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تغذیۀ وریدی
Parenteral Nutrition
Bowel obstruction, enterocutaneous fistula, peritonitis, and active gastrointestinal bleeding all are con- traindications to enteral nutrition, and in patients with these problems parenteral nutrition is an effective way to meet nutri- tional needs. fte more difficult questions are: When will the patient regain gastrointestinal function?
When should parenteral nutrition begin?
In the United States, the typical approach is to wait 1 week for a patient who was previously well nourished to recover gastroin- testinal function before starting parenteral nutrition. fte Society for Critical Care Medicine and ASPEN support this approach in their guidelines because of concerns about complications of par- enteral nutrition, including hypertriglyceridemia, hyperglycemia, cholestasis, and central line-associated bloodstream infections (CLABSI).
Subsequent to these guidelines, randomized trials evaluated the effect of starting parenteral nutrition on the first day of ICU admission, but results of these studies have been mixed, and the only reproducible benefit has been reduced costs of enteral nutrition compared with parenteral nutrition.
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