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Nutrition (Burbank, Los Angeles County,... 2019
Topics: Enteral Nutrition; History, 17th Century; History, 18th Century; History, 19th Century; History, 20th Century; History, 21st Century; Humans; Medical Oncology; Parenteral Nutrition
PubMed: 31561204
DOI: 10.1016/j.nut.2019.06.026 -
American Journal of Health-system... Jun 2024This article is based on presentations and discussions held at the International Safety and Quality of Parenteral Nutrition (PN) Summit (held November 8-10, 2021, at...
PURPOSE
This article is based on presentations and discussions held at the International Safety and Quality of Parenteral Nutrition (PN) Summit (held November 8-10, 2021, at Charleston, SC, and Bad Homburg, Germany) and aims to raise awareness concerning unresolved issues associated with the PN process and potential future directions, including a greater emphasis on patients' perspectives and the role of patient support.
SUMMARY
Ensuring that every patient in need receives adequate PN support remains challenging. It is important to have a standardized approach to identify nutritional risk and requirements using validated nutritional screening and assessment tools. Gaps between optimal and actual clinical practices need to be identified and closed, and responsibilities in the nutrition support team clarified. Use of modern technology opens up opportunities to decrease workloads or liberate resources, allowing a more personalized care approach. Patient-centered care has gained in importance and is an emerging topic within clinical nutrition, in part because patients often have different priorities and concerns than healthcare professionals. Regular assessment of health-related quality of life, functional outcomes, and/or overall patient well-being should all be performed for PN patients. This will generate patient-centric data, which should be integrated into care plans. Finally, communication and patient education are prerequisites for patients' commitment to health and for fostering adherence to PN regimes.
CONCLUSION
Moving closer to optimal nutritional care requires input from healthcare professionals and patients. Patient-centered care and greater emphasis on patient perspectives and priorities within clinical nutrition are essential to help further improve clinical nutrition.
Topics: Humans; Parenteral Nutrition; Patient Safety; Patient-Centered Care; Quality Improvement; Quality of Life; Congresses as Topic
PubMed: 38869258
DOI: 10.1093/ajhp/zxae077 -
The Veterinary Clinics of North... Sep 2023Malnutrition and need for nutritive support are both very common in exotic animals requiring critical care. Assessment and monitoring of body condition, weight, protein... (Review)
Review
Malnutrition and need for nutritive support are both very common in exotic animals requiring critical care. Assessment and monitoring of body condition, weight, protein absorption, and catabolic loss is recommended to help guide restorative therapy. Several critical care diets are available based on digestive strategy. Fluid requirements and evaporative water loss can vary based on taxa; ectoderms suffer evaporative losses at a greater magnitude than endotherms. Enteral and parenteral nutrition strategies can be appropriate for patients, with natural history and anatomic and physiologic differences considered as much as possible.
Topics: Animals; Nutritional Requirements; Malnutrition; Parenteral Nutrition; Critical Illness
PubMed: 37516460
DOI: 10.1016/j.cvex.2023.05.009 -
Supportive Care in Cancer : Official... Sep 2020Although nutritional interventions are becoming widely used in cancer patients, purposes and results of such treatment are not always well-defined. This is because... (Review)
Review
PURPOSE
Although nutritional interventions are becoming widely used in cancer patients, purposes and results of such treatment are not always well-defined. This is because nutrition is traditionally considered a palliative treatment to be confined to the area of palliative cares, whereas the modern approach includes nutrition as an early supplemental support to improve compliance of patients with the oncologic therapies and total parenteral nutrition may be recommended in patients who would be destined to succumb prior from starvation-malnutrition than from tumour progression. Purpose of this paper if to define the potential as well as the limitations of nutritional interventions on both the survival and the quality of life of the advanced cancer patients.
RECENT FINDINGS
Some RCT on the use of oral, enteral and supplemental parenteral nutrition in patients on oncologic therapy show some benefit on compliance with therapy and in some domains of quality of life. Some malnourished (hypo)aphagic incurable cancer patients may survive longer thanks to parenteral nutrition, while few data suggest that quality of life may be maintained for a limited period of time. With a few exceptions, oncology and nutrition have till recently travelled on parallel tracks without talking each other. The oncologist who knows the natural history of the patients should understand which risk of complication and of poor tolerance to the treatment can malnourished patients carry and which is the potential of parenteral nutrition in hypophagic incurable patients.
