Skip to main content
NCBI home page
Wiley Open Access Collection logoLink to Wiley Open Access Collection
. 2026 Aug 2;50(7):1003–1013. doi: 10.1002/jpen.70132

Parenteral nutrition and hospital outcomes in Australian adults: A descriptive cohort study

Frank M P van Haren 1,2,✉, Sumeet Rai 2,3, Andrew Thomson 2,4, Josie Russell‐Brown 3, Mary Nourse 3, Shakira Spiller 5, Louise Herlihy 6, Sean Weng Chan 3, Peter Velloza 7, Matthew H Anstey 8,9, Robert N Palmer 8, Bianca Mammana 8, Tania Elderkin 10, Adam Visser 11, Matt Brain 12, Sarah Mineall 12, Emma J Ridley 13
PMCID: PMC13636182  PMID: 42543879

Abstract

Background

There is limited information regarding real‐world use of parenteral nutrition in hospitals. The objective of the study was to provide a real‐world description of parenteral nutrition administration in hospitalized patients.

Methods

This was a descriptive cohort study in 507 hospitalized adults who received parenteral nutrition at five Australian hospitals from 2015 to 2020. Adult patients (≥18 years) receiving parenteral nutrition in the hospital were eligible. Data collected included baseline demographics, comorbidities, clinician‐determined indication and administration details for parenteral nutrition. The primary outcome was the indication for parenteral nutrition. Secondary outcomes included the use of supplemental parenteral nutrition and the vascular access devices used.

Results

Of the 507 enrolled patients, 263 (52%) were in the intensive care unit and 244 (48%) in the ward at the time of enrolment. The most common indication for parenteral nutrition was a non‐functioning gastrointestinal tract (45% [390/864 indications]), mostly because of ileus (18% [71/390]), followed by inadequate nutrition (35% [304/864]). More than half the patients (347/507, 68%) had a nil by mouth order by their treating team. The median duration of parenteral nutrition administration was 7 (4;14) days. Supplemental parenteral nutrition was more common for patients in the intensive care unit. Vascular access was most achieved via central venous catheter in intensive care unit patients (81%) compared to a peripherally inserted central catheter line in ward patients (75%).

Conclusion

This study provides novel real‐world data on the demographics, indications, provision and outcomes of parenteral nutrition for hospitalized patients. Commonly reported indications for parenteral nutrition were ileus and nil by mouth orders, which may warrant further study.

Keywords: clinical registry, critical care, enteral nutrition, intensive care, parenteral nutrition, real‐world data

INTRODUCTION

The use of parenteral nutrition to treat or prevent malnutrition and improve outcomes in select hospitalized patients is common practice and is supported by evidence‐based guidelines. However, there is a lack of published papers that describe the current real‐world practice of parenteral nutrition use in hospitals, and descriptive studies have mainly relied on retrospective data and point prevalence data.

Nutrition therapy for hospitalized patients who are unable to meet nutrition needs via oral intake can be provided with oral nutritional supplements, enteral nutrition or parenteral nutrition and sometimes a combination of modes. Parenteral nutrition is considered when oral or enteral nutrition is contraindicated or insufficient for prolonged periods. Parenteral nutrition can be provided as a sole source of nutrition or in combination with enteral nutrition and/or oral routes, usually referred to as supplemental parenteral nutrition. Parenteral nutrition is provided intravenously, most commonly via a central access device such as a central venous catheter or a peripherally inserted central catheter but can be provided peripherally for short periods. 1

Providing optimal nutrition therapy is crucial to prevent and mitigate malnutrition, which affects 20%–50% of hospitalized patients. 2 , 3 The consequences of malnutrition can be especially severe for critically ill patients, as catabolic state, unmet nutritional needs and physical immobilization may reduce a patient's muscle mass substantially, reportedly up to 10%–25% within 10 days. 4 , 5 , 6 This contributes to prolonged hospital stay, need for lengthy rehabilitation, and may have serious consequences for individuals and society, with only half of previously employed intensive care unit (ICU) survivors returning to work within the first year after ICU discharge. 7 The development and progression of malnutrition during hospital stay depend on several factors, including patients' age, underlying disease, length of stay, screening consistency, as well as the use of appropriate nutrition interventions. 8 , 9 Malnutrition increases morbidity and mortality, length of stay, loss of muscle mass, costs of hospitalization, and the hospital re‐admission rate. 8 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19

International guidelines recommend medical nutrition therapy according to the stage of the disease if dietary modifications do not suffice to cover nutritional needs. 20 , 21 , 22 Recent guidelines point out that enteral nutrition and parenteral nutrition are equal in terms of risk for clinical complications, though enteral nutrition should be preferred due to preservation of the gastrointestinal tract. 23 However, it is unclear to what extent clinicians adhere to these guidelines. In clinical practice, parenteral nutrition is often requested and/or prescribed in cases when enteral nutrition would be feasible or preferred (personal observation and communication). Nutrition therapy in hospitalized patients varies across regions and remains an ongoing challenge for clinicians. 24 , 25 , 26

To better understand and describe the current real‐world practice and outcomes of parenteral nutrition use in hospitals in Australia, we designed a descriptive cohort study embedded in a prospective registry, entitled the Australian Registry of the use of Parenteral Nutrition in Hospitalized Patients (ARTPN).

