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Parenteral Nutrition: Then vs Now

PN and Infectious Risk - Historical

Moore et al, 19891 VA TPN Trial, 19912 Kudsk et al, 19923

Population Abdominal Trauma, n=59 Malnourished surgical patients Blunt and penetrating trauma,

n=395 n=98

Intervention Early EN vs PN (12 hours post- 7-15 d pre-op PN + 3 d post-op Early EN vs PN (24 hours post-

© 2019 ASPEN | American Society for Parenteral and Enteral Nutrition. All Rights Reserved. op) PN vs. no PN op)

Kcals/Protein EN: 1847 kcal, 77.5 g protein PN: Mean pre-op nutrient intake EN: 15.7 NPC/kg, PN: 19.1
PN: 2261 kcal, 96.2 g protein, 2994 kcal/d (420-4543) NPC/kg, P<.05
P=.01 No PN: 1280 kcals (0-3342) Kcal:Nitrogen=150:1
Protein not reported

Outcomes Major infections (abd abscess, Major infectious complications: Pneumonia: EN 11.8% vs PN
pneumonia): EN 3%, PN 20%, PN 14.1% vs 6.4%, P=0.01 33%, P<.02
P= .03
Severely malnutrition: Abd abscess: EN 1.9% vs PN
Minor infections (wound, • Fewer non-infectious 13.3%, P<.04
catheter, urinary, misc):
EN 17%, PN 37%, P=NS complications: PN 5% vs Line Sepsis: EN 1.9% vs PN
43%, P=.03 13.3%, P<.05
• No difference in infectious
complications

1. Moore et al, J Trauma, 1989;29:916-924 .

2. Veterans Affairs Total Parenteral Nutrition Cooperative Study Group. N Engl J Med.1991;325(8):525-532.
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3. Kudsk et al, Ann Surg, 1992;215:503-513.

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