A critical assessment of the indications for total parenteral nutrition.

While total parenteral nutrition represents a powerful tool for maintaining and restoring nutritional integrity in the acutely and chronically ill patient, the enthusiasm for its impact on particular pathologic processes is largely unproved. Total parenteral nutrition can preserve body weight in almost all groups of patients studied. There is evidence for improved outcome with total parenteral nutrition in premature infants with respiratory distress syndrome, children with intractable diarrhea, patients with short bowel syndrome and acute renal failure. While this certainly does not represnet an inclusive list of the indications for parenteral nutrition, it does demonstrate the limited amount of controlled experience with total parenteral nutrition in other disease entities. The energy which has been fruitfully directed towards developing the methods and techniques which make total parenteral nutrition possible must now be directed toward more completely defining its optimal role in patient care.