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Similar metabolic responses to standardized total parenteral nutrition of septic and nonseptic critically ill patients^1,2

¹ From the Department of Internal Medicine IV, University of Vienna.

Background: Nutritional support is an important link between the response to injury and recovery in critical illness.

Objective: Our goal was to evaluate energy and substrate metabolism in septic and nonseptic critically ill patients in the resting state and during the administration of standardized total parenteral nutrition.

Design: This was a prospective, clinical cohort study of 25 consecutively admitted critically ill patients either with (n = 14) or without (n = 11) sepsis who received total parenteral nutrition. Resting energy expenditure was measured on days 0, 2, and 7 by indirect calorimetry. Energy and substrate balances were calculated on days 2 and 7.

Results: Resting energy expenditure was not significantly different between septic and nonseptic patients on day 0 (2.65 ± 0.49 and 2.36 ± 0.56 kJ•min^-1•m^-2, respectively). Energy balances were positive for both groups on days 2 (0.68 ± 0.4 and 0.74 ± 0.6 kJ•min^-1•m^-2, respectively; NS) and 7 (0.65 ± 0.3 and 0.78 ± 0.5 kJ•min^-1•m^-2, respectively; NS). Substrate balances were not significantly different between groups on days 0, 2, and 7. Resting energy expenditure on day 0 was negatively correlated with the severity of illness in septic patients only (r = -0.58, P < 0.05).

Conclusions: Metabolic changes were not significantly different between septic and nonseptic critically ill patients during the administration of standardized total parenteral nutrition. A disease-specific macronutrient composition of total parenteral nutrition formulas does not seem to be necessary in either septic or nonseptic critically ill patients.

Key Words: Body temperature • intensive care • energy expenditure • sepsis • critically ill patients • severity of illness • substrate balances • substrate metabolism • total parenteral nutrition • nutritional support

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				L J. Hoffer Protein and energy provision in critical illness Am. J. Clinical Nutrition, November 1, 2003; 78(5): 906 - 911. [Abstract] [Full Text] [PDF]

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