METHODS

Design

A descriptive cohort study in five Australian hospitals.

Reporting

Study results are reported using the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines.

Setting

For the study, an expression of interest was sent out to ICU specialists on a mailing list from the Australian and New Zealand Intensive Care Society. The study was conducted in five Australian hospitals which expressed their interest in study participation: Barwon Health, Canberra Hospital, Sir Charles Gairdner Hospital, Launceston General Hospital, and Toowoomba Hospital.

Ethical approval

The ARTPN registry was approved for all participating sites by the Australian Capital Territory Health Human Research Ethics Committee (ETH.11.17.271), adhering to the Declaration of Helsinki principles. Individual patient consent was waived as the research posed no more than minimal risks to participants. Local governance approval was obtained from each participating site.

Patient recruitment

Patients were recruited from April 10, 2015 to July 8, 2020. The inclusion criteria were: (1) hospital inpatient, (2) age ≥18 years and (3) receiving parenteral nutrition. Patients previously enrolled in the ARTPN registry were excluded.

Data collection

Data were collected by the participating sites using electronic case report forms (eCRFs) via a password‐protected ARTPN website. The data management team checked the database monthly and contacted the respective sites’ staff if corrections or clarifications regarding inconsistent or discrepant data were necessary.

For each patient, four types of eCRFs were used: (1) enrolment into study (hospital admission variables), (2) baseline (i.e., longitudinal variables for the 1st day), (3) progress (i.e., longitudinal data after baseline), and (4) discharge from hospital or death. Demographic data of patients, comorbidities and information regarding the vascular access catheter types and type of admission (ICU/ward) were documented in the enrolment eCRF. Baseline and progress eCRFs collected data on laboratory parameters, parameters of enteral nutrition and parenteral nutrition administration, including nutrient provision, indications and formulations, medications and infective complications, sequential organ failure assessment (SOFA) and Acute Physiology and Chronic Health Evaluation (APACHE III) scores (ICU only). 27 Investigators could document multiple parenteral nutrition indications for a single patient if required. Progress data was collected until parenteral nutrition was ceased. At discharge, the following parameters were documented: patient weight and parenteral nutrition status on discharge, discharge destination and cause of death, if applicable.

Variables collected

The following variables were collected: sex, age (years), height (cm), weight (kg; estimated or measured), body mass index (BMI), location of patient at entrance to the study (ICU/ward), source of admission, catheter type, central venous catheter, including number of lumens, or peripherally inserted central catheter, presence of antimicrobial coating on the catheter, parenteral nutrition indication, and parenteral nutrition provision in addition to oral or enteral nutrition (supplemental parenteral nutrition). In addition, the presence of the following comorbidities was assessed at enrolment: active malignancy, cirrhosis, chronic kidney disease according to Kidney Disease Improving Global Outcomes‐guidelines, 28 , 29 cardiovascular and respiratory comorbidities, diabetes, and immunosuppression. At discharge, transfer to other hospitals, chronic care facilities/rehabilitation or home and death were recorded.

Categorization of indications for parenteral nutrition

Indications for parenteral nutrition were a priori grouped into five major categories by the documenters. More than one indication per patient could be chosen. The categories were: (1) non‐functioning gastrointestinal tract (due to enteritis/colitis, chemotherapy, infectious diarrhea, inflammatory bowel disease, Hirschsprung's disease, ileus, intestinal pseudo obstruction, gastrointestinal bleed, perforation, gastrointestinal fistula, obstruction); (2) inadequate enteral or oral nutrition (inability to tolerate adequate oral nutrition, inability to place enteral nutrition tube, refusal of enteral nutrition tube, inability to tolerate enteral nutrition tube, inability to tolerate enteral nutrition feed, other); (3) malnutrition (cancer cachexia, cardiac cachexia, hepatic failure, pulmonary cachexia, renal cachexia, general malnutrition, preoperative nutritional support, other); (4) postoperative complications (chyle leak, anastomotic leak, abdominal abscess) and (5) malabsorption (celiac disease, congenital malabsorption, cystic fibrosis, pancreatic insufficiency, scleroderma, short bowel syndrome, idiopathic). For further information see the case report forms in the supplement.

Statistical analysis

Data were analyzed using R version 4.2.2 for Windows. 28 , 29 , 30 Parametric data are summarized as mean ± standard deviation, and quantitative data are summarized as counts and percentages. These descriptive summaries were performed for the total ARTPN registry as well as stratified by site or admission (ICU or ward). Continuous data were tested for normality via the Shapiro Wilk‐test. We compared data between patients admitted to ICU and to the hospital ward. Normally distributed data were compared via the student's t‐test, non‐normally distributed data via the Wilcoxon signed rank test. For quantitative variables, differences between counts were tested using Pearson's chi‐squared test or Fisher's exact test, as appropriate. If more than two groups were compared, these tests were followed by Benjamini‐Hochberg corrected post hoc tests. Missing data for receiving parenteral nutrition and/or enteral nutrition (binary variables) were imputed via the last observation carried forward. Other missing variables were not imputed and the patients with missing values were excluded from the respective analyses of these variables. Significance testing was performed with the use of a two‐sided alpha level of 0.05.

RESULTS

Baseline description

In total, 507 patients were added to the Registry from April 10, 2015 to July 8, 2020. The last patient was discharged on August 18, 2020 (see Table S1 for a summary of enrolment and discharge dates per site).

