Is Total Parenteral Nutrition (TPN) an Evil in Trauma Patients?

The use of parenteral nutrition has been progressively decreasing over the past 30 years, and it has been considered as harmful while enteral feeding has been preferred for critically ill trauma patients, including for head trauma patients. However, the use of enteral feeding is associated with underfeeding while the use of parenteral nutrition can create complications due to overfeeding (infections, increased length of stay, length of ventilation, increased liver tests). Measuring energy expenditure by indirect calorimetry enables more accurate energy needs and calorie targets can be optimized. Formulas with higher protein content allow increased protein administration. In case of gastrointestinal intolerance, parenteral nutrition is an efficient alternative route to reach optimal targets. This route may improve clinical outcome. The use of parenteral nutrition has recently been shown to be safe if not given in excess, challenging the theory that TPN should be avoided. A reevaluation of the use of parenteral nutrition has to be performed to decrease calorie and nitrogen deficits in critically ill trauma patients.