Efficacy and safety of total parenteral nutrition.

Total parenteral nutrition has been widely available for almost 20 years. This therapy can demonstrably support growth in neonates and children and will maintain life in adults with an inadequate intestine. It may be beneficial in highly selected preoperative patients, and patients with head trauma. Otherwise, its role in specific disease states or pathologic conditions remains unclear. Whether its benefits outweigh its hazards is largely unknown. Crucial to the decision-making process for initiation of TPN is a knowledge of when starvation becomes detrimental to an individual and whether TPN can prevent or reverse any of starvation's detrimental effects; this information is unknown. Many potential complications exist, the frequency of which generally is dependent on the expertise of the user. Nutritional support teams appear to reduce septic, mechanical, and metabolic complications and may improve the clinical efficacy and decrease the cost of TPN care.