|LETTER TO EDITOR
|Year : 2010 | Volume
| Issue : 3 | Page : 272
Parenteral nutrition: Few more facts
Preety Mittal Roy, Vijaya Pant, Jyotirmoy Das
Department of Anaesthesiology, Pain and Perioperative Medicine, Fortis Hospital, Shalimar Bagh, New Delhi, India
|Date of Web Publication||10-Jul-2010|
CD 51 F, LIG Flats, Hari Nagar, New Delhi
|How to cite this article:|
Roy PM, Pant V, Das J. Parenteral nutrition: Few more facts. Indian J Anaesth 2010;54:272
It was a pleasure reading the review article on parenteral nutrition (PN).  We congratulate the authors for their endeavor in making the topic so interesting. However, we feel that a couple of points need further discussion.
As per the guidelines for the provision and assessment of nutrition support therapy in adult critically ill patient set by the Society of Critical Care Medicine (SCCM) and American Society for Parenteral and Enteral Nutrition (A.S.P.E.N), 2009, serum protein markers (albumin, prealbumin, transferrin, C-reactive protein) are not recommended for determining adequacy of protein provision.  In all ICU patients receiving PN, initial mild 'permissive underfeeding' (providing approximately 80% of the total energy requirement) should be considered as it has been proved that excessive energy intake can lead to insulin resistance, greater infectious morbidity, extended mechanical ventilation and increased hospital length of stay. Eventually, as the patient stabilizes, PN may be increased to meet energy requirements.  The Canadian Critical Care Clinical Practice Guidelines'2003 states that there are insufficient supportive data to make a recommendation regarding parenteral Selenium supplementation in critically ill patients.  This has again been emphasized in the society's 2009 guidelines.
Finally, in patients stabilized on PN, periodically repeated efforts should be made to initiate enteral nutrition (EN).  As tolerance improves and the volume of EN calories delivered increases, the amount of PN calories supplied should be reduced. PN should not be terminated, until ≥60% of target energy requirements are being delivered by the enteral route.
| References|| |
|1.||Chowdary KVR, Reddy PN. Parenteral Nutrition: Revisited. Indian J Anaesth 2010;54:95-103. |
|2.||McClave SA, Martindale RG, Vanek VW, McCarthy M, Roberts P, Taylor B, et al. Guidelines for the provision and assessment of nutrition support therapy in the adult critically ill patient: Society of Critical Care Medicine (SCCM) and American Society for Parenteral and Enteral Nutrition (A.S.P.E.N). J Parenter Enteral Nutr 2009;33:277-316. |
|3.||Heyland DK, Dhaliwal R, Drover JW, Gramlich L, Dodek P, The Canadian Critical Care Clinical Practice Guidelines Committee. Canadian Clinical practice guidelines for nutrition support in mechanically ventilated, critically ill adult patients. J Parenter Enteral Nutr 2003;27:349-54. |