Nutritional Support and Total Parenteral Nutrition

• Enteral & parenteral with similar clinical outcomes (Lancet 2018;391:133)
• Enteral (EN): starting w/in 48 h of ICU admit may ↓ infection & mortality. Contraindic. if bowel obstruction, major GIB, uncontrolled shock. Possible complic: ischemic bowel b/c ↑ demand for splanchnic blood, aspiration PNA, metabolic abnormality.
• Parenteral (PN): start after 7 d if unable to tolerate EN; no clear benefit to early initiation. Contraindic: hyperosmolality, severe electrolyte disturbances, severe hyperglycemia; sepsis is relative contraindication. Complications: hyperglycemia, sepsis (↑ risk of fungal infections), catheter-associated thrombus, refeeding syndrome, abnl LFTs (steatosis, cholestasis, gallbladder sludge due to lack of enteric stimulation).