BACKGROUND: Parenteral nutrition (PN) is often used in severely injured patients when caloric goals are not achieved enterally. The purpose of this study is to determine whether early administration of parenteral nutrition is associated with an increased risk for infection after severe injury. STUDY DESIGN: Retrospective cohort study of severely injured blunt trauma patients enrolled from eight trauma centers participating in the "Inflammation and the Host Response to Injury" (Glue Grant) study. We compared patients receiving PN within 7 days after injury with a control group that did not receive early PN. We then focused on patients who tolerated at least some enteral nutrition (EN) during the first week and evaluated the potential influence of supplemental PN on outcomes in this "enteral tolerant" subgroup. Primary outcomes included occurrence of a nosocomial infection after the first postinjury week. Secondary outcomes included type of infection and hospital mortality. RESULTS: Of 567 patients enrolled, 95 (17%) received early PN. Early PN use was associated with a greater risk of nosocomial infection (relative risk [RR] = 2.1; 95% CI, 1.6 to 2.6; p < 0.001). In the enteral-tolerant subgroup (n = 249), early PN was also associated with an increase in nosocomial infections (RR = 1.6; 95% CI, 1.2 to 2.1; p = 0.005) in part because of an increased risk of bloodstream infection (RR = 2.8; 95% CI, 1.5 to 5.3; p = 0.002). Mortality tended to be higher in patients receiving additional EN and PN versus EN alone (RR = 2.3; 95% CI, 1.0 to 5.2; p = 0.06). CONCLUSIONS: In critically ill trauma patients who are able to tolerate at least some EN, early PN administration can contribute to increased infectious morbidity and worse clinical outcomes.
BACKGROUND: Parenteral nutrition (PN) is often used in severely injured patients when caloric goals are not achieved enterally. The purpose of this study is to determine whether early administration of parenteral nutrition is associated with an increased risk for infection after severe injury. STUDY DESIGN: Retrospective cohort study of severely injured blunt traumapatients enrolled from eight trauma centers participating in the "Inflammation and the Host Response to Injury" (Glue Grant) study. We compared patients receiving PN within 7 days after injury with a control group that did not receive early PN. We then focused on patients who tolerated at least some enteral nutrition (EN) during the first week and evaluated the potential influence of supplemental PN on outcomes in this "enteral tolerant" subgroup. Primary outcomes included occurrence of a nosocomial infection after the first postinjury week. Secondary outcomes included type of infection and hospital mortality. RESULTS: Of 567 patients enrolled, 95 (17%) received early PN. Early PN use was associated with a greater risk of nosocomial infection (relative risk [RR] = 2.1; 95% CI, 1.6 to 2.6; p < 0.001). In the enteral-tolerant subgroup (n = 249), early PN was also associated with an increase in nosocomial infections (RR = 1.6; 95% CI, 1.2 to 2.1; p = 0.005) in part because of an increased risk of bloodstream infection (RR = 2.8; 95% CI, 1.5 to 5.3; p = 0.002). Mortality tended to be higher in patients receiving additional EN and PN versus EN alone (RR = 2.3; 95% CI, 1.0 to 5.2; p = 0.06). CONCLUSIONS: In critically ill traumapatients who are able to tolerate at least some EN, early PN administration can contribute to increased infectious morbidity and worse clinical outcomes.
Authors: Joseph P Minei; Avery B Nathens; Michael West; Brian G Harbrecht; Ernest E Moore; Michael B Shapiro; Paul E Bankey; Jeffrey L Johnson; Bradley Freeman; Bruce A McKinley; Fredrick A Moore; Ronald V Maier Journal: J Trauma Date: 2006-05
Authors: Frederick A Moore; Bruce A McKinley; Ernest E Moore; Avery B Nathens; Michael West; Michael B Shapiro; Paul Bankey; Bradley Freeman; Brian G Harbrecht; Jeffrey L Johnson; Joseph P Minei; Ronald V Maier Journal: J Trauma Date: 2006-07
Authors: Avery B Nathens; Jeffrey L Johnson; Joseph P Minei; Ernest E Moore; Michael Shapiro; Paul Bankey; Brad Freeman; Brian G Harbrecht; Stephen F Lowry; Bruce McKinley; Fredrick Moore; Michael West; Ronald V Maier Journal: J Trauma Date: 2005-09
Authors: Stéphane Villet; René L Chiolero; Marc D Bollmann; Jean-Pierre Revelly; Marie-Christine Cayeux R N; Jacques Delarue; Mette M Berger Journal: Clin Nutr Date: 2005-08 Impact factor: 7.324
Authors: F A Moore; D V Feliciano; R J Andrassy; A H McArdle; F V Booth; T B Morgenstein-Wagner; J M Kellum; R E Welling; E E Moore Journal: Ann Surg Date: 1992-08 Impact factor: 12.969
Authors: Stephen C Gale; Beth-Ann Shanker; Susette M Coyle; Marie A Macor; Chun W Choi; Steve E Calvano; Siobhan A Corbett; Stephen F Lowry Journal: Shock Date: 2012-08 Impact factor: 3.454
Authors: Christina K Chung; Ryan Whitney; Callie M Thompson; Tam N Pham; Ronald V Maier; Grant E O'Keefe Journal: J Am Coll Surg Date: 2013-09-17 Impact factor: 6.113
Authors: Mark A Jonker; Joshua L Hermsen; Yoshifumi Sano; Aaron F Heneghan; Jinggang Lan; Kenneth A Kudsk Journal: Surgery Date: 2010-12-10 Impact factor: 3.982
Authors: G Elke; E Kuhnt; M Ragaller; D Schädler; I Frerichs; F M Brunkhorst; M Löffler; K Reinhart; N Weiler Journal: Med Klin Intensivmed Notfmed Date: 2013-03-03 Impact factor: 0.840
Authors: Brodie A Parent; Samuel P Mandell; Ronald V Maier; Joseph Minei; Jason Sperry; Ernest E Moore; Grant E O'Keefe Journal: J Trauma Acute Care Surg Date: 2016-06 Impact factor: 3.313