Aggressive approach to intravenous feeding of the critically ill patient
Lumb, P.D.; Dalton, B.; Bryan-Brown, C.W.; Donnelly, C.
Heart and Lung the Journal of Critical Care 8(1): 71-80
1979
ISSN/ISBN: 0147-9563 PMID: 103864 Document Number: 140809
Intravenous nutrition has become a necessary part of comprehensive critical care. The guidelines which surround the technique render it safe and effective, but are not always practical in the patient with sepsis or multisystem failure who has a shortage of sites for catheter insertion. After an 8-year experience in a multidisciplinary intensive care unit in which 40% of patients admitted are fed parenterally, modified techniques have been developed so a more aggressive and liberal approach can be used for treating acutely ill patients. Additional crystalloid fluids and medications can be given through the total parenteral nutrition (TPN) catheter, high energy can be used initially and TPN can be stopped abruptly and insulin dosages as high as 28 U/h given safely. When critically ill patients undergo major surgery, TPN may be continued. This is made possible by staff competent to follow and act on the results of very close monitoring in a special care area with efficient laboratory backing. Complication rates have to be kept low by rigorous supervision of catheter insertion and aftercare. This has made frequent catheter changes a practical safety measure. Management and monitoring are described.