Clinical Guidelines for the Use of Parenteral and Enteral Nutrition in Adult and Pediatric Patients

Druyan, Mary Ellen; Compher, Charlene; Boullata, Joseph I.; Braunschweig, Carol L.; George, Donald E.; Simpser, Edwin; Worthington, Patricia A.

doi:10.1177/0148607111420157

Cited by 80 publications

(52 citation statements)

References 6 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…[16][17][18][19] A full description of the methodology has been published. 20 Briefly, specific clinical questions where nutrition support is a relevant mode of therapy are developed and key clinical outcomes are identified. A rigorous search of the published literature is conducted, each included study assessed for research quality, tables of findings developed, the body of evidence for the question evaluated and graded.…”

Section: Methodsmentioning

confidence: 99%

A.S.P.E.N. Clinical Guidelines

Choban

Dickerson

Malone

et al. 2013

J Parenter Enteral Nutr

Self Cite

136

View full text Add to dashboard Cite

Background: Due to the high prevalence of obesity in adults, nutrition support clinicians are encountering greater numbers of obese patients who require nutrition support during hospitalization. The purpose of this clinical guideline is to serve as a framework for the nutrition support care of adult patients with obesity. Method: A systematic review of the best available evidence to answer a series of questions regarding management of nutrition support in patients with obesity was undertaken and evaluated using concepts adopted from the Grading of Recommendations, Assessment, Development and Evaluation working group. A consensus process, that includes consideration of the strength of the evidence together with the risks and benefits to the patient, was used to develop the clinical guideline recommendations prior to multiple levels of external and internal review and approval by the A.S.P.E.N. Board of Directors. Questions: (1) Do clinical outcomes vary across levels of obesity in critically ill or hospitalized non−intensive care unit (ICU) patients? (2) How should energy requirements be determined in obese critically ill or hospitalized non‐ICU patients? (3) Are clinical outcomes improved with hypocaloric, high protein diets in hospitalized patients? (4) In obese patients who have had a malabsorptive or restrictive surgical procedure, what micronutrients should be evaluated?

show abstract

Section: Methodsmentioning

confidence: 99%

A.S.P.E.N. Clinical Guidelines

Choban

Dickerson

Malone

et al. 2013

J Parenter Enteral Nutr

Self Cite

136

View full text Add to dashboard Cite

show abstract

“…91 Thus, monitoring a patient’s physiologic and metabolic responses during illness is essential for optimal clinical care, and in particular nutrition support. Furthermore, under- and overfeeding can have deleterious effects on medical outcomes in the critically ill patient, so it is important to obtain a baseline assessment of the degree of metabolic response to injury followed by intermittent or continuously measures until a steady state is achieved.…”

Section: Discussionmentioning

confidence: 99%

Measuring energy expenditure in clinical populations: rewards and challenges

Psota

Chen

2013

Eur J Clin Nutr

View full text Add to dashboard Cite

The measurement of energy expenditure (EE) is recommended as an important component of comprehensive clinical nutrition assessments in patients with altered metabolic states, who failed to respond to nutrition support and with critical illness that require individualized nutrition support. There is evidence that EE is variable in patients with metabolic diseases, such as chronic renal disease, cirrhosis, HIV, cancer cachexia, cystic fibrosis and patients under intensive care. By using appropriate techniques and interpretations of basal or resting EE, clinicians can facilitate the adequate nutrition support with minimum negative impacts from under- or overfeeding in these patients. This review is based on our current understanding of the different components of EE and the techniques to measure them, and to re-examine advances and challenges to determine energy needs in clinical populations with more focuses on the obese, pediatric and elderly patients. In addition, technological advances have expanded the choices of market-available equipments for assessing EE, which also bring specific challenges and rewards in selecting the right equipment with specific performance criteria. Lastly, analytical considerations of interpreting the results of EE in the context of changing body composition are presented and discussed.

show abstract

“…[18][19][20][21] A full description of the methodology has been published. 22 Briefly, specific clinical questions where nutrition support is a relevant mode of therapy are developed and key clinical outcomes are identified. A rigorous search of the published literature is conducted, each included study is assessed for research quality, tables of findings are developed, and the body of evidence for the question is evaluated and graded.…”

Section: Methodsmentioning

confidence: 99%

“…With respect to IVFE infusion times, the American Academy of Pediatrics recommends continuous infusion of IVFE of up to 3 g/kg per day to promote optimal IVFE clearance in neonates and infants. 187 Providing IVFE as part of a TNA offers protection from microbial contamination [20][21][22][23] and allows for a 24-hour infusion time; however, TNAs are not recommended for use in neonates and infants due to concerns about stability and calcium and phosphate solubility.…”

Section: Question 11 What Methods Of Repackaging Ivfe Intomentioning

confidence: 99%

A.S.P.E.N. Clinical Guidelines

Boullata

Gilbert

Sacks

et al. 2014

J Parenter Enteral Nutr

Self Cite

265

View full text Add to dashboard Cite

Background: Parenteral nutrition (PN) is a high-alert medication available for patient care within a complex clinical process. Beyond application of best practice recommendations to guide safe use and optimize clinical outcome, several issues are better addressed through evidence-based policies, procedures, and practices. This document provides evidence-based guidance for clinical practices involving PN prescribing, order review, and preparation. Method: A systematic review of the best available evidence was used by an expert work group to answer a series of questions about PN prescribing, order review, compounding, labeling, and dispensing. Concepts from the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) format were applied as appropriate. The specific clinical guideline recommendations were developed using consensus prior to review and approval by the American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.) Board of Directors. The following questions were addressed: (1) Does education of prescribers improve PN ordering? (2) What is the maximum safe osmolarity of PN admixtures intended for peripheral vein administration? (3) What are the appropriate calcium intake and calciumphosphate ratios in PN for optimal neonatal bone mineralization? (4) What are the clinical advantages or disadvantages of commercially available premade ("premixed") multichambered PN formulations compared with traditional/customized PN formulations? (5) What are the clinical (infection, catheter occlusion) advantages or disadvantages of 2-in-1 compared with 3-in-1 PN admixtures? (6) What macronutrient dosing limits are expected to provide for the most stable 3-in-1 admixtures? (7) What are the most appropriate recommendations for optimizing calcium (gluconate) and (Na-or K-) phosphate compatibility in PN admixtures? (8) What micronutrient contamination is present in parenteral stock solutions currently used to compound PN admixtures? (9) Is it safe to use the PN admixture as a vehicle for non-nutrient medication delivery? (10) Should heparin be included in the PN admixture to reduce the risk of central vein thrombosis? (11) What methods of repackaging intravenous fat emulsion (IVFE) into smaller patient-specific volumes are safe? (12) What beyond-use date should be used for (a) IVFE dispensed for separate infusion in the original container and (b) repackaged IVFE? (JPEN J Parenter Enteral Nutr. 2014;38:334-377)

show abstract

Clinical Guidelines for the Use of Parenteral and Enteral Nutrition in Adult and Pediatric Patients

Cited by 80 publications

References 6 publications

A.S.P.E.N. Clinical Guidelines

A.S.P.E.N. Clinical Guidelines

Measuring energy expenditure in clinical populations: rewards and challenges

A.S.P.E.N. Clinical Guidelines

Contact Info

Product

Resources

About