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Guidelines for Parenteral Nutrition in Critically Ill Patients

This guide outlines best practices for administering parenteral nutrition (PN) to critically ill patients, particularly focusing on hypocaloric PN within the first 10 days. Key recommendations include withholding IV lipids unless the patient is malnourished, providing necessary energy levels, and considering enteral nutrition (EN) strategies before PN. Specific guidelines on IV glutamine administration and intensive insulin therapy for blood sugar control are included. Evidence-based recommendations are prioritized, ensuring optimal patient care in critical settings.

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Guidelines for Parenteral Nutrition in Critically Ill Patients

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  1. PARENTERAL NUTRITION (PN) GUIDELINES. www.criticalcarenutrition.com PN delivered <10 days? Yes No 1) Provide hypocaloric PN. 2) Withhold IV lipids high In soybean oil . (unless pt malnourished) 1) Provide required energy level. 2) Provide IV lipids. All strategies to maximize EN ruled out? (i.e. acceptable gastric residual volume threshold 250 ml; prokinetics; small bowel feeding). No Yes Implement strategies; increase EN to goal rate as per ‘Enteral Nutrition Feeding Guideline’. Provide EN at 10-25 ml/hr if possible. Provide IV glutamine. If IV N/A consider enteral glutamine (0.25 gm/kg/day - 0.5 gm/kg/day mixed in 50 ml saline; delivered in divided doses). In surgical critically ill patients intensive insulin therapy to tightly control blood sugars between 4.4 - 6.1 should be considered. Evidence-based recommendation. All other recommendations opinion-based. Formatted by: J. Greenwood, RD (Vancouver General Hospital) in collaboration with the CCCCPGC (21/7/03).

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