Table 1 provides an overview of the population characteristics for the whole registry, and for patients in the ICU or on the ward (see Table S2 for site‐specific baseline characteristics). Patients were on average 64 years old, predominantly male (295, 58%) and just over half were admitted to the ICU. Most patients (285, 56%) had at least one comorbidity, with cancer being the most common comorbidity, present in 173 (34%) of patients. Ward patients were more likely to be immunosuppressed, otherwise there were no significant differences in demographic characteristics between ICU and ward patients. ICU patients were more likely to have a central venous catheter line for parenteral nutrition and more likely to have antimicrobial coated lines, while peripherally inserted central catheters were more common in ward patients.

Table 1.

Characteristics and outcomes of the Australian Parenteral Nutrition population from the ARTPN registry.

Variable, n (%) Total 507 ICU 263 (52%) Ward 244 (48%) p
Age (years), mean (SD) 63.8 (15.5) 64.0 (15.8) 63.5 (15.2) 0.484a
Sex, male, n (%) 295 (58.2) 165 (62.7) 130 (53.3) 0.04b
Weight (kg), mean (SD)e 75.4 (23.1) 77.1 (24.9) 73.6 (20.7) 0.324a
Height (m), mean (SD) 170.5 (10.1) 171.2 (9.7) 169.7 (10.5) 0.04a
BMI (kg/m2), mean (SD) 26.3 (7.3) 26.7 (7.6) 25.9 (6.8) 0.324a
Health status
APACHE III Score, mean (SD) 70.8 (27.2) 70.8 (27.2) n/a –
SOFA score, median [IQR] 7 [0; 4] 7 [0; 4] n/a –
SOFA score ≥10, n (%) 51 (10.1) 51 (19.4) n/a –
Immunosuppression, yes, n (%) 48 (9.5) 17 (6.5) 31 (12.7) 0.05b
Active oncologic process, n (%) 173 (34.1) 80 (30.4) 93 (38.1) 0.187c
Cardiovascular, n (%) 16 (3.2) 11 (4.2) 5 (2.0) 0.329c
Cirrhosis, n (%) 7 (1.4) 7 (2.7) 0 (0) 0.03c
Chronic kidney disease, n (%) 21 (4.1) 13 (4.9) 8 (3.3) 0.721c
Diabetes, n (%) 92 (18.1) 50 (19.0) 42 (17.2) 0.498c
Respiratory n (%) 40 (7.9) 27 (10.3) 13 (5.3) 0.058c
None of the above comorbidities, n (%) 222 (43.8) 111 (42.2) 111 (45.5) 0.446b
Catheters
PICC, n (%) 226 (44.6) 43 (16.3) 183 (75.0) <0.001c
CVC, n (%) 253 (49.9) 214 (81.4) 39 (16.0) <0.001c
Catheter with antimicrobial coating, % (n) 177 (34.9) 135 (51.3) 42 (17.2) <0.001b
Discharge
Discharge: other hospital, n (%) 94 (18.5) 54 (20.5) 40 (16.4) 0.301b
Discharge: chronic care facility/rehabilitation, n (%) 53 (10.5) 31 (11.8) 22 (9.0) 0.383b
Discharge: home, n (%) 258 (50.9) 104 (39.5) 154 (63.1) <0.001b
Discharge: deceased, n (%) 86 (17.0) 67 (25.5) 19 (7.8) <0.001b
Hospital LOS (days), median [IQR] 31 [19, 55] 24 [17, 36] 0.141d
Open in a new tab

Abbreviations: APACHE, acute physiology and chronic health evaluation; BMI, body mass index; CKD, chronic kidney disease; CVC, central venous catheter; Hospital LOS, length of stay in hospital; ICU, intensive care unit; IQR, interquartile range; ns, not significant; PICC, peripherally inserted central catheter; SD, standard deviation; SOFA, sequential organ failure assessment.

a

Student's t‐test.

b

Pearson's chi‐squared test.

c

Fisher's exact test.

d

Wilcoxon signed‐rank test.

e

Weight was either measured (66%), estimated (24%) or the method was not mentioned (5%).

Surgery immediately before commencement of parenteral nutrition had been performed on 120 patients (46%) in the ICU (see Table S3 for other admission sources).

Indications for parenteral nutrition

Overall, 864 indications for parenteral nutrition were documented among 507 patients in the registry, with some patients recorded to have multiple concomitant indications. The most common indication for parenteral nutrition in the overall cohort was non‐functioning gastrointestinal tract in 390 (45%), with a majority of them in the ICU (Figure 1). The second‐most common indication was inadequate nutrition, defined as the inability to provide the prescribed nutrition solely by enteral and oral route. This included patients with conditions preventing them from eating and/or patients who had a nil by mouth order (ICU: 215 patients [42%], ward: 132 patients [26%]) by the treating clinical team.

Figure 1.

Figure 1

Open in a new tab

Baseline frequencies of main indications for parenteral nutrition in the ARTPN registry. Multiple indications were possible, total number of documented indications was 864. Numbers on the right indicate absolute patient numbers with the respective indication.

Non‐functioning gastrointestinal tract, inadequate enteral/oral nutrition, and malnutrition comprised 811 documented indications (94%) of all main indications (864 documented indications) for parenteral nutrition at baseline. Figure 2 shows the most common sub‐indications for each of them.

