The Impact of Parenteral Nutrition Support on Nutrition Care Outcomes of Hepatic Encephalopathy Patients in the Intensive Care Unit

Abstract

Background: Malnutrition and hepatic encephalopathy are two of the most common complications of cirrhosis and both have detrimental effects on outcome. Malnutrition is prevalent among cirrhotic patients and is an important prog-nostic factor. Etiologic factors include hypermetabolism, malabsorption, altered nutrient metabolism, and anorexia. It is a challenge to manage nutrition in cirrhotic patients because of alterations to metabolic and storage functions of the liver. Aim of Study: The aim of this study is to evaluate the impact of a parenteral nutrition protocol on nutrition outcomes of hepatic encephalopathy patients admitted to the ICU. Subjects and Methods: This prospective study was done on 76 hepatic encephalopathy patients with low tolerance or contraindications to enteral nutrition undergoing total parenteral nutrition starting from the day of admission and follow-up until discharge from ICU or 14 days as a length of the study. Daily assessment of the body functions was done and parenteral nutrition associated complications were recorded. 47 male patients and 39 female patients were suspected to the study with 53 patients older than 50 years and 23 patients younger than 50 years. Results: 40.8% of patients were exposed to hospital related complications. 35.5% were exposed to one type of complica-tions and 5.3% were exposed to two types or more. Hospital acquired pneumonia was the most complication affecting patients with 10.5% followed by CVC related infection with 7.9% and also Hypoglycemic Attacks with 7.9% then urinary catheter-related infection with 6.6%. Acute cholecystitis and thrombosis were the least complications affecting patients with 1.3% for each one. Conclusions: Total parenteral nutrition does not influence the overall mortality rate of critically ill patients. It may reduce the complication rate, especially in malnourished patients.