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Nutrients Jan 2023Parenteral nutrition (PN) in children with short bowel syndrome is crucial and lifesaving. Taking care of such patients requires interprofessional practice and multiple...
Parenteral nutrition (PN) in children with short bowel syndrome is crucial and lifesaving. Taking care of such patients requires interprofessional practice and multiple team resource management. Home PN (HPN) usage allows patients and families to live regular lives outside hospitals. We share our experiences for the last two decades and identify the risk factors for complications and mortality. A retrospective study of HPN patients was conducted between January 2000 and February 2022. Medical records of age, body weight, diagnosis, length of residual intestines, HPN period, central line attempts, complications, weaning, and survival were collected and analyzed. The patients were classified as HPN free, HPN dependent, and mortality groups. A total of 25 patients received HPN at our outpatient clinic, and one was excluded for the adult age of disease onset. There were 13 patients (54.1%) who were successfully weaned from HPN until the record-enroled date. The overall mortality rate was 20.8% (five patients). All mortality cases had prolonged cholestasis, Child Class B or C, and a positive Pediatric End-Stage Liver Disease (PELD) score. For HPN dependence, extended resection and multiple central line placement were two significant independent factors. Cholestasis, Child Class B or C, and positive PELD score were the most important risk factors for mortality. The central line-related complication rate was not different in all patient groups. The overall central line infection rate was 1.58 per 1000 catheter days. Caution should be addressed to prevent cholestasis and intestinal failure-associated liver disease during the HPN period, to prevent mortality. By understanding the risks of HPN dependence and mortality, preventive procedures could be addressed earlier.
Topics: Adult; Humans; Child; Retrospective Studies; End Stage Liver Disease; Severity of Illness Index; Parenteral Nutrition, Home; Intestinal Diseases; Cholestasis
PubMed: 36771412
DOI: 10.3390/nu15030706 -
Journal of Visceral Surgery Aug 2015The surgeon plays a key role in the perioperative nutritional care in patients undergoing elective major digestive surgery; therefore, he has to be able to anticipate... (Review)
Review
The surgeon plays a key role in the perioperative nutritional care in patients undergoing elective major digestive surgery; therefore, he has to be able to anticipate needs and to implement corrective measures according to recommendations. Pre- and postoperative enteral feeding is preferred. In patients without obvious undernutrition, postoperative nutritional support has to be initiated if patients cannot maintain oral intake above 60% of recommended intake for more than 7 days, and it has to be programmed if it is anticipated that the patient will be unable to eat for more than 7 days. Preoperative and postoperative nutritional support has to be offer in malnourished patients (grades 3 and 4).
Topics: Digestive System Surgical Procedures; Enteral Nutrition; Humans; Nutritional Support; Parenteral Nutrition; Perioperative Care; Postoperative Complications
PubMed: 26315578
DOI: 10.1016/S1878-7886(15)30004-7 -
Nutrients Jan 2020Parenteral nutrition (PN) is a complex and specialized form of nutrition support that has revolutionized the care for both pediatric and adult patients with acute and... (Review)
Review
Parenteral nutrition (PN) is a complex and specialized form of nutrition support that has revolutionized the care for both pediatric and adult patients with acute and chronic intestinal failure (IF). This has led to the development of multidisciplinary teams focused on the management of patients receiving PN: nutrition support teams (NSTs). In this review we aim to discuss the historical aspects of IF management and NST development, and the practice, composition, and effectiveness of multidisciplinary care by NSTs in patients with IF. We also discuss the experience of two IF centers as an example of contemporary NSTs at work. An NST usually consists of at least a physician, nurse, dietitian, and pharmacist. Multidisciplinary care by an NST leads to fewer complications including infection and electrolyte disturbances, and better survival for patients receiving short- and long-term PN. Furthermore, it leads to a decrease in inappropriate prescriptions of short-term PN leading to significant cost reduction. Complex care for patients receiving PN necessitates close collaboration between team members and NSTs from other centers to optimize safety and effectiveness of PN use.
Topics: Humans; Intestinal Diseases; Netherlands; Parenteral Nutrition; Patient Care Team
PubMed: 31936271
DOI: 10.3390/nu12010172 -
Asia Pacific Journal of Clinical... 2019Parenteral nutrition (PN) is one of the main nutritional methods used in newborns; however, long-term PN may induce PN-associated cholestasis (PNAC). This study aims to...
BACKGROUND AND OBJECTIVES
Parenteral nutrition (PN) is one of the main nutritional methods used in newborns; however, long-term PN may induce PN-associated cholestasis (PNAC). This study aims to evaluate the effect of cyclic PN in the prevention and improvement of PNAC in newborns requiring long-term PN.
