Indications for Parenteral Nutrition

1. Unable to meet > 50% caloric needs through an enteral route by post-injury day #7

2. Any of the contraindications for enteral nutrition listed in above that persist and patient is without nutritional support for 3 days or patient is not anticipated to start enteral nutrition for more than 3-5 days.

3. Massive small bowel resection refractory to enteral feeds.

4. High output fistula after failure of elemental diet.

5. Any patient with pre-existing malnutrition (>15% involuntary weight loss or pre-injury albumin < 3 g/dl) or categorized as “high nutritional risk” based on a validated nutritional risk scoring system (NUTRIC or other) and with contraindication or intolerance to enteral feeding. 1-4