the study. Patients were randomly assigned to receive parenteral nutrition within 24 hours (early PN) or after 1 week (late PN) of admission to the PICU. Both groups received enteral nutrition after admission to ensure minimum nutritional requirements were met. Doses of glucose, lipids, and amino acids administered in both groups were converted from grams per day to percentage of ideal doses based on age, weight and current nutritional guidelines. The following outcomes were measured at the end of the study: 1) time to first infection acquired in PICU, 2) time before weaning from the mechanical ventilator, and 3) length of stay in the PICU.
The results of the study show that late administration of parenteral feeding reduces the risk of acquiring a new infection from 18.5% to 10.7%. It also reduced the length of PICU stay and reduced the time spent dependent on mechanical ventilation. Furthermore, increasing amounts of amino acids administered correlate to higher infection rates, longer time weaning from the mechanical ventilator, and longer stays in the PICU. Higher daily glucose levels within the first 3 days of admission were associated with lower infection rates while shorter stays in the PICU was observed with higher lipid levels.
Overall, the study shows that early administration of parenteral feeding in PICU is indeed associated with worse clinical outcomes. Amino acids, not lipid or glucose, could be responsible for the harms associated with early administration of parenteral feeding in patients admitted to the PICU. Future studies are needed to investigate whether early administration of parenteral nutrition with lower doses of amino acids reduces infection rates and other harms associated with parenteral feeding.
Written By: Karla Sevilla