METHODS AND STUDY DESIGN
A retrospective cohort study was conducted on patients admitted at the Seoul National University Children's Hospital neonatal intensive care unit between October 2010 and September 2015 and referred to the nutrition support team with total parenteral nutrition for more than 14 days. The primary outcome was the incidence of PNAC. The incidence of hypoglycemia, changes in direct bilirubin (DB) concentrations, and length of hospital stay were investigated.
RESULTS
A total of 124 patients were observed in this study. Among these, 100 patients received continuous PN, whereas 24 patients received both continuous and cyclic PN. PNAC occurred in 31.5% (39/124) of study population. The incidence rates of PNAC were 27.4% during continuous PN period and 20.8% during cyclic PN period. Cyclic PN was an independent factor that significantly decreased PNAC incidence (OR=0.154; 95% CI, 0.045-0.529, p=0.003). DB concentrations significantly decreased (p=0.049) with therapeutic cyclic PN, but remained normal with prophylactic cyclic PN. No significant difference in hypoglycemia incidence and length of hospital stay was observed in both continuous PN and continuous to cyclic PN groups.
CONCLUSIONS
Cyclic PN could be effective in the prevention and improvement of PNAC and also safe in terms of hypoglycemia in newborns.
Topics: Cholestasis; Drug Administration Schedule; Energy Intake; Female; Humans; Infant, Newborn; Intensive Care Units, Neonatal; Logistic Models; Male; Parenteral Nutrition; Retrospective Studies; Risk Factors
PubMed: 30896413
DOI: 10.6133/apjcn.201903_28(1).0007 -
Nutrition in Clinical Practice :... Apr 2021Errors have been reported in the literature to occur at each step of the parenteral nutrition (PN) use process, necessitating standardized processes, clinician...
INTRODUCTION
Errors have been reported in the literature to occur at each step of the parenteral nutrition (PN) use process, necessitating standardized processes, clinician competence, and open communication for those involved. This study was performed at Central Admixture Pharmacy Services (CAPS®) in collaboration with the American Society for Parenteral and Enteral Nutrition (ASPEN) with the purpose to study the need for and success of PN pharmacist interventions.
METHODS
A survey was developed and sent to all CAPS customers for study enrollment and to identify their demographic and practice characteristics. For those enrolled, CAPS pharmacists reviewed every PN order in a 1-month period using an error/intervention tool to capture data on prescription elements requiring intervention, along with acceptance of that intervention.
RESULTS
Two hundred thirty-two unique CAPS customers (23% response rate) participated in the study, representing 37,634 unique PN prescriptions. Two hundred forty-eight PN prescriptions (0.66%) from 59 customers required ≥1 intervention. The top 3 intervention types were electrolyte dose clarification, calcium/phosphorus incompatibility, and amino acid dose clarification. A greater number and percentage of interventions were required for neonatal prescriptions, as compared with adult and pediatric prescriptions. No significant difference was found in many of the other customer characteristics.
CONCLUSION
This study supports the need for institutions to develop systems to comply with published PN safety recommendations, including knowledgeable and skilled pharmacists to complete the order review and verification steps for this high-alert medication.
Topics: Adult; Child; Enteral Nutrition; Humans; Infant, Newborn; Parenteral Nutrition; Parenteral Nutrition, Total; Pharmacists; Prescriptions
PubMed: 33275303
DOI: 10.1002/ncp.10600 -
Nutrients Sep 2022Retrospective studies indicate that the parenteral provision of calories, proteins, and lipids in the first week of life is associated with improved later... (Randomized Controlled Trial)
Randomized Controlled Trial
Retrospective studies indicate that the parenteral provision of calories, proteins, and lipids in the first week of life is associated with improved later neurodevelopment. We aimed to determine whether infants randomized to an enhanced parenteral nutrition protocol had improved developmental outcomes at 4, 12, or 24 months corrected age (CA). In total, 90 preterm infants (<32 weeks gestational age and <1500 g) were randomized to receive enhanced parenteral nutrition (PN) or standard PN during the first week of life. The enhanced group received a higher glucose infusion rate and intralipids. Neurodevelopmental outcomes included pattern-reversal visually evoked potentials (VEP) at 4 months CA (n = 33) and the Bayley Scales of Infant Development (BSID) at 12 (n = 46) and 24 (n = 29) months CA. P100 latency was longer in the intervention group, indicating slower processing speed (145 vs. 178 ms, p = 0.01). This association did not hold in multivariable analysis adjusting for potentially confounding variables. BSID scores were not associated with enhanced PN. Higher enteral energy and protein intake regardless of randomization group were associated with faster processing speed at 4 months CA (p ≤ 0.02 for both). Enhanced early PN was not associated with improved neurodevelopment; however, first-week enteral caloric and protein intake were associated with improved speed of processing.
