Changing the way that critically ill patients suffering from sepsis or multiple organ failure are fed could reduce liver dysfunction.
A large study published in the journal Critical Care recommends that clinicians should strictly control calorie intake, start artificial nutrition within 24 hours and regularly monitor liver function in patients at high risk. The researchers find that patients given enteral nutrition were less likely to suffer from liver dysfunction than those fed through a central venous catheter. Liver dysfunction was more frequent in patients who had sepsis on admission or were fed more than 25kcal/kg a day.
The study was conducted by Teodoro Grau, from the Hospital Severo Ochoa in Madrid, Spain, and colleagues from hospitals in Spain and London, UK. The researchers looked at incidence of liver dysfunction associated with artificial nutrition in 40 intensive care units (ICU) in Spain. Patients were followed until hospital discharge or 28 days after ICU admission.
Of 3,409 patients in the study, 725 received artificial nutrition. Of these, 303 received total parental nutrition (TPN) via a central venous catheter, while 422 were given enteral nutrition (EN) through a nasogastric or nasojejunal tube, at the doctor's discretion. 23% (166) of all patients who received artificial nutrition developed liver dysfunction. Rates of liver dysfunction were higher in the TPN group (30%) than in the EN group (18%).
The researchers found that patients who were suffering from sepsis and treated with TPN were at a greater risk of liver dysfunction. Patients receiving TPN were also less nourished.
Liver dysfunction was associated with a longer stay in the ICU and in hospital, but did not increase mortality. Patients who were fed early in their stay had significantly lower incidence of liver dysfunction.
Article: Liver dysfunction associated to artificial nutrition in critically ill patients. Teodoro Grau, Alfonso Bonet, Rubio Mercedes and Mateo Dolores Critical Care 2007, 11:R10 (25 January 2007) Article available at: http://ccforum.com/content/11/1/R10
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