**3.2 More caution should be placed on the use of total parenteral nutrition (TPN)**

Parenteral nutrition (PN) is the administering of specialist nutritional products to a person by way of a vein, bypassing the usual process of eating and digestion (referred as enteral nutrition). Total parenteral nutrition (TPN) was introduced by Dudrick et al. in clinical practice over 50 years ago [35]. The principal indication for TPN is a seriously ill patient where enteral feeding is not possible.

For critically ill patients, there is an ongoing debate on whether providing them with early enteral nutrition, or tolerating permissive underfeeding. Recently ESICM clinical practice guidelines [36] and the Surviving Sepsis Campaign [37] all suggest using early enteral nutrition (EEN), initiated at a low rate, in the majority of critically ill patients, and suggest delaying EN only in some special cases like in patients with uncontrolled shock, uncontrolled hypoxemia and acidosis, and other sever complications. These suggestions agrees well with our finding about the Luigi

### **Figure 6.**

*Most of the publications on self-healing are in materials science and artificial intelligence.*


**123**

capacity.

**Figure 7.**

*publications on topic 7 to topic 11 of self-healing.*

*Scientometrics as a Powerful Tool in Integrating Isolated Medical Specialties: A Case Study…*

Cornaro diet, since low rate early nutrition supports and protects the proper function of GIT mucosa, while the serum starvation ensures the full function of UA in the body, helping the patient in recovering from the illness by his own self-healing

*(a) Relative volume trends of publications on topic 1 to topic 6 of self-healing. (b) Relative volume trends of* 

While Luigi Cornaro diet introduce small amount of food in the GIT and keep a serum starvation to meet the requirement of SUA, TPN just does the opposite. It introduces nutrition to the blood to interfere the proper functioning of UA, depriving the body of a key cell survival mechanism. Furthermore, TPN starves the GIT, which may result in GIT mucosa atrophy and dysfunction. Research shows that it is critical to have small amount food in the GIT to maintain a full functioning GIT mucosa,

*DOI: http://dx.doi.org/10.5772/intechopen.86680*

### **Table 1.**

*Representative keywords for topics on self-healing.*

*Scientometrics as a Powerful Tool in Integrating Isolated Medical Specialties: A Case Study… DOI: http://dx.doi.org/10.5772/intechopen.86680*

### **Figure 7.**

*Scientometrics Recent Advances*

**3.2 More caution should be placed on the use of total parenteral nutrition (TPN)**

For critically ill patients, there is an ongoing debate on whether providing them with early enteral nutrition, or tolerating permissive underfeeding. Recently ESICM clinical practice guidelines [36] and the Surviving Sepsis Campaign [37] all suggest using early enteral nutrition (EEN), initiated at a low rate, in the majority of critically ill patients, and suggest delaying EN only in some special cases like in patients with uncontrolled shock, uncontrolled hypoxemia and acidosis, and other sever complications. These suggestions agrees well with our finding about the Luigi

TPN is a seriously ill patient where enteral feeding is not possible.

*Most of the publications on self-healing are in materials science and artificial intelligence.*

Parenteral nutrition (PN) is the administering of specialist nutritional products to a person by way of a vein, bypassing the usual process of eating and digestion (referred as enteral nutrition). Total parenteral nutrition (TPN) was introduced by Dudrick et al. in clinical practice over 50 years ago [35]. The principal indication for

**122**

**Table 1.**

**Figure 6.**

*Representative keywords for topics on self-healing.*

*(a) Relative volume trends of publications on topic 1 to topic 6 of self-healing. (b) Relative volume trends of publications on topic 7 to topic 11 of self-healing.*

Cornaro diet, since low rate early nutrition supports and protects the proper function of GIT mucosa, while the serum starvation ensures the full function of UA in the body, helping the patient in recovering from the illness by his own self-healing capacity.

While Luigi Cornaro diet introduce small amount of food in the GIT and keep a serum starvation to meet the requirement of SUA, TPN just does the opposite. It introduces nutrition to the blood to interfere the proper functioning of UA, depriving the body of a key cell survival mechanism. Furthermore, TPN starves the GIT, which may result in GIT mucosa atrophy and dysfunction. Research shows that it is critical to have small amount food in the GIT to maintain a full functioning GIT mucosa,

### **Figure 8.**

*Keywords analysis for publications on TPN shows the close relation of TPN to bacterial translocation and sepsis.*

preventing it from atrophy, avoiding its proneness for bacterial translocation and sepsis [13]. **Figure 8** shows the keywords mapping of publications on TPN, with the term "sepsis" highlighted. We can clearly see the close relation of TPN to sepsis.

Based on the above discussion, we suggest that great caution should be placed on the use of TPN in treating sickness. TPN should only be conducted for seriously ill patients who are too emaciated to have proper running of SUA activity in their body, and enteral feeding is truly not possible.
