fungemia and parenteral nutrition

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HildaSeyler

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Jan 9, 2017, 8:08:28 AM1/9/17
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Can anyone direct me to any guidelines / best practice recommendations regarding the use of parenteral nutrition for patients who have fungemia?
Our pharmacist tells me that they had an education session where material was presented that indicated to stop IV lipids, but could continue with amino acid/dextrose infusion.

Drover, Dr. John W.

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Jan 11, 2017, 11:08:11 PM1/11/17
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Dear Hilda,

I am not aware of guidelines specific to fungemia. The best we might do is look at the data that is available on the use of IV lipids in critically ill patients. This is relatively weak evidence but is a recommendation that can be found here:

http://www.criticalcarenutrition.com/docs/CPGs%202015/9.2%202015.pdf

 

As you will note it comes with our weakest recommendation that a strategy that reduces the load of omega-6 fatty acids/soy bean oils should be considered.

 

On the practical side I would usually recommend not using soy based IV lipid emulsions in the first week of illness associated with bacteremia/fungemia/sepsis and then introduce lipids. We are then more commonly using another source of lipids rather than Intralipid but if that is not available would start with low dose Intralipid such as thrice weekly.

 

I hope this helps.

Cheers

 

John W. Drover, MD, FRCSC, FACS, CCPE
Professor
Departments of Critical Care Medicine and Surgery
Queen’s University
Critical Care Physician Lead, South East LHIN
Kingston General Hospital

Davies 2
76 Stuart Street
Kingston, Ontario
Canada
K7L 2V7
Phone 613-549-6666 ext 6336
Fax 613-548-1325

 


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