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BMJ Supportive & Palliative Care Dec 2023Parenteral nutrition in palliative care is contentious, and decisions on starting or continuing its treatment in palliative patients centre on an individual's...
Parenteral nutrition in palliative care is contentious, and decisions on starting or continuing its treatment in palliative patients centre on an individual's preference, balanced with quality of life. This case report describes the unusual onset of pain and agitation secondary to fluid retention, in a patient with metastatic pseudomyxoma peritonei, established on 2.5 L/day of parenteral nutrition. Immediate volume reduction of the parenteral nutrition to 1 L/day successfully reversed the patient's symptoms. To our knowledge, this is the first case of parenteral nutrition inducing pain and agitation in a palliative care patient. There is no specific internationally acclaimed guidance concerning parenteral nutrition content and volume in palliative patients, due to a lack of high quality studies. This case study highlights the need for further research into parenteral nutrition content and volume in palliative care, to prevent harmful effects from fluid retention, impacting on quality of life.
Topics: Humans; Palliative Medicine; Quality of Life; Parenteral Nutrition; Palliative Care; Pain
PubMed: 33771817
DOI: 10.1136/bmjspcare-2021-002991 -
World Review of Nutrition and Dietetics 2021
Review
Topics: Humans; Infant; Infant, Newborn; Infant, Premature; Parenteral Nutrition; Parenteral Nutrition, Total
PubMed: 34352767
DOI: 10.1159/000514751 -
Nutrition in Clinical Practice :... Dec 2023Parenteral nutrition (PN) remains an important aspect of treating hospitalized adult patients who are otherwise unable to achieve adequate nutrition intake. PN is highly... (Review)
Review
Parenteral nutrition (PN) remains an important aspect of treating hospitalized adult patients who are otherwise unable to achieve adequate nutrition intake. PN is highly individualized and requires careful adjustment of macronutrients and micronutrients to minimize complications. One frequent complication associated with PN involves blood glucose (BG) derangements including both hypoglycemia and hyperglycemia. PN-related glycemic complications are complex and multifactorial. Close BG monitoring is required for selecting and evaluating therapeutic interventions. BG goals for patients treated with PN may vary depending on patient-specific characteristics. Since dextrose provides the carbohydrate source in PN prescriptions, hyperglycemia may be expected, but nondextrose causes must also be considered. Insulin is a mainstay of therapy for managing glycemic complications related to PN, and the regimen chosen depends on patient-specific factors. However, insulin therapy also places the patient at an increased risk of hypoglycemia. Similarly, insulin is not the sole cause of hypoglycemia in these patients. The aim of this review is to describe the factors associated with dysglycemia during PN therapy and provide recommendations for minimizing and managing these complications, which is paramount to providing high-quality patient care and improving clinical outcomes.
Topics: Humans; Adult; Blood Glucose; Hyperglycemia; Hypoglycemia; Insulin; Parenteral Nutrition
PubMed: 37749749
DOI: 10.1002/ncp.11073 -
Swiss Medical Weekly 2014Critical illness is characterised by nutritional and metabolic disorders, resulting in increased muscle catabolism, fat-free mass loss, and hyperglycaemia. The objective... (Review)
Review
Critical illness is characterised by nutritional and metabolic disorders, resulting in increased muscle catabolism, fat-free mass loss, and hyperglycaemia. The objective of the nutritional support is to limit fat-free mass loss, which has negative consequences on clinical outcome and recovery. Early enteral nutrition is recommended by current guidelines as the first choice feeding route in ICU patients. However, enteral nutrition alone is frequently associated with insufficient coverage of the energy requirements, and subsequently energy deficit is correlated to worsened clinical outcome. Controlled trials have demonstrated that, in case of failure or contraindications to full enteral nutrition, parenteral nutrition administration on top of insufficient enteral nutrition within the first four days after admission could improve the clinical outcome, and may attenuate fat-free mass loss. Parenteral nutrition is cautious if all-in-one solutions are used, glycaemia controlled, and overnutrition avoided. Conversely, the systematic use of parenteral nutrition in the ICU patients without clear indication is not recommended during the first 48 hours. Specific methods, such as thigh ultra-sound imaging, 3rd lumbar vertebra-targeted computerised tomography and bioimpedance electrical analysis, may be helpful in the future to monitor fat-free mass during the ICU stay. Clinical studies are warranted to demonstrate whether an optimal nutritional management during the ICU stay promotes muscle mass and function, the recovery after critical illness and reduces the overall costs.
