Enteral and Parenteral Nutrition in the Perioperative Period: State of the Art

Abunnaja, Salim; Cuviello, Andrea; Sánchez, Juan A.

doi:10.3390/nu5020608

Cited by 115 publications

(90 citation statements)

References 61 publications

(138 reference statements)

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…We did not use endoscopically placed gastrostomy or combined gastrostomy-jejunal tubes. Although we did not perform any cost estimate analysis of parenteral vs enteral feeding in this cohort, it is well established that enteral nutrition is less costly than TPN[24,25]. Data from Mack et al[22], as well as cost-analysis modeling[26], demonstrated that costs for patients treated with a gastrojejunostomy tube were less than those for patients treated without a gastrojejunostomy, even though 100% of patients in the gastrojejunostomy group received nutritional supplementation compared with only 20% to 40% of the patients in the group treated by more standard methods[22,26].…”

Section: Discussionmentioning

confidence: 99%

Delayed gastric emptying following pancreaticoduodenectomy: Incidence, risk factors, and healthcare utilization

Mohammed¹,

Buren²,

McElhany³

et al. 2017

WJGS

View full text Add to dashboard Cite

AIMTo characterize incidence and risk factors for delayed gastric emptying (DGE) following pancreaticoduodenectomy and examine its implications on healthcare utilization.METHODSA prospectively-maintained database was reviewed. DGE was classified using International Study Group of Pancreatic Surgery criteria. Patients who developed DGE and those who did not were compared.RESULTSTwo hundred and seventy-six patients underwent pancreaticoduodenectomy (PD) (> 80% pylorus-preserving, antecolic-reconstruction). DGE developed in 49 patients (17.8%): 5.1% grade B, 3.6% grade C. Demographic, clinical, and operative variables were similar between patients with DGE and those without. DGE patients were more likely to present multiple complications (32.6% vs 4.4%, ≥ 3 complications, P < 0.001), including postoperative pancreatic fistula (POPF) (42.9% vs 18.9%, P = 0.001) and intra-abdominal abscess (IAA) (16.3% vs 4.0%, P = 0.012). Patients with DGE had longer hospital stay (median, 12 d vs 7 d, P < 0.001) and were more likely to require transitional care upon discharge (24.5% vs 6.6%, P < 0.001). On multivariate analysis, predictors for DGE included POPF [OR = 3.39 (1.35-8.52), P = 0.009] and IAA [OR = 1.51 (1.03-2.22), P = 0.035].CONCLUSIONAlthough DGE occurred in < 20% of patients after PD, it was associated with increased healthcare utilization. Patients with POPF and IAA were at risk for DGE. Anticipating DGE can help individualize care and allocate resources to high-risk patients.

show abstract

Section: Discussionmentioning

confidence: 99%

Delayed gastric emptying following pancreaticoduodenectomy: Incidence, risk factors, and healthcare utilization

Mohammed¹,

Buren²,

McElhany³

et al. 2017

WJGS

View full text Add to dashboard Cite

show abstract

“…70 Previous economic analyses report cost savings with the use of the enteral route, rather than the parenteral route, in critically ill patients. 3,75,76 However, these results need to be interpreted with caution, as no incremental cost-effectiveness results were provided. A few economic analyses performed only cost-minimisation analysis because there were no differences in outcome between the parenteral and enteral routes.…”

Section: Results In Contextmentioning

confidence: 99%

A multicentre, randomised controlled trial comparing the clinical effectiveness and cost-effectiveness of early nutritional support via the parenteral versus the enteral route in critically ill patients (CALORIES)

