It is thought that patients in intensive care units (ICU) may benefit from additional calorie and protein delivery in the first week of care. However, data has shown surgical ICU patients to be more poorly fed than other ICU groups. In a previous international multicentre, observational study, significant results for an additional 1000kcals in those with a body mass index (BMI) of <25 or >35 were observed. This calorie increase was associated with an almost 50% reduction of 60-day mortality in these groups, independent of the route of delivery (either parenteral nutrition [EN] or enteral nutrition [PN]).

In a recent pilot trial, Wischmeyer et al (2017) explored the use of SPN + EN versus EN alone.  In total, of the 125 patients enrolled in the study, the SPN + EN group showed a 26% increase in calorie/protein delivery, while those receiving EN alone had a 22% increase (both P<0.001) over the first ICU week. Although not significant, encouraging trends were also observed in ICU mortality and quality of life for SPN + EN use. Furthermore, no increased infection risk was found from PN use.

This research highlights that SPN may play an important role in high-nutritional-risk ICU patients.

To read the paper in full, please see the below reference:

Wischmeyer et al (2017) A randomized trial of supplemental parenteral nutrition in underweight and overweight critically ill patients: the TOP-UP pilot trial. Critical Care 21:142 DOI 10.1186/s13054-017-1736-8