Appropriate Use of Parenteral Nutrition Through the Perioperative Period

McClave, Stephen A.; Martindale, Robert G.; Taylor, Beth; Gramlich, Leah

doi:10.1177/0148607113495570

Cited by 15 publications

(6 citation statements)

References 40 publications

(130 reference statements)

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“…In many elective operations, especially gastrointestinal surgery, PN seems to inappropriately be the most common method of preoperative artificial nutrition. 32,33 As a quality-improvement method, the nutrition support team, which has been adopted by many medical institutions today, has been proven to reduce the inappropriate use of PN support 33 and improve the safety of PN catheters. 34 We also report that the hospitalization costs of the PN support group were significantly higher than that of the control group (57,899 vs 42,761 ¥; P < .001).…”

Section: Discussionmentioning

confidence: 99%

“…However, because of the rapid development of feeding technology and parenteral preparations, nutrition support can be used for most patients. In many elective operations, especially gastrointestinal surgery, PN seems to inappropriately be the most common method of preoperative artificial nutrition 32,33 . As a quality‐improvement method, the nutrition support team, which has been adopted by many medical institutions today, has been proven to reduce the inappropriate use of PN support 33 and improve the safety of PN catheters 34 …”

Section: Discussionmentioning

confidence: 99%

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Impact of Preoperative Short‐Term Parenteral Nutrition Support on the Clinical Outcome of Gastric Cancer Patients: A Propensity Score Matching Analysis

Huang

Zhang

et al. 2020

J Parenter Enteral Nutr

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Objectives: Nutrition status is of great significance to the clinical outcome after major abdominal surgery. However, the effect of preoperative short-term parenteral nutrition (PN) support among gastric cancer (GC) patients remains unknown and was evaluated in the current study. Methods: We retrospectively analyzed 455 nutritionally at-risk GC patients after radical resection from 2010 to 2016. We matched patients with 3-7 days of PN support to those without PN support. χ 2 And Mann-Whitney U tests were used to compare differences between the PN and control groups. Results: The propensity-matched sample included 368 GC patients (PN group, n = 184; control group, n = 184). The PN and control groups did not differ regarding postoperative complications (P = .528). The incidence of anastomotic leakage in the PN group was lower than in the control group (P = .011), whereas other complications were not found to differ between the groups. The hospitalization cost of the PN group was significantly higher than that of the control group (P < .001), whereas other outcome indicators were similar. Subgroup analysis showed that short-term PN support may have an improved benefit for patients with serum albumin level <35 g/L, but not at the level of statistical significance (P = .17). Conclusion: Short-term PN support did not significantly improve the short-term clinical outcomes of nutritionally at-risk GC patients, with the exception of a lower incidence of anastomotic leakage. Considering that short-term PN support increases economic burden, PN should not be the preferred method among these patients.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Impact of Preoperative Short‐Term Parenteral Nutrition Support on the Clinical Outcome of Gastric Cancer Patients: A Propensity Score Matching Analysis

Huang

Zhang

et al. 2020

J Parenter Enteral Nutr

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“…Furthermore, in patients undergoing gastrointestinal surgery who are malnourished and unable to tolerate EN, studies suggest that preoperative PN may decrease overall major complications 18 , 19 . Studies show that PN must be provided for 7–10 days to improve outcomes 20 . In the postoperative period, adequate nutrition is an important aspect of recovery.…”

Section: Question 8: What Is the Role Of Perioperative Pn In Patientsmentioning

confidence: 99%

When Is Parenteral Nutrition Appropriate?

Worthington

Balint

Bechtold

et al. 2017

J Parenter Enteral Nutr

180

202

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Parenteral nutrition (PN) represents one of the most notable achievements of modern medicine, serving as a therapeutic modality for all age groups across the healthcare continuum. PN offers a life-sustaining option when intestinal failure prevents adequate oral or enteral nutrition. However, providing nutrients by vein is an expensive form of nutrition support, and serious adverse events can occur. In an effort to provide clinical guidance regarding PN therapy, the Board of Directors of the American Society for Parenteral and Enteral Nutrition (ASPEN) convened a task force to develop consensus recommendations regarding appropriate PN use. The recommendations contained in this document aim to delineate appropriate PN use and promote clinical benefits while minimizing the risks associated with the therapy. These consensus recommendations build on previous ASPEN clinical guidelines and consensus recommendations for PN safety. They are intended to guide evidence-based decisions regarding appropriate PN use for organizations and individual professionals, including physicians, nurses, dietitians, pharmacists, and other clinicians involved in providing PN. They not only support decisions related to initiating and managing PN but also serve as a guide for developing quality monitoring tools for PN and for identifying areas for further research. Finally, the recommendations contained within the document are also designed to inform decisions made by additional stakeholders, such as policy makers and third-party payers, by providing current perspectives regarding the use of PN in a variety of healthcare settings. (JPEN J Parenter Enteral Nutr. 2017;41:324-377) The etiology-based nutrition diagnoses in adults in clinical practice settings are as follows: Starvation-related malnutrition: Chronic starvation without inflammation (eg, anorexia nervosa). Chronic disease-related malnutrition: Inflammation is chronicand of mild to moderate degree (eg, organ failure, pancreatic cancer, rheumatoid arthritis, sarcopenic obesity). Acute disease or injury-related malnutrition:Inflammation is acute and of severe degree (eg, major infection burns, trauma, closed head injury). 2,3Malnutrition, pediatric: An imbalance between nutrient requirement and intake, resulting in cumulative deficits of energy, protein, or micronutrients that may negatively affect growth, development, and other relevant outcomes. It is recommended that growth charts based on a standard deviation z score system be used to track and assess nutrition status in children. 4,5Nutritionally-at-risk: Consider the individual nutritionally-atrisk if any of the following is present. Nutritionally-At-Risk Adult Summary of RecommendationsThese consensus recommendations are designed to identify best practices, guide day-to-day clinical decisions, reduce variations in practice, and enhance patient safety. They are not intended to supersede the judgment of the healthcare professional based on the circumstances of the individual patient.

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“…En casos seleccionados de disfunción gastrointestinal severa, isquemia intestinal, hemorragia digestiva, intestino corto o fistulas enterocutáneas de alto débito, la nutrición parenteral puede iniciarse precozmente 19 . 84 .…”

Section: Soporte Nutricional Postoperatoriounclassified