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JAMA Jun 2019
Topics: Catheterization, Central Venous; Humans; Parenteral Nutrition; Parenteral Nutrition, Total
PubMed: 31162570
DOI: 10.1001/jama.2019.4410 -
The Journal of the Royal College of... Mar 2015Over the last 50 years, parenteral nutrition has been recognised as an invaluable and potentially lifesaving tool in the physician's arsenal in the management of... (Review)
Review
Over the last 50 years, parenteral nutrition has been recognised as an invaluable and potentially lifesaving tool in the physician's arsenal in the management of patients with intestinal failure or inaccessibility; however, it may also be associated with a number of potentially life-threatening complications. A recent NCEPOD report (2010) identified a number of inadequacies in the overall provision and management of parenteral nutrition and recommendations were made with the aim of improving clinical practice in the future. This paper focuses on the practical aspects relating to parenteral nutrition for adults, including important concepts, such as patient selection, as well as general management. We also explore the various pitfalls and potential complications and how these may be minimised.
Topics: Adult; Bacteremia; Catheter-Related Infections; Humans; Parenteral Nutrition; Parenteral Nutrition, Home; Patient Selection; Refeeding Syndrome
PubMed: 25874831
DOI: 10.4997/JRCPE.2015.111 -
Nutrients Feb 2013Nutritional support of surgical and critically ill patients has undergone significant advances since 1936 when Studley demonstrated a direct relationship between... (Comparative Study)
Comparative Study Review
Nutritional support of surgical and critically ill patients has undergone significant advances since 1936 when Studley demonstrated a direct relationship between pre-operative weight loss and operative mortality. The advent of total parenteral nutrition followed by the extraordinary progress in parenteral and enteral feedings, in addition to the increased knowledge of cellular biology and biochemistry, have allowed clinicians to treat malnutrition and improve surgical patient's outcomes. We reviewed the literature for the current status of perioperative nutrition comparing parenteral nutrition with enteral nutrition. In a surgical patient with established malnutrition, nutritional support should begin at least 7-10 days prior to surgery. Those patients in whom eating is not anticipated beyond the first five days following surgery should receive the benefits of early enteral or parenteral feeding depending on whether the gut can be used. Compared to parenteral nutrition, enteral nutrition is associated with fewer complications, a decrease in the length of hospital stay, and a favorable cost-benefit analysis. In addition, many patients may benefit from newer enteral formulations such as Immunonutrition as well as disease-specific formulations.
Topics: Cost-Benefit Analysis; Enteral Nutrition; Humans; Immunity; Length of Stay; Malnutrition; Nutrition Assessment; Nutritional Requirements; Parenteral Nutrition; Parenteral Nutrition, Total; Perioperative Care; Perioperative Period; Postoperative Complications
PubMed: 23429491
DOI: 10.3390/nu5020608 -
JPEN. Journal of Parenteral and Enteral... 2004
Topics: Drug Labeling; Drug Stability; Food, Formulated; Humans; Parenteral Nutrition; Quality Control; Safety; United States
PubMed: 15568296
DOI: 10.1177/0148607104028006s39 -
Current Opinion in Gastroenterology Mar 2006During the past 12 months there have been clinically important advances in intravenous nutrition and adjunctive therapies. (Review)
Review
PURPOSE OF REVIEW
During the past 12 months there have been clinically important advances in intravenous nutrition and adjunctive therapies.
RECENT FINDINGS
Useful steps have been taken in the understanding of the altered physiology of the intravenously fed patient, the potential for specific gains from manipulation with gut hormones, and avoidance of complications from amended lipid emulsions. The role of the nutrition team and the place of IVN in malignancy have also been addressed.
SUMMARY
Glucagon-like peptide-2, and lipid emulsions based less on soy-bean oil appear safe and effective. Euglycaemia is recommended at all times, but not too much vitamin C. Long-term intravenous nutrition in cancer patients can be justified, and hospital nutrition teams are probably cost-effective.
Topics: Animals; Humans; Nutrition Disorders; Parenteral Nutrition; Treatment Outcome
PubMed: 16462173
DOI: 10.1097/01.mog.0000203869.22706.84 -
Nutrition Reviews Jul 1981
Review
Topics: Amino Acids; Dietary Carbohydrates; Fat Emulsions, Intravenous; Humans; Parenteral Nutrition; Parenteral Nutrition, Total
PubMed: 6791057
DOI: 10.1111/j.1753-4887.1981.tb06783.x -
Lancet (London, England) Sep 1992
Review
Topics: Animals; Circadian Rhythm; Energy Metabolism; Humans; Nitrogen; Parenteral Nutrition; Physical Exertion
PubMed: 1355164
DOI: 10.1016/0140-6736(92)92116-w -
Nutrition in Clinical Practice :... Apr 2022Parenteral nutrition (PN) is a therapy that delivers essential nutrients intravenously to patients who are unable to meet their nutrition requirements via standard... (Review)
Review
Parenteral nutrition (PN) is a therapy that delivers essential nutrients intravenously to patients who are unable to meet their nutrition requirements via standard enteral feeding. This methodology is often referred to as PN when accompanied by minimal or no enteral nutrition (EN). Although PN is lifesaving, significant complications can arise, such as intestinal failure-associated liver disease and gut-mucosal atrophy. The exact mechanism of injury remains ill defined. This review was designed to explore the available literature related to the drivers of injury mechanisms. The Farnesoid X receptor and fibroblast growth factor 19 signaling pathway seems to play an important role in gut-systemic signaling, and its alteration during PN provides insights into mechanistic links. Central line infections also play a key role in mediating PN-associated injury. Although lipid reduction strategies, as well as the use of multicomponent lipid emulsions and vitamin E, have shown promise, the cornerstone of preventing injury is the early establishment of EN.
Topics: Humans; Lipids; Liver Diseases; Parenteral Nutrition; Parenteral Nutrition, Total
PubMed: 35124837
DOI: 10.1002/ncp.10830 -
ESMO Open Jul 2020
Topics: Cost-Benefit Analysis; Parenteral Nutrition; Parenteral Nutrition, Total
PubMed: 32661187
DOI: 10.1136/esmoopen-2020-000831 -
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