J.Jpn. Surg. Soc.. 99(3): 159-163, 1998

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Feature topic

CLINICAL SIGNIFICANCE AND PROBLEMS IN PARENTERAL NUTRITIONAL CARE

The clinical indications for and types of intravenous nutritional support are reviewed from the standpoint of their advantages and disadvantages. Total parenteral nutrition (TPN, also known as intravenous hyperalimentation) improves and maintains not only nutritional status but immunocompetence in patients with restricted food intake, because almost all essential nutritional substrates can be administered in the parenteral root alone to meet energy requirements. In surgical fields, TPN reduces perioperative risk and complication rates and enhances postoperative recovery of patients with severe stress such as those under going thoracic esophagectomy or pancreatoduodenectomy.
In addition to calory administration, another type of parenteral nutrition a the disease-specific formulation has been attempted to improve directly such pathophysiologic conditions as renal failure, hepatic failure, or severe acute pancreatitis. Despite the great benefits of TPN, it is associated with several complications related to the indwelling catheter or to inadequate substrates administered. Disuse atrophy of the intestinal mucosa in patients receiving TPN to decreases the host defense against bacterial infection.
To avoid the abuse of TPN, the indications for it should be selected rigorously. Moderate calory administration of a maximum of 15-20 cal/kg/day via a peripherally inserted catheter has been reevaluated in patients on short-term fasts.

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