Figure 2.

Figure 2

Open in a new tab

Most common parenteral nutrition sub‐indications for (A) non‐functioning gastrointestinal tract, (B) inadequate enteral and oral nutrition, and (C) malnutrition. Frequencies are stratified for patients in the intensive care unit (ICU) and on the ward. Multiple indications per patient were possible. Numbers on the right indicate absolute patient numbers with the respective indication.

For non‐functioning gastrointestinal tract, ileus was the most common sub‐indication for patients both in the ICU (71 documented indications, 30%) and on the ward (74 documented indications, 35%) (Figure 2A). Both inflammation and gastrointestinal perforation were more common as indication for parenteral nutrition in the ICU than on the ward (18% vs. 9% and 22% vs. 6%, respectively). In contrast, less patients in the ICU had gastrointestinal obstruction (14% vs. 29%, P = 0.011). With inadequate nutrition, the most common sub‐indication was intolerance to oral nutrition (86% of patients in ICU and 88% on the ward, Figure 2B). For malnutrition, general malnutrition was the main factor in both ICU and ward (75% vs. 69%), while cancer cachexia contributed to 26% in ICU and 23% on the ward (Figure 2C).

Nutritional therapy

The median duration of parenteral nutrition was six (3;10) days in the ICU and nine (5;17) days on the ward. For both groups combined the median parenteral nutrition duration was seven (4;14) days.

The treatment patterns regarding the transition to enteral nutrition were investigated for the first 28 days of follow‐up. Figure 3 shows the use of parenteral nutrition alone and in combination with enteral nutrition for patients in the ICU with documented enteral nutrition, (n = 253). At enrolment, 27 ICU patients (11%) received some form of enteral nutrition. In the first 28 days after commencement of parenteral nutrition and enrolment, the majority of ICU patients received parenteral nutrition alone at all time points. The number of patients receiving both parenteral nutrition and enteral nutrition increased mostly during the first 7 days. While total patient numbers remained relatively stable up to Day 7 (253 to 243), the proportion of patients with some enteral nutrition, supplemented with parenteral nutrition increased from 11% to 31% (Day 7, Figure 3).

Figure 3.

Figure 3

Open in a new tab

Parenteral and enteral nutrition within the first 28 days after enrolment (Day 0) for patients in the intensive care unit (ICU). Numbers on top show total patient numbers. Within 28 days, 133 (53%) patients in ICU were discharged. Missing data for parenteral nutrition/enteral nutrition were imputed via last observation carried forward.

For patients on the ward, the use of enteral nutrition with supplemental parenteral nutrition was substantially lower (Figure 4). In the first week, only up to 3% of patients (7 patients) received some enteral nutrition. The proportion and absolute number of patients receiving enteral nutrition supplemented with parenteral nutrition increased gradually over nearly 3 weeks, with 16 patients at the maximum (10%, Day 19).

Figure 4.

Figure 4

Open in a new tab

Parenteral and enteral nutrition within the first 28 days after enrolment (Day 0) for patients on the ward. Numbers on top show total patient numbers. Within 28 days, 135 ward patients (57%) were discharged. Missing data for parenteral nutrition/enteral nutrition were imputed via last observation carried forward.

Disposition and mortality

Compared to ward patients, the ICU cohort had a higher mortality rate, and a significantly lower proportion of patients in the ICU returned home after discharge (40% vs. 66%, P < 0.001; Table 1). The hospital length of stay from enrolment to discharge from ICU or ward was not significantly different between the two groups (P = 0.141): the median hospital length of stay was 31 (19, 55) days for ICU and 24 (17, 36) days for the ward cohort.

DISCUSSION

This study provides an overview of an adult Australian patient population receiving parenteral nutrition, both for patients in the ICU and on the ward. In this registry, the numbers of patients receiving parenteral nutrition in ICU and on the ward were similar. In the ICU, enteral nutrition was initiated earlier in conjunction with parenteral nutrition and for a larger proportion of patients, and the total median number of days on parenteral nutrition was lower compared to ward patients.

The most common indications for parenteral nutrition were non‐functioning gastrointestinal tract and inadequate nutrition via the oral or enteral route. The parenteral nutrition sub‐indications for non‐functioning gastrointestinal tract in the study, including ileus, mechanical obstruction or intolerance of oral or enteral nutrition are commonly reported in literature. 31 However, there exists a degree of uncertainty and/or controversy about what “ileus” is in cases where there is no mechanical obstruction, and whether it is a contraindication to oral/enteral intake or whether it can in fact be prevented/managed by giving oral/enteral intake to stimulate gut function. The recently updated ESPEN guideline for clinical nutrition in surgery suggests that early oral/enteral intake may reduce postoperative ileus, reduce length of stay, is generally safe and may reduce the use of nasogastric tubes. 32 Our results may indicate a disconnect between evidence‐based guidelines and real‐world clinical practice in this regard, which would warrant further confirmation and study. In the authors’ own experience, parenteral nutrition is often requested when the treating team is concerned about the risk of development of ileus in their patient, which then may become a self‐fulfilling prophecy by denying their patient any oral or enteral intake. 33 A similar observation in this regard is the large proportion of patients who had a nil by mouth order by their treating team. While our study was not designed to assess whether these nil by mouth orders were clinically justified, it does highlight a common practice in the real world and a potential target for further study.

