From the Guidelines
The most common complication that enteral and parenteral feeding can cause is increased incidence of sepsis (option A), as highlighted by the high-quality study published in 2019 1. This occurs particularly with parenteral nutrition, where patients are at a higher risk of developing infections due to the invasive nature of the treatment. The study found a dramatic reduction in ICU infections with enteral nutrition (EN) as compared to parenteral nutrition (PN) (RR 0.64,95% CI 0.48,0.87, P = 0.004, I² = 47%) 1. Some key points to consider when assessing the risk of complications from enteral and parenteral feeding include:
- The route of nutrition: parenteral nutrition is associated with a higher risk of infections and other complications compared to enteral nutrition 1
- The timing of nutrition: early enteral nutrition is generally recommended to reduce the risk of complications 1
- The caloric and protein target: avoiding over-nutrition is crucial to prevent complications, and the energy/protein goal should be achieved progressively, not before the first 48 hours 1 While the other options (elevated liver transaminases, intestinal villous atrophy, and hyperosmolar non-ketotic coma) can occur as complications of artificial nutrition, increased incidence of sepsis is a significant concern, particularly with parenteral nutrition, as highlighted by other studies 1.
From the Research
Common Complications of Enteral and Parenteral Feeding
The most common complications of enteral and parenteral feeding include:
- Gastrointestinal disturbances, such as diarrhea, vomiting, and aspiration pneumonia 2, 3, 4, 5
- Mechanical complications, such as tube obstruction and displacement 2
- Metabolic complications, such as hyperglycemia, hyponatremia, and elevated liver transaminases 2, 3, 4
- Increased risk of bloodstream infections and sepsis 6, 4
Specific Complications
Some specific complications associated with enteral feeding include:
- Aspiration pneumonia, with a prevalence ranging from 4% to 95% and a mortality rate of 17%-62% 5
- Diarrhea, which can be caused by multiple factors, including concomitant drug therapy, malnutrition, and formula-related factors 2, 3
- Intestinal villous atrophy, which can occur due to malnutrition and hypoalbuminemia 3
Comparison of Enteral and Parenteral Feeding
A systematic review and meta-analysis found that enteral nutrition had more beneficial effects than parenteral nutrition, with fewer bloodstream infections and a reduction in hospital length of stay, but was associated with an increased incidence of gastrointestinal complications 4