Indications for administration of parenteral nutrition in adults.

BACKGROUND

Who benefits from parenteral nutrition (PN) has been the subject of much debate and 4 recent meta-analyses.

METHODS

We reviewed the 4 meta-analyses that examined the prospective, randomized, clinical trials (PRCT) that compared PN with no nutrition support (standard care) for design, study population, outcomes evaluated, and results.

RESULTS

Overall, a total of 113 PRCT were included in the 4 meta-analyses; however, only 4 studies were included in all of them. Despite the differences in populations studied and outcomes evaluated, some similarities emerged: (1) PN does not affect mortality; (2) PN does not reduce complications in normally nourished patients; (3) in malnourished patients, PN demonstrated a trend for reduced infections and complication rates; and (4) PN reduced postoperative complications in patients having surgery for cancer of the esophagus or stomach.

CONCLUSION

PN does not appear to be beneficial for most hospitalized patients. Among those with malnutrition or with upper gastrointestinal cancer, benefits may exist; however, these were influenced by quality of the study and year of publication.