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Clinical Nutrition (Edinburgh, Scotland) Jul 2024Parenteral nutrition (PN) is recognized as a complex high-risk therapy. Its practice is highly variable and frequently suboptimal in pediatric patients. Optimizing care... (Review)
Review
Parenteral nutrition (PN) is recognized as a complex high-risk therapy. Its practice is highly variable and frequently suboptimal in pediatric patients. Optimizing care requires evidence, consensus-based guidelines, audits of practice, and standardized strategies. Several pediatric scientific organizations, expert panels, and authorities have recently recommended that standardized PN should generally be used over individualized PN in the majority of pediatric patients including very low birth weight premature infants. In addition, PN admixtures produced and validated by a suitably qualified institution are recommended over locally produced PN. Licensed multi chamber bags are standardized PN bags that comply with Good Manufacturing Practice and high-quality standards for the finished product in the frame of their full manufacturing license. The purpose of this article is to review the practical aspects of PN and the evidence for using such multi-chamber bags in pediatric patients. It highlights the safety characteristics and the limitations of the different PN practices and provides some guidance for ensuring safe and efficient therapy in pediatric patients.
Topics: Humans; Infant, Newborn; Parenteral Nutrition; Infant; Child; Child, Preschool; Adolescent; Parenteral Nutrition Solutions; Infant, Premature; Practice Guidelines as Topic; Infant, Very Low Birth Weight
PubMed: 38823267
DOI: 10.1016/j.clnu.2024.05.023 -
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 -
Clinical Nutrition (Edinburgh, Scotland) Mar 2021To investigate the acute effects of intravenous vs enteral meal administration on circulating bile acid and gut hormone responses. (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND & AIMS
To investigate the acute effects of intravenous vs enteral meal administration on circulating bile acid and gut hormone responses.
METHODS
In a randomized crossover design, we compared the effects of duodenal (via a nasoduodenal tube) vs parenteral (intravenous) administration over 180 min of identical mixed meals on circulating bile acid and gut hormone concentrations in eight healthy lean men. We analysed the bile acid and gut hormone responses in two periods: the intraprandial period from time point (T) 0 until T180 during meal administration and the postprandial period from T180 until T360, after discontinuation of meal administration.
RESULTS
Intravenous meal administration decreased the intraprandial (AUC (μmol/L∗min) duodenal 1469 ± 284 vs intravenous 240 ± 39, p < 0.01) and postprandial bile acid response (985 ± 240 vs 223 ± 5, p < 0.05) and was accompanied by decreased gut hormone responses including glucose-dependent insulinotropic polypeptide, glucagon-like peptide 1, glucagon-like peptide 2 and fibroblast growth factor 19. Furthermore, intravenous meal administration elicited greater glucose concentrations, but similar insulin concentrations compared to enteral administration.
CONCLUSIONS
Compared to enteral administration, parenteral nutrition results in lower postprandial bile acid and gut hormone responses in healthy lean men. This was accompanied by higher glucose concentrations in the face of similar insulin concentrations exposing a clear incretin effect of enteral mixed meal administration. The alterations in bile acid homeostasis were apparent after only one intravenous meal.
Topics: Adult; Bile Acids and Salts; Blood Glucose; Cross-Over Studies; Duodenum; Enteral Nutrition; Gastrointestinal Hormones; Healthy Volunteers; Humans; Insulin; Male; Meals; Parenteral Nutrition; Postprandial Period
PubMed: 32747206
DOI: 10.1016/j.clnu.2020.06.032 -
Nutricion Hospitalaria Sep 2015the precise role of parenteral nutrition in the management of oncologic patients with intestinal occlusion is not well defined yet. We aimed to identify the effects of...
INTRODUCTION AND AIMS
the precise role of parenteral nutrition in the management of oncologic patients with intestinal occlusion is not well defined yet. We aimed to identify the effects of parenteral nutrition in these patients regarding prognosis.
MATERIAL AND METHODS
55 patients with intestinal occlusion and peritoneal carcinomatosis were included. Parenteral nutrition aimed at 20-35 kcal/Kg/day, and 1.0 g/kg/day of amino-acids. Weight, body mass index, type of tumor, type of chemotherapy, and ECOG among others were recorded and analyzed.
RESULTS
69.1% of the patients had gastrointestinal tumors, 18.2% gynecologic and 12.7% others. Age was 60 ± 13y, baseline ECOG 1.5 ± 0.5 and body mass index 21.6 ± 4.3. Malnutrition was present in 85%. Survival from the start of parenteral nutrition was not significant when considering baseline ECOG (log rank = 0.593, p = 0.743), previous lines of chemotherapy (log rank = 2.117, p = 0.548), baseline BMI (log rank = 2.686, p = 0.261), or type of tumor (log rank = 2.066, p = 0.356). Survival in patients who received home parenteral nutrition after hospital discharge was higher than those who stayed in-hospital (log rank = 7.090, p = 0.008). Survival in patients who started chemotherapy during or after parenteral nutrition was higher than those who did not so (log rank = 17.316, p < 0.001). A total of 3.6% of patients presented catheter related infection without affecting survival (log rank = 0.061, p = 0.804).
CONCLUSIONS
Parenteral nutrition in patients with advanced cancer and intestinal occlusion is safe, and in tho se who respond to chemotherapy, further administration of home parenteral nutrition together with chemotherapy may enhance prolonged survival.
