OVERVIEW OF RANDOMIZED CLINICAL-TRIALS OF TOTAL PARENTERAL-NUTRITION FOR MALNOURISHED SURGICAL PATIENTS

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.