The higher rate of gastrointestinal perforations in patients in the ICU might be an indication bias because gastrointestinal perforation usually requires active surgical rescue followed by ICU admission. Although gastrointestinal obstructions may present as either acute or chronic conditions, the markedly higher prevalence of gastrointestinal obstruction among ward patients in the ARTPN registry suggests that, within the Australian parenteral nutrition population, this indication is predominantly associated with chronic states, such as subacute presentations of inflammatory bowel disease or colorectal cancer. 34 , 35

The process of transitioning patients to enteral nutrition while supplementing with parenteral nutrition in our study is in line with observations made in a similar study on nutrition practice during the first 10 days of ICU stay of French and Belgian patients. 36 Similar to provision patterns in ARTPN, a small proportion of parenteral nutrition patients in these studies were transitioned to enteral nutrition with supplemental parenteral nutrition each day, resulting in an increasing ratio of enteral nutrition with parenteral nutrition versus parenteral nutrition alone. After about 2 weeks, the number of patients that were switched from total parenteral nutrition to enteral nutrition with supplemental parenteral nutrition dropped notably. Another descriptive cohort study with European patients in the ICU also found that the ratio of enteral nutrition with parenteral nutrition versus parenteral nutrition alone increased mostly during the first 7–10 days of ICU stay. 37 In contrast to these two studies, ARTPN used parenteral nutrition provision as an inclusion criterion. In a study in which parenteral nutrition was an inclusion criteria, 49% of the patients initially receiving parenteral nutrition subsequently were provided with enteral nutrition. 38 Most shifts from parenteral nutrition to enteral nutrition with supplemental parenteral nutrition in the ICU occurred during the first 2–3 days after enrolment, which reflects the ESPEN guideline recommendation for early commencement of enteral nutrition, if possible. 22 However, a substantial proportion of patients in ARTPN did not receive any enteral nutrition after 2 or even 4 weeks, which is likely related to the failure of resolution of the clinical condition that led to the need for parenteral nutrition.

Ward patients were more likely to receive parenteral nutrition via a peripherally inserted central catheter compared to ICU patients, who most commonly had a central venous catheter. Regarding vascular access management, the practice patterns for ICU and ward patients in ARTPN are in line with literature data. Central venous catheters can deliver multiple fluids and medications at once, and allow for hemodynamic patient monitoring, something that is much less often required in a ward setting. For these reasons, they were the most commonly used vascular access devices in patients in the ICU. 39 , 40 For patients on the ward, the predominant use of peripherally inserted central catheters could be expected as patient comfort and mobility is better than with central venous catheters. 31 , 41 Patients in the ICU are more susceptible to catheter‐related blood stream infections due to factors like multiple invasive procedures/devices and their critical status. 42 In addition, the higher acuity of the ICU patients and the associated increased use of multi‐lumen central venous catheters for monitoring and drug and fluid administration may increase the risk of line infection in ICU patients. In fact, catheter‐related blood stream infections are regarded as the most frequent complication with central venous catheters. 43 The high use of catheters with antimicrobial coating for patients in the ICU also found in this study likely constitutes an attempt to lessen the incidence of catheter‐related blood stream infections and reflects current practice. 43 , 44 At the time the data was collected for the registry, antimicrobial coated peripherally inserted central catheters were not yet available in Australia, which may explain the low proportion of antimicrobial coated lines in ward patients, who mostly received parenteral nutrition via a peripherally inserted central catheter line. Other measures that may be useful in terms of reducing line infections include scrupulous attention to aseptic technique when touching the line and commensurate nursing education in this domain.

The in‐hospital mortality of ICU patients who received parenteral nutrition in our study was three times higher than published mortality of ICU patients in Australia and New Zealand, based on data from the Australian and New Zealand Intensive Care Society Adult Patient Database. 44 This suggests that patients who have gastrointestinal failure and therefore require parenteral nutrition in ICU represent a separate cohort of patients with a higher mortality risk compared to ICU patients who do not require parenteral nutrition.

Strengths and limitations

Numerous issues have prevented the generation of robust, accurate data on the effects of clinical nutrition for critically ill patients: small sample sizes, discrepant definitions of critical illness, inappropriate blinding, selection bias, or the lack of an intention‐to‐treat design. 45 Moreover, the variability in efficacy outcome measures across randomized controlled trials and a lack of a consensus about a minimum core outcome set also complicates comparison of nutritional trials results. 46 Given the challenges to conduct randomized controlled trials on nutrition in critical care, large observational and registry based studies such as the current one are suitable to complement the evidence in this field and improve quality of care. 47

The main strengths of this study are the prospective overview of an Australian parenteral nutrition population using clinical practice data from both the ICU and ward, and the completeness of our dataset. The large sample size and multicenter design supports the generalizability of results. 48 Our study also had several limitations. Participating hospitals represent a convenience sample, and this may present a bias in terms of parenteral nutrition use and preferences. The observational nature of the study and the inherent presence of unknown confounders limit the ability to make inferences around causation, and the results need to be interpreted with caution.

CONCLUSION

The ARTPN registry provides insight into the demographics, practice patterns and outcomes of an Australian parenteral nutrition population in both wards and ICUs. Commonly clinician‐reported indications for parenteral nutrition were ileus and nil by mouth orders, which may warrant further study. The reported results inform clinicians on the current practice of the use of parenteral nutrition and may provide a valuable data source to compare and improve practice patterns, and to design future studies.

