Parenteral and enteral feeding in hospitals in Italy: a national survey

Abstract

A multicentre prospective survey on the use of artificial nutrition (AN) and its complications has been carried out on 1657 hospitalised patients including 7.8% in surgical departments, 7.1% in medical departments and 59.9% in intensive care units. Gastrointestinal diseases and cancer were the most frequent pathologies among patients requiring AN. Parenteral nutrition (PN) alone was employed in 1103 (66.5%) patients. In 267 (16.1%) PN was associated with enteral nutrition (EN). 287 (17.3%) patients were fed by the enteral route alone. The average daily energy intake was 35 kcal/kg for central PN, 26 kcal/kg for peripheral PN and 33 kcal/kg for EN. The mean daily nitrogen intake was 0.19 g/kg for central PN, 0.17 g/kg for peripheral PN and 0.20 g/kg for EN. In 10% of patients PN was electrolyte free and in only 50% all the main electrolytes were added. Trace elements were added in 48% of formulations, mainly as multiple combination. Insulin was added in 61% of PN patients, while albumin was given with PN in 20% of patients. Adverse reactions were observed in 10.9% of PN patients and in 11.5% of EN patients. The most frequent complications occurring in parenterally fed patients were infections of the central venous catheter and metabolic alterations (severe electrolyte abnormalities, liver or renal dysfunction, hypo or persistent hyperglycemia). In enterally fed patients the frequent complications were abdominal distension, cramps and diarrhoea. Adverse reactions were responsible for discontinuation of AN in 2.2% of parenterally supported patients and in 5.7% of enterally fed patients.