Báo cáo y học: The risk for bloodstream infections is associated with increased parenteral caloric intake in patients receiving parenteral nutrition

Tuyển tập các báo cáo nghiên cứu về y học được đăng trên tạp chí y học Critical Care giúp cho các bạn có thêm kiến thức về ngành y học đề tài: The risk for bloodstream infections is associated with increased parenteral caloric intake in patients receiving parenteral nutrition...
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Báo cáo y học: "The risk for bloodstream infections is associated with increased parenteral caloric intake in patients receiving parenteral nutrition" Available online http://ccforum.com/content/11/5/R114Research Open AccessVol 11 No 5The risk for bloodstream infections is associated with increasedparenteral caloric intake in patients receiving parenteral nutritionSharmila Dissanaike1, Marilyn Shelton2, Keir Warner2 and Grant E OKeefe21Harborview Medical Center, 325 9th Ave, Seattle, WA 98104, USA2Department of Surgery, Texas Tech University Health Sciences Center, 3601 4th St Lubbock, TX 79430, USACorresponding author: Sharmila Dissanaike, sharmila.dissanaike@ttuhsc.eduReceived: 12 Apr 2007 Revisions requested: 17 May 2007 Revisions received: 6 Sep 2007 Accepted: 24 Oct 2007 Published: 24 Oct 2007Critical Care 2007, 11:R114 (doi:10.1186/cc6167)This article is online at: http://ccforum.com/content/11/5/R114© 2007 Dissanaike et al., licensee BioMed Central Ltd.This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.See related commentary by Griffiths, http://ccforum.com/content/11/6/176AbstractBackground Patients receiving total parenteral nutrition (TPN) Results A total of 78 patients (39%) developed at least oneare at high risk for bloodstream infections (BSI). The notion that BSI, which were more common in ICU patients than in otherintravenous calories and glucose lead to hyperglycemia, which hospitalized patients (60/122 patients versus 18/78 patients; Pin turn contributes to BSI risk, is widely held but is unproven. We < 0.001). Maximum daily blood glucose concentrations weretherefore sought to determine the role that hyperglycemia and similar in patients with BSI and in patients without BSI (197 mg/parenteral calories play in the development of BSI in hospitalized dl versus 196 mg/dl, respectively). Patients with BSI receivedpatients receiving TPN. more calories parenterally than patients without BSI (36 kcal/kg/ day versus 31 kcal/kg/day, P = 0.003). Increased maximumMethods Two hundred consecutive patients initiated on TPN parenteral calories, increased average parenteral calories, andbetween June 2004 and August 2005 were prospectively treatment in the ICU were strong risk factors for developing BSI.studied. Information was collected on patient age, sex, There was no difference in mortality between patients with andadmission diagnosis, baseline laboratory values, intensive care without BSI.unit (ICU) status and indication for TPN. Patients in the ICUwere managed with strict glycemic control, whereas control on Conclusion Increased parenteral caloric intake is anthe general ward was more liberal. The maximum blood glucose independent risk factor for BSI in patients receiving TPN. Thislevel over each 8-hour period was recorded, as were parenteral association appears unrelated to hyperglycemia. Based upondaily intake, enteral daily intake and total daily caloric intake. The our observations, we suggest that parenteral caloric intake beprimary outcome measure was the incidence of BSI. Additional prescribed and adjusted judiciously with care taken to accountendpoints were ICU length of stay, hospital length of stay and for all intravenous caloric sources and to avoid even shortmortality. periods of increased intake.Introduction parenteral nutrition [8-11]. The high risk of sepsis is a majorTotal parenteral nutrition (TPN) can be a valuable adjunct in factor leading to an overall preference for enteral nutrition overproviding nutrition to hospitalized patients. Reviews of surgical parenteral nutrition.patients receiving perioperative TPN have shown a reductionin morbidity in severely malnourished patients [1,2]. A meta- Tight glycemic control has been demonstrated to reduce mor-analysis of nine randomized trials showed an aggregate mor- tality in critically ill surgical patients and to limit certain morbid-tality benefit in critically ill patients on TPN [3], despite a 1.7- ities (acute renal ...