Nutrition support team impact on critically ill patients receiving parenteral nutrition

Abstract

Background

Parenteral nutrition (PN) increases risk of metabolic complications. Limited literature assesses multidisciplinary nutrition support team (NST) impact on critically ill patients receiving PN.

Objective

This study aimed to evaluate safety outcomes and guideline concordance of macronutrients prescribed for intensive care unit (ICU) patients on PN with and without an NST.

Methods

This was a dual-center, retrospective cohort study of adult ICU patients initiated on PN between June 1, 2018, and June 30, 2023. The primary outcome was the proportion of patients who experienced an electrolyte abnormality (EA) in the first 72 hours of PN.

Results

An NST reduced the proportion of patients experiencing EAs in the first 72 hours of PN by 16% (90% vs. 74% [95% CI 8–24], P < 0.001). Multivariate logistic regression further identified a lack of an NST as an independent risk factor for EA (odds ratio 3.35 [1.74–6.46]). In the first 72 hours of PN, patients with an NST had a greater proportion of patients experience hyperglycemia (67.3% vs. 79.3%, −12% difference [−22.7 to −2.7], P = 0.019) and hypoglycemia (6% vs. 24%, −18% difference [−25.3 to −9.3], P < 0.001). Finally, no differences were observed in macronutrient prescription concordance with guideline recommendations.

Conclusion

In our study, an NST had a mixed impact on PN metabolic complications. It significantly reduced EAs, but increased hyper- and hypoglycemic events. Larger studies including more locations and NSTs are needed to confirm these findings and further evaluate NST impact on patient outcomes such as length of stay and mortality.