Parenteral nutrition: A clear and present danger unabated by tight glucose control

Kazuhide Matsushima, Alan Cook, Tracy Tyner, Lauren Tollack, Richard Williams, Susan Lemaire, Randall Friese, Heidi Frankel

Research output: Contribution to journalArticlepeer-review

15 Scopus citations

Abstract

Background: The infectious risks of parenteral nutrition (PN) in critical illness are well described, although most literature predates tight glucose control (TGC) practice. The authors hypothesized that PN-related complications are ameliorated by TGC and are equivalent to those in enteral nutrition (EN) patients. Methods: A prospective cohort study of patients admitted to the surgical intensive care unit was conducted, comparing PN and EN patients. TGC target was 80 to 110 mg/dL. Univariate and multivariate logistic regression was used to explore the association between infectious outcomes and PN use. Results: One hundred fifty-five patients were studied. Mean daily glucose values were lower for the PN group than for the EN patients (118.2 vs 125.6 mg/dL, P = .002). Nonetheless, the incidence of bloodstream infection and catheter-related bloodstream infection was significantly associated with the administration of PN. In a multivariate logistic regression model, PN was associated with a >4-fold increase in the odds of having a catheter-related bloodstream infection (odds ratio, 4.48; 95% confidence interval, 1.1417.49; P = .03). Conclusions: Despite the successful implementation of TGC, PN is still a significant risk factor for infectious complications among surgical intensive care unit patients.

Original languageEnglish (US)
Pages (from-to)386-390
Number of pages5
JournalAmerican journal of surgery
Volume200
Issue number3
DOIs
StatePublished - Sep 2010
Externally publishedYes

Keywords

  • Critically ill patient
  • Nosocomial infection
  • Tight glucose control
  • Total parenteral nutrition

ASJC Scopus subject areas

  • Surgery

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