AUTHOR CONTRIBUTIONS

Frank M. P. van Haren: Conceptualization; methodology; writing—original draft; writing—review and editing; formal analysis; supervision. Sumeet Rai: Conceptualization; methodology; writing—review and editing. Andrew Thomson: Conceptualization; methodology; writing—review and editing. Josie Russell‐Brown: Project administration; writing—review and editing. Mary Nourse: Project administration; writing—review and editing. Shakira Spiller: Project administration; writing—review and editing. Louise Herlihy: Writing—review and editing; methodology; conceptualization. Sean Weng Chan: Conceptualization; methodology; writing—review and editing. Peter Velloza: Conceptualization; methodology; writing—review and editing. Matthew H. Anstey: Supervision; writing—review and editing. Robert N. Palmer: Project administration; writing—review and editing. Bianca Mammana: Project administration; writing—review and editing. Tania Elderkin: Project administration; writing—review and editing. Adam Visser: Project administration; writing—review and editing. Matt Brain: Supervision; writing—review and editing. Sarah Mineall: Project administration; writing—review and editing. Emma J. Ridley: Conceptualization; methodology; writing—review and editing.

CONFLICT OF INTEREST STATEMENT

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this manuscript.

Supporting information

Supporting File 1.

JPEN-50-1003-s003.docx (26.1KB, docx)

Supporting File 2.

JPEN-50-1003-s002.docx (33.7KB, docx)

Supporting File 3.

JPEN-50-1003-s001.pdf (529.6KB, pdf)

ACKNOWLEDGMENTS

We thank Mathieu Licht and Alexandra Wendler DBM Wissenschafft GmbH, Wiesloch, Germany, for expert medical writing support. Open access publishing facilitated by Australian National University, as part of the Wiley ‐ Australian National University agreement via the Council of Australasian University Librarians.

DATA AVAILABILITY STATEMENT

De‐identified data will be available from 12 to 36 months after article publication to researchers who provide a methodologically sound and ethically approved proposal, for any purpose of analysis.

