Parenteral nutrition is often used in severely injured patients when caloric goals are not achieved enterally.
Dr Matthew Sena and colleagues from California, USA determined whether early administration of parenteral nutrition is associated with an increased risk for infection after severe injury.
The team enrolled severely injured blunt trauma patients from 8 trauma centers participating in the “Inflammation and the Host Response to Injury” (Glue Grant) study.
|Mortality tended to be higher with additional enteral nutrition|
|Journal of the American College of Surgeons|
The team compared patients receiving parenteral nutrition within 7 days after injury with a control group that did not receive early parenteral nutrition.
The research team then focused on patients who tolerated at least some enteral nutrition during the first week.
The team evaluated the potential influence of supplemental parenteral nutrition on outcomes in this 'enteral tolerant' subgroup.
Primary outcomes included occurrence of a nosocomial infection after the first postinjury week.
Secondary outcomes included type of infection and hospital mortality.
The researchers enrolled 567 patients, of which 95 received early parenteral nutrition.
Early parenteral nutrition use was associated with a greater risk of nosocomial infection.
The team found that in the enteral-tolerant subgroup, early parenteral nutrition was also associated with an increase in nosocomial infections in part because of an increased risk of bloodstream infection.
Mortality tended to be higher in patients receiving additional enteral nutrition and parenteral nutrition versus enteral nutrition alone.
Dr Sena’s team concluded, “In critically ill trauma patients who are able to tolerate at least some enteral nutrition, early parenteral nutrition administration can contribute to increased infectious morbidity and worse clinical outcomes.”