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For instructor materials including Power Points, Answers to Clinical Encounter Questions, please contact userservices@mhprofessional.com.
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Content Update
July 23, 2024
Update to Guidelines for Nutrition Support in Adult Critically Ill Patients from the American Society for Parenteral and Enteral Nutrition: The 2016 Guidelines for the Provision and Assessment of Nutrition Support Therapy in the Adult Critically Ill Patient were jointly published by the American Society for Parenteral and Enteral Nutrition (ASPEN) and the Society of Critical Care Medicine (SCCM). These Guidelines had many “expert consensus” recommendations because of a dearth of randomized controlled trials exploring many of the practice areas. A 2021 update by ASPEN to these guidelines addressed five questions for which trials had been conducted, some before and some after the previous guidelines were put together, which are summarized in this update.
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LEARNING OBJECTIVES
Upon completion of the chapter, the reader will be able to:
List appropriate indications for parenteral nutrition (PN) in adult patients.
Describe the components of PN and their role in nutrition support therapy.
List key elements of nutrition assessment and factors considered in assessing an adult patient’s nutritional status and nutritional requirements.
List important recommendations to improve PN safety.
Explain important pharmaceutical and compounding concerns with PN admixtures.
Develop a plan to design, initiate, and adjust a PN formulation for an adult patient based on patient-specific factors.
Describe the etiology and risk factors for PN macronutrient-associated complications in adult patients receiving PN.
Describe the etiology and risk factors for refeeding syndrome, as well as measures to prevent refeeding syndrome.
Design a plan to assess the efficacy and monitor for safety, as well as fluid, electrolyte, vitamin, and trace element abnormalities in adult patients receiving PN.
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Malnutrition in hospitalized patients is associated with significant complications (eg, increased infection risk, poor wound healing, prolonged hospital stays, increased mortality), especially in surgical and critically ill patients.1 Maintaining adequate nutritional status, especially during periods of illness and metabolic stress, is an essential part of patient care. Nutrition support therapy refers to the administration of nutrients via the oral, enteral, or parenteral route for therapeutic purposes.1 
Parenteral nutrition (PN), also called total parenteral nutrition (TPN), is the intravenous (IV) administration of fluids, macronutrients, electrolytes, vitamins, and trace elements for the purpose of weight maintenance or gain, to preserve or replete lean body mass and visceral proteins, and to support anabolism and nitrogen balance when the oral or enteral route is not feasible or adequate. PN is a potentially lifesaving therapy in patients with intestinal failure but can be associated with significant or life-threatening complications.
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Desired Outcomes and Goals
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The goals of nutrition support therapy include:
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Correction or avoidance of nutritional deficiencies
Weight maintenance (or weight gain in malnourished patients and growing children)
Preservation or repletion of lean body mass and visceral ...