Topics: Critical Care; Critical Illness; Energy Intake; Energy Metabolism; Enteral Nutrition; Humans; Nutrition Assessment; Parenteral Nutrition; Treatment Outcome
PubMed: 25144728
DOI: 10.4414/smw.2014.13997 -
African Health Sciences Sep 2023To explore the clinical nursing effect of parenteral nutrition combined with enteral nutrition support in neurosurgery. (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
To explore the clinical nursing effect of parenteral nutrition combined with enteral nutrition support in neurosurgery.
METHODOLOGY
200 neurosurgical patients were randomly divided into two groups. The time of parenteral nutrition combined with enteral nutrition support in our hospital (January 2021) was used as the cut-off point, the PN group and the PN+EN group were divided according to the cut-off point. Nutritional status, immune status, occurrence of adverse events, prognosis-related indicators were compared between the two groups.
RESULTS
Nutritional status and immune status at 7 days of nutritional support in the PN+EN group were higher than those in the PN group, The difference was statistically significant. The total incidence of adverse events in the PN+EN group (3.00%) was significantly lower than that in the PN group (11.00%), and the difference was statistically significant. The average ICU treatment time, average hospital stay and emerging infection rate in the PN+EN group were lower than those in the PN group, and the differences were statistically significant ( < 0.05).
CONCLUSION
Parenteral nutrition combined with enteral nutrition support in neurosurgery can achieve a more ideal intervention effect. It is beneficial to the prognosis of patients and has a certain value of promotion and application.
Topics: Humans; Enteral Nutrition; Neurosurgery; Nutritional Support; Parenteral Nutrition; Nutritional Status
PubMed: 38357139
DOI: 10.4314/ahs.v23i3.64 -
Archives of Disease in Childhood. Fetal... Mar 2022
Topics: Gestational Age; Humans; Infant, Newborn; Infant, Premature; Parenteral Nutrition; Patient Selection; Perinatology; Risk Assessment; Survival Analysis; Time-to-Treatment
PubMed: 34795010
DOI: 10.1136/archdischild-2021-323072 -
Current Opinion in Clinical Nutrition... May 2021To review the current evidence evaluating early versus delayed commencement of parenteral nutrition in infants. (Review)
Review
PURPOSE OF REVIEW
To review the current evidence evaluating early versus delayed commencement of parenteral nutrition in infants.
RECENT FINDINGS
Recent studies in very premature infants (<32 weeks gestation) have shown that early commencement of parenteral nutrition immediately after birth improves physical growth. However, there are concerns that early use of very high dose of amino-acids (>3.5 g/kg/day immediately after birth) may cause metabolic acidosis, elevated blood urea, slower head growth and refeeding-hypophosphatemia syndrome. A recent multicentre randomized controlled trial found that commencement of parenteral nutrition within 24-h of admission increases the risk of infections and prolongs the duration of ventilation and ICU stay in full-term neonates, older infants and children. The study also found that delaying to day 8 of admission increased the risk of hypoglycaemia.
SUMMARY
Benefits of commencing parenteral nutrition on the first day of life appear to outweigh risks in very premature infants; however, it is prudent to avoid early very high doses of amino acids (>3.5 g/kg/day) in the first few days of life. In moderate to late preterm infants, if enteral feeds are not tolerated by 72 h, it is reasonable to commence parenteral nutrition. In full-term and older infants, it is preferable to avoid parenteral nutrition within 24 h of admission and consider delaying by further few days. Diligent monitoring of blood glucose, serum phosphate and other parameters is essential while on parenteral nutrition.
Topics: Child; Enteral Nutrition; Humans; Infant; Infant, Newborn; Infant, Premature; Infant, Very Low Birth Weight; Parenteral Nutrition; Randomized Controlled Trials as Topic; Time Factors
PubMed: 33284201
DOI: 10.1097/MCO.0000000000000720 -
JPEN. Journal of Parenteral and Enteral... Jul 2020Parenteral nutrition (PN) is associated with risks that could threaten the clinical condition of premature neonates hospitalized in the neonatal intensive care unit. In...
