Gp. Buzby, OVERVIEW OF RANDOMIZED CLINICAL-TRIALS OF TOTAL PARENTERAL-NUTRITION FOR MALNOURISHED SURGICAL PATIENTS, World journal of surgery, 17(2), 1993, pp. 173-177
The past decade has seen a maturation of the art and science of periop
erative nutritional support. We now have sufficient data to make infor
med and reasonable judgments regarding when we should and should not p
rovide perioperative TPN. These judgments can be considered medically
sound and fiscally responsible. The following guidelines are proposed:
(1) Postoperative TPN should be considered when oral or enteral feedi
ng is not anticipated within 7 to 10 days in previously well-nourished
patients or within 5 to 7 days in previously malnourished or critical
ly ill patients. (2) Preoperative TPN should be considered in patients
who cannot or should not eat or receive enteral feedings if the opera
tion must be delayed for more than 3 to 5 days. (3) Preoperative TPN s
hould be considered in the most severely malnourished surgical candida
tes if an operative delay is not contraindicated. In patients with onl
y mild to moderate degrees of malnutrition preoperative TPN is not ind
icated.