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TPN: A 6-year review of total parenteral nutrition use and association with late-onset acute respiratory distress syndrome among ventilated trauma victims

re: COVID
re: total parenteral nutrition

Just one of the many ways hospitals endeavored to cause death in COVID victims, with ARDS a major killer and yet TPN facilitating it. This is the standard of care (“standard of contempt”?). On top of the approaches forbidden* that virtually guaranteed death for half a million people.

ARDS = Acute Respiratory Distress Syndrome, common in COVID deaths. Think ventilators, themselves a killer.

* That now, by law in California, can threaten your medical license if criticized.

Science Direct: A 6-year review of total parenteral nutrition use and association with late-onset acute respiratory distress syndrome among ventilated trauma victims

May 2009

Aim

To establish whether total parenteral nutrition (TPN) for ventilated trauma victims is associated with late-onset acute respiratory distress syndrome (ARDS) independent of ventilation and transfusion parameters.

Method

Intensive care unit data over 6 years from a level I centre regarding all trauma victims ≥16 years old who underwent mechanical ventilation within the first 48 h of admission were examined. Patients were prospectively followed for late ARDS. Variables were examined for significant changes over time and independent associations with late ARDS were determined.

Result

Of 2346 eligible patients among whom 404 (17.2%) were exposed to TPN, 192 (8.2%) met criteria for late ARDS. The incidence of late ARDS among those exposed to TPN was 28.7% (116/404) compared with 3.9% (76/1942) among those not so exposed. Adjustments for potential confounding associated risk factors were made.

Conclusions

TPN administration is independently associated with late ARDS, and its use among critically ill trauma victims should be carefully scrutinised.

...

Total parenteral nutrition (TPN) has been has been implicated in perioperative infection, septic morbidity,  poor wound healing and even increased mortality. Possible mechanisms include hyperglycaemia,  immunomodulation, gut barrier dysfunction, and production of pro-inflammatory mediators as well as free radicals (particularly as a consequence of lipid components). Intravenous administration of lipids predisposes to ALI and ARDS as well as to poor outcomes in established ARDS.

...

Discussion

TPN is associated with pulmonary dysfunction and increased days of mechanical ventilation and ICU stay.35 Furthermore, lipid infusions interact with cardiopulmonary function and increase morbidity and mortality among people with established ARDS.6, 13, 18, 39 Possible mechanisms include inflammation,22 immunomodulation10 (potentially mediated by congestion of the reticuloendothelial system with particulate emulsion),33 altered cell membrane composition15 and increased free radical production.30

Conflict of interest

We do not have any relevant financial relationships with any commercial interests as it pertains to the above article.

WIND: years ago I spend 12 weeks in the hospital twice daily attending my premature daughter. I quickly learned just how dangerous hospitals are. How little I understood about the scope and malignancy of modern medical “care”.


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