BACKGROUND
Parenteral nutrition (PN) is associated with risks that could threaten the clinical condition of premature neonates hospitalized in the neonatal intensive care unit. In this work, risk-analysis methodology was implemented to contain the risks associated with the PN production process and improve PN safety.
METHODS
The Failure Modes, Effects, and Criticality Analysis was performed by a multidisciplinary team. All potential failure modes of the PN preparation process were recorded, and associated risks were scored based on their severity, occurrence, and detectability, with a risk priority number (RPN). All identified failure scenarios and the respective work stages were ranked in descending order of criticality. Corrective actions were proposed to address critical points, and the safety of the process was reassessed by the same method in a prospective manner.
RESULTS
The highest RPN scores were obtained with the PN composition calculation performed manually (RPN: 530) or electronically (RPN: 478), completion of the PN medical order form (RPN: 354), manual compounding of PN admixtures (RPN: 258), and the structure/organization/maintenance of the PN preparation unit (RPN: 133). The quality and safety of PN admixtures could be compromised by many critical factors, such as the increased particle-microbial load in the unit and the inadequate training/experience of the involved health professionals and their incompliance with the given instructions. The implementation of the proposed corrective measures is expected to reduce the risks of the overall PN production process by 67.5%.
CONCLUSIONS
Improvement of the PN production process through risk-analysis methodologies enhances safety for premature neonates.
Topics: Child; Child Nutritional Physiological Phenomena; Humans; Infant, Newborn; Parenteral Nutrition; Parenteral Nutrition, Total; Pharmacy Service, Hospital; Prospective Studies
PubMed: 32026498
DOI: 10.1002/jpen.1787 -
Nutrition in Clinical Practice :... Oct 2016Parenteral nutrition (PN) is a life-sustaining therapy providing nutrients to individuals with impaired intestinal tract function and enteral access challenges. It is... (Review)
Review
Parenteral nutrition (PN) is a life-sustaining therapy providing nutrients to individuals with impaired intestinal tract function and enteral access challenges. It is one of the most complex prescriptions written routinely in the hospital and home care settings. This article is to aid the nutrition support clinician in the safe provision of PN, including selecting appropriate patients for PN, vascular access, development of a PN admixture, appropriate therapy monitoring, recognition of preparation options, and awareness of preparation and stability concerns.
Topics: Adult; Humans; Parenteral Nutrition; Parenteral Nutrition Solutions
PubMed: 27440772
DOI: 10.1177/0884533616657650 -
JPEN. Journal of Parenteral and Enteral... Nov 2020Inappropriate parenteral nutrition (PN) administration often occurs in hospitalized patients, increasing the risk of complications. Nutrition support teams (NSTs)...
Inappropriate parenteral nutrition (PN) administration often occurs in hospitalized patients, increasing the risk of complications. Nutrition support teams (NSTs) regulate and approve PN use in some hospitals. This systematic review examined whether appropriateness of PN use in hospitalized adult patients increased under NST oversight. Ten databases were searched systematically to select studies from 2004 to 2020 that analyzed appropriateness of PN use in adult hospitalized patients under NST oversight. Studies were included if appropriateness of PN was examined and NSTs were involved in PN orders or recommendations. Studies were evaluated using the Quality Criteria Checklist from the Academy of Nutrition and Dietetics Evidence Analysis Library. Nine studies were included in the final analysis. One received a positive rating on the quality checklist, whereas 8 received a neutral rating. Inappropriate PN use varied from 4.3% to 18%. Two studies compared PN use between multiple hospitals, both with and without NSTs. Two compared appropriateness before and after NST implementation, whereas another 2 studies compared it before and after NST restructuring. Three studies examined appropriateness of PN with NST oversight at a single facility with no control group. Overall, NSTs were associated with decreased incidence of inappropriate PN use. No studies were randomized, and several did not describe demographics between groups. Although NSTs appear to decrease inappropriate PN use, the results are limited because of study design or reporting. Future studies should monitor and evaluate clinical outcomes, such as mortality, and utilize more rigorous methodologies.
Topics: Adult; Hospitals; Humans; Nutritional Support; Parenteral Nutrition; Parenteral Nutrition, Total; Patient Care Team
PubMed: 32378732
DOI: 10.1002/jpen.1864