The Addition of Trickle Feeds Reduces the Complications Associated with Parenteral Nutrition

Background: “Trickle feeds” are frequently added to patients receiving parenteral nutrition on the assumption that providing small volumes of enteral nutrition reduces the complications associated with parenteral nutrition. This hypothesis, however, has not been tested. Objective: The aim of this study was to compare the incidence of ventilator-associated pneumonia and the Standardized Mortality Ratio in critically ill ICU patients receiving parenteral nutrition alone as compared to parenteral nutrition together with trickle feeds. Design: This was a non-randomized cohort study. The incidence of ventilator-associated pneumonia and the Standardized Mortality Ration was compared in critically ill ICU patients with an acute abdominal processes who had received at least 3 days of parenteral nutrition or parenteral nutrition together with trickle feeds. The diagnoses of pneumonia was made by protected specimen bruch sampling. Results: Thirty two patients received parenteral nutrition alone and 34 parenteral nutrition together with trickle feeds. The patients receiving trickle feeds had a loweer incidence of confirmed bacterial pneumonia (8 vs 28%; p=0.05) and a trend towards a lower hospital mortality. The Standardized Mortality Ratio was 1.4 in the patients receiving parenteral nutrition alone and 0.85 in patients receiving trickle feeds together with parenteral nutrition; a 44% reduction in mortality. Conclusion: This study suggests that the addition of “trickle” feeds to parenteral nutrition reduces infective complications and may reduce hospital mortality.