Topics: Female; Humans; Male; Nutritional Status; Palliative Care; Parenteral Nutrition; Quality of Life
PubMed: 32417968
DOI: 10.1007/s00520-020-05505-x -
Pediatric Blood & Cancer Dec 2019Multiple disease and treatment-related factors contribute to intestinal insult and influence the nutritional status of children with cancer. Many children with cancer... (Review)
Review
Multiple disease and treatment-related factors contribute to intestinal insult and influence the nutritional status of children with cancer. Many children with cancer will experience intestinal dysfunction during their cancer journey and children with cancer are a common referral group for inpatient parenteral nutrition. Appropriate use of parenteral nutrition in children with cancer and intestinal failure may alleviate malnutrition and associated risks. However, proper selection of patients, correct parenteral nutrition prescription, and close monitoring is important to avoid unnecessary intestinal failure or parenteral nutrition-related complications, minimize long-term nutritional sequelae or additional costs to health services, and optimize intestinal rehabilitation.
Topics: Child; Humans; Malnutrition; Neoplasms; Nutritional Support; Parenteral Nutrition
PubMed: 31535458
DOI: 10.1002/pbc.28000 -
Critical Care (London, England) 2015This review emphasizes the benefits of parenteral nutrition (PN) in critically ill patients, when prescribed for relevant indications, in adequate quantities, and in due... (Review)
Review
This review emphasizes the benefits of parenteral nutrition (PN) in critically ill patients, when prescribed for relevant indications, in adequate quantities, and in due time. Critically ill patients are at risk of energy deficit during their ICU stay, a condition which leads to unfavorable outcomes, due to hypercatabolism secondary to the stress response and the difficulty to optimize feeding. Indirect calorimetry is recommended to define the energy target, since no single predictive equation accurately estimates energy expenditure. Energy metabolism is intimately associated with protein metabolism. Recent evidence calls for adequate protein provision, but there is no accurate method to estimate the protein requirements, and recommendations are probably suboptimal. Enteral nutrition (EN) is the preferred route of feeding, but gastrointestinal intolerance limits its efficacy and PN allows for full coverage of energy needs. Seven recent articles concerning PN for critically ill patients were identified and carefully reviewed for the clinical and scientific relevance of their conclusions. One article addressed the unfavorable effects of early PN, although this result should be more correctly regarded as a consequence of glucose load and hypercaloric feeding. The six other articles were either in favor of PN or concluded that there was no difference in the outcome compared with EN. Hypercaloric feeding was not observed in these studies. Hypocaloric feeding led to unfavorable outcomes. This further demonstrates the beneficial effects of an early and adequate feeding with full EN, or in case of failure of EN with exclusive or supplemental PN. EN is the first choice for critically ill patients, but difficulties providing optimal nutrition through exclusive EN are frequently encountered. In cases of insufficient EN, individualized supplemental PN should be administered to reduce the infection rate and the duration of mechanical ventilation. PN is a safe therapeutic option as long as sufficient attention is given to avoid hypercaloric feeding.
Topics: Critical Care; Critical Illness; Energy Intake; Energy Metabolism; Enteral Nutrition; Evidence-Based Medicine; Female; Humans; Male; Parenteral Nutrition; Treatment Outcome
PubMed: 26728859
DOI: 10.1186/cc14723 -
Advances in Nutrition (Bethesda, Md.) Mar 2022
Topics: Humans; Copper; Parenteral Nutrition; Parenteral Nutrition, Total; Nutritional Status
PubMed: 34940824
DOI: 10.1093/advances/nmab157 -
Nutrition in Clinical Practice :... Jun 2015Parenteral nutrition (PN) is a life-sustaining therapy designed to deliver essential nutrients to patients unable to meet nutrition needs via the enteral route. PN may... (Review)
Review
Parenteral nutrition (PN) is a life-sustaining therapy designed to deliver essential nutrients to patients unable to meet nutrition needs via the enteral route. PN may be delivered via a 2-in-1 system (one solution containing amino acids, dextrose, electrolytes, vitamins, minerals, and fluids and one solution containing intravenous fat emulsions [IVFEs]) or via a 3-in-1 system (all nutrients mixed in one container). Although the use of 3-in-1 PN solutions is not necessarily therapeutically advantageous, certain benefits may exist such as the potential to reduce the risk of contamination due to decreased manipulations; ease of administration, particularly in the home care setting; possible cost savings; and reduced IVFE wastage. However, the incorporation of IVFE in 3-in-1 solutions also presents unique risks for the neonatal and pediatric population such as decreased stability, increased lipid globule size, decreased sterility and the potential for increased microbial growth/infectious complications, the need to use a larger filter size, precipitation and compatibility risks, and an increased chance of catheter occlusion. This review outlines the unique issues and challenges to be considered when formulating neonatal and pediatric 3-in-1 PN admixtures. While 3-in-1 PN solutions may be advantageous for certain pediatric populations, specifically those dependent on home PN, the risks do not outweigh the benefits in neonatal patients, and use should be avoided in this population.