Topics: Child; Glucose; Humans; Infant; Infant, Newborn; Infant, Premature; Lipids; Parenteral Nutrition; Retrospective Studies
PubMed: 36235546
DOI: 10.3390/nu14193890 -
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 -
Critical Care (London, England) Aug 2014Critically ill patients depend on artificial nutrition for the maintenance of their metabolic functions and lean body mass, as well as for limiting underfeeding-related... (Review)
Review
Critically ill patients depend on artificial nutrition for the maintenance of their metabolic functions and lean body mass, as well as for limiting underfeeding-related complications. Current guidelines recommend enteral nutrition (EN), possibly within the first 48 hours, as the best way to provide the nutrients and prevent infections. EN may be difficult to realize or may be contraindicated in some patients, such as those presenting anatomic intestinal continuity problems or splanchnic ischemia. A series of contradictory trials regarding the best route and timing for feeding have left the medical community with great uncertainty regarding the place of parenteral nutrition (PN) in critically ill patients. Many of the deleterious effects attributed to PN result from inadequate indications, or from overfeeding. The latter is due firstly to the easier delivery of nutrients by PN compared with EN increasing the risk of overfeeding, and secondly to the use of approximate energy targets, generally based on predictive equations: these equations are static and inaccurate in about 70% of patients. Such high uncertainty about requirements compromises attempts at conducting nutrition trials without indirect calorimetry support because the results cannot be trusted; indeed, both underfeeding and overfeeding are equally deleterious. An individualized therapy is required. A pragmatic approach to feeding is proposed: at first to attempt EN whenever and as early as possible, then to use indirect calorimetry if available, and to monitor delivery and response to feeding, and finally to consider the option of combining EN with PN in case of insufficient EN from day 4 onwards.
Topics: Critical Care; Critical Illness; Humans; Intensive Care Units; Nutritional Status; Parenteral Nutrition
PubMed: 25184816
DOI: 10.1186/s13054-014-0478-0 -
Clinical Nutrition ESPEN Dec 2022Advances in technology enable patients on home parenteral nutrition (HPN) to manage their treatment more independently and safely. eHealth is a promising application of...
BACKGROUND & AIMS
Advances in technology enable patients on home parenteral nutrition (HPN) to manage their treatment more independently and safely. eHealth is a promising application of electronic means in healthcare, aimed at improving and simplifying processes and connecting the different parties involved. A thorough understanding of the attitudes and expectations of patients on HPN towards eHealth is a prerequisite for a successful implementation. However, to the best of our knowledge, such a survey preceding the implementation of HPN specific eHealth care has never been conducted. The objective of this preliminary survey is the acquisition of insights on the attitudes and expectations of patients on HPN towards eHealth. Resulting findings then serve as the basis for the design of an eHealth platform to facilitate communication among those involved in HPN care, improve the HPN management, and safeguard and monitor the treatment.
METHODS
We conducted a survey on the attitudes and expectations of patients towards an envisioned eHealth platform for HPN. Patients were recruited from large Swiss hospitals by their treating physician or directly by the research team. The surveys were conducted between September 2020 and October 2021 by structured personal interviews based on a questionnaire.
RESULTS
We included 35 patients on HPN (21 [60%] females) treated in ambulant care of 4 hospitals. They had a median (interquartile range) age of 55 (18) years and a median (interquartile range) duration of parenteral nutrition of 1.3 (3.1) years. Most patients (n = 30, 86%) were equipped with a smartphone, tablet, or computer and 22 (63%) used apps and rated themselves as proficient with the corresponding digital device. A majority of patients rated the following aspects and features of the platform as important: Data collection and storage (n = 29, 83%), checklists for PN, catheter, and infusion pump handling (n = 28, 80%), video instructions (n = 27, 77%), and videoconferencing with physicians (n = 25, 71%). Most patients (n = 26, 74%) were willing to enter data into the platform themselves. The type of data to be entered should be defined on an individual basis.
CONCLUSIONS
Patients on HPN are open to videoconference consultations and using an eHealth platform. Two-thirds have the necessary technical skills including suitable digital devices for an eHealth care. We identified key features of an eHealth platform to improve HPN management.
Topics: Female; Humans; Infant; Male; Attitude; Motivation; Parenteral Nutrition, Home; Surveys and Questionnaires; Telemedicine
PubMed: 36513485
DOI: 10.1016/j.clnesp.2022.09.026