Clinical Reviews: Total Parenteral Nutrition in the ICU

Malnutrition is seen commonly in critically ill patients and may contribute to overall morbidity and mortality. Total parenteral nutrition (TPN) is a specialized form of intravenous nutrition provided to patients with a nonfunctioning gut, malabsorption syndrome, or other indications that prevent enteral feeding. When used appropriately, TPN improves patient outcomes; however, inappropriate use can lead to infectious and metabolic complications. Dedicated multidisciplinary nutrition support teams (NSTs) improve patient safety and quality of care and can lead to tangible cost savings. This article describes indications for appropriate TPN use as developed by the Nutrition Care Committee of the Medical Board at Mount Sinai Hospital. The authors explain how to calculate goals for providing patient-specific nutrition, macronutrient and micronutrient compounding of the TPN formula, follow-up care, and the roles of indirect calorimetry and nitrogen balance. A sample TPN prescription and electronic nursing order set are provided.