REFERENCES

  • 1. Fetterplace K, Holt D, Udy A, Ridley E. Parenteral nutrition in adults during acute illness: a clinical perspective for clinicians. Intern Med J. 2020;50(4):403‐411. 10.1111/imj.14786 [DOI] [PubMed] [Google Scholar]
  • 2. Norman K, Pichard C, Lochs H, Pirlich M. Prognostic impact of disease‐related malnutrition. Clin Nutr. 2008;27(1):5‐15. 10.1016/j.clnu.2007.10.007 [DOI] [PubMed] [Google Scholar]
  • 3. Feinberg J, Nielsen EE, Korang SK, et al. Nutrition support in hospitalised adults at nutritional risk. Cochrane Database Syst Rev. 2017;5(5):CD011598. 10.1002/14651858.CD011598.pub2 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 4. Singer P, Blaser AR, Berger MM, et al. ESPEN guideline on clinical nutrition in the intensive care unit. Clin Nutr. 2019;38(1):48‐79. 10.1016/j.clnu.2018.08.037 [DOI] [PubMed] [Google Scholar]
  • 5. Puthucheary ZA, Rawal J, McPhail M, et al. Acute skeletal muscle wasting in critical illness. JAMA. 2013;310(15):1591‐1600. 10.1001/jama.2013.278481 [DOI] [PubMed] [Google Scholar]
  • 6. Fazzini B, Märkl T, Costas C, et al. The rate and assessment of muscle wasting during critical illness: a systematic review and meta‐analysis. Crit Care. 2023;27(1):2. 10.1186/s13054-022-04253-0 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 7. Kamdar BB, Suri R, Suchyta MR, et al. Return to work after critical illness: a systematic review and meta‐analysis. Thorax. 2020;75(1):17‐27. 10.1136/thoraxjnl-2019-213803 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 8. Barker LA, Gout BS, Crowe TC. Hospital malnutrition: prevalence, identification and impact on patients and the healthcare system. Int J Environ Res Public Health. 2011;8(2):514‐527. 10.3390/ijerph8020514 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 9. Correia MITD, Perman MI, Waitzberg DL. Hospital malnutrition in Latin America: a systematic review. Clin Nutr. 2017;36(4):958‐967. 10.1016/j.clnu.2016.06.025 [DOI] [PubMed] [Google Scholar]
  • 10. Eglseer D, Hoedl M, Schoberer D. Malnutrition risk and hospital‐acquired falls in older adults: a cross‐sectional, multicenter study. Geriatr Gerontol Int. 2020;20(4):348‐353. 10.1111/ggi.13885 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 11. Kaegi‐Braun N, Mueller M, Schuetz P, Mueller B, Kutz A. Evaluation of nutritional support and in‐hospital mortality in patients with malnutrition. JAMA Netw Open. 2021;4(1):e2033433. 10.1001/jamanetworkopen.2020.33433 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 12. Leiva Badosa E, Badia Tahull M, Virgili Casas N, et al. Hospital malnutrition screening at admission: Malnutrition increases mortality and length of stay. Nutr Hosp. 2017;34(4):907‐913. 10.20960/nh.657 [DOI] [PubMed] [Google Scholar]
  • 13. Isabel T. D., Correia M. The impact of malnutrition on morbidity, mortality, length of hospital stay and costs evaluated through a multivariate model analysis. Clin Nutr. 2003;22(3):235‐239. 10.1016/s0261-5614(02)00215-7 [DOI] [PubMed] [Google Scholar]
  • 14. Kaddoura R, Shanks A, Chapman M, O'Connor S, Lange K, Yandell R. Relationship between nutritional status on admission to the intensive care unit and clinical outcomes. Nutr Diet. 2021;78(2):128‐134. 10.1111/1747-0080.12637 [DOI] [PubMed] [Google Scholar]
  • 15. Ferrie S, Weiss NB, Chau HY, Torkel S, Stepniewski ME. Association of Subjective Global Assessment with outcomes in the intensive care unit: a retrospective cohort study. Nutr Diet. 2022;79(5):572‐581. 10.1111/1747-0080.12767 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 16. Kruizenga H, van Keeken S, Weijs P, et al. Undernutrition screening survey in 564,063 patients: Patients with a positive undernutrition screening score stay in hospital 1.4 d longer. Am J Clin Nutr. 2016;103(4):1026‐1032. 10.3945/ajcn.115.126615 [DOI] [PubMed] [Google Scholar]
  • 17. Ruiz AJ, Buitrago G, Rodríguez N, et al. Clinical and economic outcomes associated with malnutrition in hospitalized patients. Clin Nutr. 2019;38(3):1310‐1316. 10.1016/j.clnu.2018.05.016 [DOI] [PubMed] [Google Scholar]
  • 18. Pohlenz‐Saw JAE, Merriweather JL, Wandrag L. Malnutrition in critical illness and beyond: a narrative review. Anaesthesia. 2023;78(6):770‐778. 10.1111/anae.15951 [DOI] [PubMed] [Google Scholar]
  • 19. Lim SL, Ong KCB, Chan YH, Loke WC, Ferguson M, Daniels L. Malnutrition and its impact on cost of hospitalization, length of stay, readmission and 3‐year mortality. Clin Nutr. 2012;31(3):345‐350. 10.1016/j.clnu.2011.11.001 [DOI] [PubMed] [Google Scholar]
  • 20. Thibault R, Abbasoglu O, Ioannou E, et al. ESPEN guideline on hospital nutrition. Clin Nutr. 2021;40(12):5684‐5709. 10.1016/j.clnu.2021.09.039 [DOI] [PubMed] [Google Scholar]
  • 21. Gomes F, Schuetz P, Bounoure L, et al. ESPEN guidelines on nutritional support for polymorbid internal medicine patients. Clin Nutr. 2018;37(1):336‐353. 10.1016/j.clnu.2017.06.025 [DOI] [PubMed] [Google Scholar]
  • 22. Singer P, Blaser AR, Berger MM, et al. ESPEN practical and partially revised guideline: clinical nutrition in the intensive care unit. Clin Nutr. 2023;42(9):1671‐1689. 10.1016/j.clnu.2023.07.011 [DOI] [PubMed] [Google Scholar]
  • 23. Compher C, Bingham AL, McCall M, et al. Guidelines for the provision of nutrition support therapy in the adult critically ill patient: The American Society for Parenteral and Enteral Nutrition. J Parenter Enteral Nutr. 2022;46(1):12‐41. 10.1002/jpen.2267 [DOI] [PubMed] [Google Scholar]
  • 24. Bellanti F, Lo Buglio A, Quiete S, Vendemiale G. Malnutrition in hospitalized old patients: screening and diagnosis, clinical outcomes, and management. Nutrients. 2022;14(4):910. 10.3390/nu14040910 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 25. Hill A, Elke G, Weimann A. Nutrition in the intensive care unit—A narrative review. Nutrients. 2021;13(8):2851. 10.3390/nu13082851 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 26. Tarantino S, Hiesmayr M, Sulz I. nutritionDay worldwide annual report 2019. Clin Nutr ESPEN. 2022;49:560‐667. 10.1016/j.clnesp.2022.01.001 [DOI] [PubMed] [Google Scholar]
