Strategies of parenteral nutrition in critically ill patients after abdominal surgery
1ChangZhigang,1YanXiaoyu,2ZhuMingwei
1
Department of Surgical ICU, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medi?
cal Sciences, Beijing 100730, China；2
Department of General Surgery, Beijing Hospital, National Center of Gerontology, Institute of Geri?
atric Medicine, Chinese Academy of Medical Sciences, Beijing 100730, China
Abstract：With the development of clinical and basic research, as well as practical experience of nutrition therapy, enteral
nutrition occupies the dominant route of therapy after abdominal surgery compared with parenteral nutrition. Currently, parenteral
nutrition is often used supplementarily for patients with insufficient enteral feeding, or totally for whom unable to carry out
enteral nutrition. Cautions should be paid according to the indications and contraindications of parenteral nutrition, avoiding the
misuse of parenteral nutrition. A considerable percent of postoperative patients who need parenteral nutrition have complex
complications with prolonged courses of disease, thus often need intensive care treatment. Nutrition therapy including energy and
protein needs should be individualized based on the pathophysiological and metabolic characteristics of critically ill patients.
Timing of adding supplemental parenteral nutrition should be based on patient′s nutrition risk, early supplemental parenteral
nutrition is indicated to those with high nutrition risk. Glutamine can be added to parenteral nutrition, while attention should also
be paid to the choice of lipids. New lipids including structured lipids, omega⁃3 fatty acids, and lipid emulsion formulas of
soybean oil, medium⁃chain triglycerides, olive oil, and fish oil (SMOF) might be beneficial to surgical critically ill patients. This
article reviews the indications, targets of energy and proteins, time to initiation and formula of parenteral nutrition for critically ill
patients after abdominal surgery, as well as the related progress and concepts in recent years, with the aim to provide new
information for clinical practice.