Topics: Aged; Carcinoma; Combined Modality Therapy; Female; Humans; Intestinal Obstruction; Male; Neoplasms; Parenteral Nutrition; Peritoneal Neoplasms; Treatment Outcome
PubMed: 26319842
DOI: 10.3305/nh.2015.32.3.9184 -
Seminars in Oncology Jun 2011The decision to utilize parenteral nutrition in patients with advanced cancer is difficult. There are variable opinions in the literature. Those who routinely care for... (Review)
Review
The decision to utilize parenteral nutrition in patients with advanced cancer is difficult. There are variable opinions in the literature. Those who routinely care for cancer patients often confront the challenges of discussing these interventions with patients and their families. We review results from previous randomized controlled trials, published guidelines, and recent work that describes the emotional challenges patients and families face as they make such decisions with their healthcare providers.
Topics: Decision Making; Humans; Neoplasms; Parenteral Nutrition; Practice Guidelines as Topic; Terminal Care
PubMed: 21600375
DOI: 10.1053/j.seminoncol.2011.03.020 -
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 -
California Medicine Aug 1953Parenteral feeding is not an adequate substitute for oral feeding. Water and electrolytes can readily be supplied parenterally, but not all necessary nutrients. To...
Parenteral feeding is not an adequate substitute for oral feeding. Water and electrolytes can readily be supplied parenterally, but not all necessary nutrients. To provide the 2,000 to 2,500 calories per day needed for adequate energy and to avoid oxidation of protein, concentrations of dextrose as great as 25 per cent with an additional 5 per cent of ethyl alcohol have been used parenterally with success. Fat emulsions have been given intravenously with some success, but undesirable reactions in as many as 16 per cent of patients have been reported. Protein may be given as amino acids in solution with 10 to 15 per cent dextrose. Water-soluble vitamins may be lost through diuresis if administered intravenously; of these vitamin C is necessary to healing of wounds and appears to have special value in reactions to stress. If fat nutrition is impaired, deficiency in fat-soluble vitamins is to be expected; of these, vitamin K is important to production of prothrombin and therefore especially necessary to recovery from operation or injury.
Topics: Amino Acids; Ascorbic Acid; Electrolytes; Glucose; Humans; Infusions, Parenteral; Oxidation-Reduction; Parenteral Nutrition; Parenteral Nutrition, Total; Postoperative Period; Proteins; Solutions; Vitamins
PubMed: 13067024
DOI: No ID Found -
Nutrients May 2023This study aimed to investigate the activity of a nutrition support team (NST) and the trends of multi-chamber bag (MCB) and customized parenteral nutrition (PN) with...
This study aimed to investigate the activity of a nutrition support team (NST) and the trends of multi-chamber bag (MCB) and customized parenteral nutrition (PN) with NST consultations in South Korea. Data were obtained from the National Inpatient Sample Cohort between 2015 and 2020. Three datasets were constructed for NST consultation, MCB-PN product prescriptions, and aseptic preparation of total PN. The intersections of the NST consultation and each PN dataset were compiled into MCB-PN with NST or customized PN with a NST sub-dataset, respectively. Using personal identifiers, the patients' characteristics were evaluated in the NST cohort. A total of 91,384 reimbursements and 70,665 patients were included. The NST activity had increased by more than 50% over 6 years. Approximately 70% and 11%, respectively, of the NST cohort were classified into two subgroups: MCB-PN with NST (M-NST) and customized PN with NST (C-NST). M-NST had many elderly patients with cancer and showed a higher in-hospital mortality than C-NST (12.6% vs. 9.5%). C-NST included a larger number of patients under the age of 5 years, and the hospitalization period was more extended than M-NST (26.2 vs. 21.2 days). The present study showed that NST activities and the proportion of PN with NST consultation are gradually increasing in South Korea.
Topics: Humans; Aged; Child, Preschool; Parenteral Nutrition; Nutritional Support; Parenteral Nutrition, Total; Hospitalization; Inpatients
PubMed: 37299494
DOI: 10.3390/nu15112531 -
Medicine Jan 2020Whether combined parenteral nutrition (PN) and enteral nutrition (EN) is superior to EN alone remains controversial. (Meta-Analysis)
Meta-Analysis
BACKGROUND
Whether combined parenteral nutrition (PN) and enteral nutrition (EN) is superior to EN alone remains controversial.
OBJECTIVES
This study aimed to evaluate the efficacy and safety of combined PN and EN versus EN alone for critically ill patients based on published randomized controlled trials (RCTs).
DATA SOURCES
Studies designed as RCTs evaluating the treatment effectiveness of combined PN and EN versus EN alone for critically ill patients were identified from PubMed, Embase, and the Cochrane Library from inception to April 2019.
METHODS
The pooled relative risks and weighted mean differences with corresponding 95% confidence intervals were calculated using the random-effects model. Twelve RCTs recruiting a total of 5609 adults and 1440 children were selected for the final meta-analysis.
RESULTS
The summary relative risks indicated that combined PN and EN was not associated with the risk of all-cause mortality, respiratory infection, urinary tract infection, and nutrition-related complications. Moreover, combined PN and EN was associated with longer hospital stay and higher albumin and prealbumin levels compared with EN alone. No significant differences were, however, found between combined PN and EN and EN alone in terms of ventilatory support, intensive care unit stay, and transferrin and C-reactive protein levels.
CONCLUSIONS
This study showed that combined PN and EN significantly increased hospital stay duration and albumin and prealbumin levels compared with EN alone for critically ill patients. Large-scale RCTs should be conducted to compare the treatment effectiveness of combined PN and EN versus EN alone for critically ill patients due to a specific cause.
Topics: Critical Illness; Enteral Nutrition; Humans; Parenteral Nutrition; Randomized Controlled Trials as Topic
PubMed: 32011471
DOI: 10.1097/MD.0000000000018778 -
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