  • 27. Knaus WA, Wagner DP, Draper EA, et al. The APACHE III prognostic system. risk prediction of hospital mortality for critically ill hospitalized adults. Chest. 1991;100(6):1619‐1636. 10.1378/chest.100.6.1619 [DOI] [PubMed] [Google Scholar]
  • 28. R: A Language and Environment for Statistical Computing. R Foundation for Statistical Computing. 2024. https://www.R-project.org/ [Google Scholar]
  • 29. Wickham H, Averick M, Bryan J, et al. Welcome to the tidyverse. J Open Source Software. 2019;4(43):1686. 10.21105/joss.01686 [DOI] [Google Scholar]
  • 30. Survival: A Package for Survival Analysis in R. 2024. https://CRAN.R-project.org/package=survival
  • 31. Berlana D. Parenteral nutrition overview. Nutrients. 2022;14(21):4480. 10.3390/nu14214480 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 32. Weimann A, Bezmarevic M, Braga M, et al. ESPEN guideline on clinical nutrition in surgery—Update 2025. Clin Nutr. 2025;53:222‐261. 10.1016/j.clnu.2025.08.029 [DOI] [PubMed] [Google Scholar]
  • 33. Boelens PG, Heesakkers FFBM, Luyer MDP, et al. Reduction of postoperative ileus by early enteral nutrition in patients undergoing major rectal surgery: Prospective, randomized, controlled trial. Ann Surg. 2014;259(4):649‐655. 10.1097/SLA.0000000000000288 [DOI] [PubMed] [Google Scholar]
  • 34. Franke AJ, Iqbal A, Starr JS, Nair RM, George TJ. Management of malignant bowel obstruction associated with GI cancers. J Oncol Pract. 2017;13(7):426‐434. 10.1200/jop.2017.022210 [DOI] [PubMed] [Google Scholar]
  • 35. Rieder F, Fiocchi C, Rogler G. Mechanisms, management, and treatment of fibrosis in patients with inflammatory bowel diseases. Gastroenterology. 2017;152(2):340‐350.e6. 10.1053/j.gastro.2016.09.047 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 36. Pardo E, Lescot T, Preiser J‐C, et al. Association between early nutrition support and 28‐day mortality in critically ill patients: The FRANS prospective nutrition cohort study. Crit Care. 2023;27(1):7. 10.1186/s13054-022-04298-1 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 37. Matejovic M, Huet O, Dams K, et al. Medical nutrition therapy and clinical outcomes in critically ill adults: a European multinational, prospective observational cohort study (EuroPN). Crit Care. 2022;26(1):143. 10.1186/s13054-022-03997-z [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 38. Lopez‐Delgado JC, Grau‐Carmona T, Mor‐Marco E, et al. Parenteral nutrition: Current use, complications, and nutrition delivery in critically ill patients. Nutrients. 2023;15(21):4665. 10.3390/nu15214665 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 39. Timsit J‐F, Baleine J, Bernard L, et al. Expert consensus‐based clinical practice guidelines management of intravascular catheters in the intensive care unit. Ann Intensive Care. 2020;10(1):118. 10.1186/s13613-020-00713-4 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 40. Bhalla A . Can we place central venous catheter safely in intensive care units? Indian J Crit Care Med. 2020;24(7):498‐499. 10.5005/jp-journals-10071-23510 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 41. Pitiriga V, Bakalis J, Theodoridou K, Kanellopoulos P, Saroglou G, Tsakris A. Lower risk of bloodstream infections for peripherally inserted central catheters compared to central venous catheters in critically ill patients. Antimicrob Resist Infect Control. 2022;11(1):137. 10.1186/s13756-022-01180-1 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 42. Chopra V, Ratz D, Kuhn L, Lopus T, Chenoweth C, Krein S. PICC‐associated bloodstream infections: Prevalence, patterns, and predictors. Am J Med. 2014;127(4):319‐328. 10.1016/j.amjmed.2014.01.001 [DOI] [PubMed] [Google Scholar]
  • 43. Polderman K, Girbes A. Central venous catheter use. Part 2: Infectious complications. Intensive Care Med. 2002;28(1):18‐28. 10.1007/s00134-001-1156-7 [DOI] [PubMed] [Google Scholar]
  • 44. Godfrey G, Pilcher D, Hilton A, Bailey M, Hodgson CL, Bellomo R. Treatment limitations at admission to intensive care units in Australia and New Zealand: Prevalence, outcomes, and resource use*. Crit Care Med. 2012;40(7):2082‐2089. 10.1097/CCM.0b013e31824ea045 [DOI] [PubMed] [Google Scholar]
  • 45. Doig GS, Simpson F, Delaney A. A review of the true methodological quality of nutritional support trials conducted in the critically ill: Time for improvement. Anesth Analg. 2005;100(2):527‐533. 10.1213/01.Ane.0000141676.12552.D0 [DOI] [PubMed] [Google Scholar]
  • 46. Taverny G, Lescot T, Pardo E, Thonon F, Maarouf M, Alberti C. Outcomes used in randomised controlled trials of nutrition in the critically ill: a systematic review. Crit Care. 2019;23(1):12. 10.1186/s13054-018-2303-7 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 47. Hoque DME, Kumari V, Hoque M, Ruseckaite R, Romero L, Evans SM. Impact of clinical registries on quality of patient care and clinical outcomes: a systematic review. PLoS One. 2017;12(9):e0183667. 10.1371/journal.pone.0183667 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 48. Reineck LA, Le TQ, Seymour CW, Barnato AE, Angus DC, Kahn JM. Effect of public reporting on intensive care unit discharge destination and outcomes. Ann Am Thorac Soc. 2015;12(1):57‐63. 10.1513/AnnalsATS.201407-342OC [DOI] [PMC free article] [PubMed] [Google Scholar]

Associated Data

This section collects any data citations, data availability statements, or supplementary materials included in this article.

Supplementary Materials

Supporting File 1.

JPEN-50-1003-s003.docx (26.1KB, docx)

Supporting File 2.

JPEN-50-1003-s002.docx (33.7KB, docx)

Supporting File 3.

JPEN-50-1003-s001.pdf (529.6KB, pdf)

Data Availability Statement

De‐identified data will be available from 12 to 36 months after article publication to researchers who provide a methodologically sound and ethically approved proposal, for any purpose of analysis.

Articles from JPEN. Journal of Parenteral and Enteral Nutrition are provided here courtesy of Wiley

RESOURCES