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Enteral nutrition versus glucose-based or lipid-based parenteral nutrition and tight glycaemic control in critically ill patients
ABSTRACT
Objective: Early administration of nutrition and attention to tight glycaemic control are both associated with improved outcomes in critically ill patients. We hypothesisedthat blood glucose control would be better achieved inpatients receiving enteral rather than parenteral nutrition and, in the latter group, would be better achieved using a“balanced” glucose plus lipid solution than a dextrosebased solution as calorie source.
Methods: We conducted a retrospective interrogation ofthe intensive care database as part of a clinical audit of a12-bed mixed medical and surgical ICU in a tertiary referralteaching hospital between September 2003 and March 2004. Patients expected to stay in the ICU for longer than 48 hours were treated according to an intensive insulintherapy protocol. They received enteral nutrition (EN) or, ifEN was not tolerated, parenteral nutrition (PN) or combinedEN and PN. PN comprised a glucose-based solution (GluPN)during the first 3 months of the study and a balancedglucose plus lipid solution (LipPN) during the second 3 months.
Results: 96 patients were treated according to theprotocol. Patients receiving PN (n = 26) had significantly longer ICU length of stay and greater daily caloric intake than did those receiving EN (n = 70) during both studyperiods. Mean blood glucose, percentage of blood glucose measurements within the target range, and daily insulindose did not differ significantly between patients receiving EN and PN or GluPN and LipPN.
Conclusion: When used in association with a tight glycaemic control regimen, PN is not associated with poorerglycaemic control in critically ill patients than EN.
Crit Care Resusc 2006; 8: 283-288