The Current Role of Parenteral Nutrition in the Hospitalized Patient

The role of early versus late initiation of total parenteral nutrition in critically ill patients is a topic of debate among nutrition experts. The European Society of Parenteral and Enteral Nutrition (ESPEN) recommends that all patients who are not expected to be on normal nutrition within 3 days of ICU admission should receive parenteral nutrition (PN) within 24–48 h if enteral nutrition (EN) is contraindicated or if they cannot tolerate EN. The American Society of Parenteral and Enteral Nutrition (ASPEN) guidelines recommend that if early EN is not feasible or available the first 7 days following admission to the ICU, no supplemental PN support therapy should be provided. Since the release of these guidelines, several large multi-center trials have been published that may alter the previously published recommendations. With the anticipated release of the new ASPEN guidelines, a number of recent studies will not be evaluated since the cut-off for the inclusion of new studies was December 31, 2013. The current article reviews both the ESPEN and ASPEN guidelines for the recommendation of PN support in critically ill adult patients and reviews large multi-center studies that were performed since these guidelines were published.