Topics: Amino Acids; Child; Electrolytes; Fat Emulsions, Intravenous; Glucose; Humans; Infant, Newborn; Parenteral Nutrition; Pediatrics; Risk Assessment; Trace Elements; Vitamins
PubMed: 25857309
DOI: 10.1177/0884533615580596 -
Nutrients Feb 2022Necrotizing enterocolitis (NEC) is the main gastrointestinal emergency of preterm infants for whom bowel rest and parenteral nutrition (PN) is essential. Despite the... (Review)
Review
Necrotizing enterocolitis (NEC) is the main gastrointestinal emergency of preterm infants for whom bowel rest and parenteral nutrition (PN) is essential. Despite the improvements in neonatal care, the incidence of NEC remains high (11% in preterm newborns with a birth weight <1500 g) and up to 20−50% of cases still require surgery. In this narrative review, we report how to optimize PN in severe NEC requiring surgery. PN should begin as soon as possible in the acute phase: close fluid monitoring is advocated to maintain volemia, however fluid overload and electrolytes abnormalities should be prevented. Macronutrients intake (protein, glucose, and lipids) should be adequately guaranteed and is essential in each phase of the disease. Composite lipid emulsion should be the first choice to reduce the risk of parenteral nutrition associated liver disease (PNALD). Vitamin and trace elements deficiency or overload are frequent in long-term PN, therefore careful monitoring should be planned starting from the recovery phase to adjust their parenteral intake. Neonatologists must be aware of the role of nutrition especially in patients requiring long-term PN to sustain growth, limiting possible adverse effects and long-term deficiencies.
Topics: Enterocolitis, Necrotizing; Humans; Infant; Infant, Newborn; Infant, Premature; Micronutrients; Parenteral Nutrition; Parenteral Nutrition, Total; Preoperative Care
PubMed: 35267894
DOI: 10.3390/nu14050919 -
Current Opinion in Pediatrics Jun 2017The goal of this review is to provide updates on the definition, pathophysiology, treatment, and prevention of intestinal failure-associated liver disease (IFALD) that... (Review)
Review
PURPOSE OF REVIEW
The goal of this review is to provide updates on the definition, pathophysiology, treatment, and prevention of intestinal failure-associated liver disease (IFALD) that are relevant to care of pediatric patients.
RECENT FINDINGS
Current literature emphasizes the multifactorial nature of IFALD. The pathogenesis is still largely unknown; however, molecular pathways have been identified. Key to these pathways are proinflammatory cytokines involved in hepatic inflammation and bile acids synthesis such as Toll-like receptor 4 and farnesoid X receptor, respectively. Research for prevention and treatment is aimed at alleviating risk factors associated with IFALD, principally those associated with parental nutrition. Multiple nutrients and amino acids are relevant to the development of IFALD, but lipid composition has been the primary focus. Lipid emulsions with a lower ratio of omega-6-to-omega-3 polyunsaturated fatty acids (FAs) appear to improve bile flow and decrease intrahepatic inflammation. Long-term consequences of these alternative lipid emulsions are yet to be determined.
SUMMARY
IFALD remains the greatest contributor of mortality in patients with intestinal failure. Many factors contribute to its development, namely, alterations in the gut microbiome, sepsis, and lack of enteral intake. Novel combinations of lipid formulations are promising alternatives to purely soy-based formulas to reduce cholestasis.
Topics: Child; Gastrointestinal Microbiome; Humans; Intestinal Diseases; Liver Diseases; Parenteral Nutrition; Pediatrics; Risk Factors
PubMed: 28333693
DOI: 10.1097/MOP.0000000000000484