Total parenteral nutrition in critically ill and injured patients

Background: Malnutrition is common in critically ill and severely injured patients. Many factors are responsible for the development of malnutrition in critically ill and injured patients, including the hypercatabolic states associated with trauma, sepsis, often repeated surgical intervention, long periods of inability to take nutrition by mouth and many other factors. While oral or enteral nutrition is the preferable technique of provision nutrition support, often this is impossible, impractical or ill advised. To this end, the total parenteral nutrition (TPN), in clinical practice since 1968, as developed by Dr. Stanley J. Dudrick, has been an instrumental technique in providing all needed nutrient substrates and calories intravenously to all those patients who cannot eat, will not eat or should not eat. Methods: Review of literature. Results: TPN is efficacious in patients who are malnourished and unable to receive adequate oral or enteral nutrients in particular in short gut syndromes, severe gut dysfunction, mesenteric vascular insufficiency, prolonged bowel obstruction, high volume fistulas, sepsis with hemodynamic instability, and many other conditions. Conclusions: TPN can remain the primary technique of providing all nutrient substrates and caloric needs until the GI tract can safely and effectively be used.