However, using EN may result in fewer respiratory infections and shorter hospital stays, and it is more cost-effective.Ĭonsider using high-carbohydrate, high-protein, low-fat EN in patients with burns on more than 10% of their total body surface area. 4, 17 – 19Ī large randomized controlled trial and a systematic review of low-quality studies comparing EN and PN in critically ill patients showed no difference in 90-day mortality. In critically ill patients who need nutrition support therapy, use EN instead of PN or a combination of the two. 12Ī systematic review of low-quality studies showed that EN may have fewer serious adverse events than PN. Use EN over PN in patients with a functioning gastrointestinal tract. 14, 15Ī systematic review showed no harms of early feeding and a reduced length of stay a systematic review showed that in patients needing nutrition support, EN significantly decreased morbidity and mortality compared with total PN. If nutrition support therapy is needed, use EN over total PN. In nonsevere acute pancreatitis, initiate early oral feeding. 13Ī systematic review of low-quality studies showed a decreased length of hospital stay, but no effect on other outcomes. Guidelines recommended using a standard process for assessing nutritional risk.Ĭonsider initiating EN feedings within 24 hours of gastrointestinal surgery. Physicians should work with a registered dietitian nutritionist who uses the Nutrition Care Process framework to assess the need for nutrition support therapy in patients at risk of malnutrition. Clinicians should engage in shared decision-making with patients and caregivers about nutrition support in palliative and end-of-life care. Nutrition support therapy does not improve quality of life in patients with dementia. Patients receiving nutrition support therapy should be monitored for complications, including refeeding syndrome. Family physicians can use the Mifflin-St Jeor equation to calculate the resting metabolic rate, and they should consult with a registered dietitian nutritionist to determine total energy needs and select a nutritional formula. Parenteral nutrition has an increased risk of complications and should be administered only when enteral nutrition is contraindicated. When nutrition support therapy is required, enteral nutrition is preferred for a patient with a functioning gastrointestinal tract, even in patients who are critically ill. Family physicians should work with registered dietitian nutritionists to complete a comprehensive nutritional assessment for patients with acute or chronic conditions that put them at risk of malnutrition. ![]() The evidence for when to use nutrition support therapy is inconsistent and based mostly on low-quality studies. Family physicians can provide nutrition support therapy to patients at risk of malnutrition when it would improve quality of life. Nutrition support therapy is the delivery of formulated enteral or parenteral nutrients to restore nutritional status.
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