Texte long argumentaire - CHAMP 7 - Nutrition parentérale en réanimation. Recommandations formalisées d'experts. Nutrition artificielle en réanimation SFAR-SRLF-SFNEP

Parenteral nutrition (PN) is a nutritional support technique consisting in the intravenous infusion of macronutrients (glucose, aminoacids and triglycerides), micronutrients (vitamins and trace elements), water and electrolytes. In the intensive care, PN is indicated in case of failure, insufficient or contra-indicated enteral nutrition. This paper has allowed the elaboration, according to the GRADE method, of the field 7 recommendations “Parenteral nutrition in the intensive care unit” of the French Societies SFAR-SRLF-SFNEP guidelines “Nutrition support in the intensive care unit”: 7.1 Ready-to-use tricompatimental bags rather than separated solutions have to be used (strong agreement); 7.2 It is requested to supplement the patient with vitamins and trace elements together with the administration of parenteral nutrition (strong agreement); 7.3 Lipid intake must be no more than 1.5 g/kg/day (strong agreement); 7.4 Parenteral nutrition must be administered continuously with an electric nutrition output-controlled pump, and cyclic administration must be avoided (strong agreement); 7.5 A central venous catheter must be used if the osmolarity of solutions exceed 850 mosm/l) (strong agreement); 7.6 Parenteral nutrition should be delivered through a dedicated route of the central venous catheter (weak agreement); 7.7 A metabolic complication or an excessive intake of nutrients should be looked after in case of blood analyses abnormalities (transaminases, bilirubin, gamma GT, alkaline phosphatases, ionogram, phosphates, glycemia, triglyceridemia) (strong agreement).