Harvey

Parrott

Harrison

et al. 2016

Health Technol Assess

View full text Add to dashboard Cite

BackgroundMalnutrition is a common problem in critically ill patients in UK NHS critical care units. Early nutritional support is therefore recommended to address deficiencies in nutritional state and related disorders in metabolism. However, evidence is conflicting regarding the optimum route (parenteral or enteral) of delivery.ObjectivesTo estimate the effect of early nutritional support via the parenteral route compared with the enteral route on mortality at 30 days and on incremental cost-effectiveness at 1 year. Secondary objectives were to compare the route of early nutritional support on duration of organ support; infectious and non-infectious complications; critical care unit and acute hospital length of stay; all-cause mortality at critical care unit and acute hospital discharge, at 90 days and 1 year; survival to 90 days and 1 year; nutritional and health-related quality of life, resource use and costs at 90 days and 1 year; and estimated lifetime incremental cost-effectiveness.DesignA pragmatic, open, multicentre, parallel-group randomised controlled trial with an integrated economic evaluation.SettingAdult general critical care units in 33 NHS hospitals in England.Participants2400 eligible patients.InterventionsFive days of early nutritional support delivered via the parenteral (n = 1200) and enteral (n = 1200) route.Main outcome measuresAll-cause mortality at 30 days after randomisation and incremental net benefit (INB) (at £20,000 per quality-adjusted life-year) at 1 year.ResultsBy 30 days, 393 of 1188 (33.1%) patients assigned to receive early nutritional support via the parenteral route and 409 of 1195 (34.2%) assigned to the enteral route had died [p = 0.57; absolute risk reduction 1.15%, 95% confidence interval (CI) −2.65 to 4.94; relative risk 0.97 (0.86 to 1.08)]. At 1 year, INB for the parenteral route compared with the enteral route was negative at −£1320 (95% CI −£3709 to £1069). The probability that early nutritional support via the parenteral route is more cost-effective – given the data – is < 20%. The proportion of patients in the parenteral group who experienced episodes of hypoglycaemia (p = 0.006) and of vomiting (p < 0.001) was significantly lower than in the enteral group. There were no significant differences in the 15 other secondary outcomes and no significant interactions with pre-specified subgroups.LimitationsBlinding of nutritional support was deemed to be impractical and, although the primary outcome was objective, some secondary outcomes, although defined and objectively assessed, may have been more vulnerable to observer bias.ConclusionsThere was no significant difference in all-cause mortality at 30 days for early nutritional support via the parenteral route compared with the enteral route among adults admitted to critical care units in England. On average, costs were higher for the parenteral route, which, combined with similar survival and quality of life, resulted in negative INBs at 1 year.Future workNutritional support is a complex combination of timing, dose, duration, delivery and type, all of which may affect outcomes and costs. Conflicting evidence remains regarding optimum provision to critically ill patients. There is a need to utilise rigorous consensus methods to establish future priorities for basic and clinical research in this area.Trial registrationCurrent Controlled Trials ISRCTN17386141.FundingThis project was funded by the NIHR Health Technology Assessment programme and will be published in full inHealth Technology Assessment; Vol. 20, No. 28. See the NIHR Journals Library website for further project information.

show abstract

“…More than that, the composition of free intracellular amino acid and α-ketoacid pools in body cells do not seem to be arbitrary in any direction, but may rather represent a relevant metabolic correlate, a quasi-immunonutritional metabolic fingerprint, for the underlying functions [24]- [26]. It is thus not surprising that scientific interest here also focused on the possibility to use selected amino-or ketoacids as part of a "standard" diet therapeutically [27]- [29]. However, many questions are unfortunately here still unclear.…”

Section: Discussionmentioning

confidence: 99%

Pyruvate-Dependent Changes in Neutrophil Amino- and Alpha-Keto Acid Profiles or Immunity: Which Mechanisms Are Involved?

Deller¹,

Mathioudakis²,

Engel³

et al. 2014

OJI

View full text Add to dashboard Cite

High current findings indicate that a substitution with pyruvate can lead to significant alterations or even improvement in neutrophil immunonutrition. However, it is still unknown which intracellular pathways might be involved here. Hence, in this study, we investigated whether preincubation with an inhibitor of •NO-synthase (L-NAME), an •NO donor (SNAP), an analogue of taurine (beta-alanine), an inhibitor of ornithine-decarboxylase (DFMO) as well as a glutamine-analogue (DON), is able to alter the intragranulocytic metabolic response to pyruvate, here for example studied for neutrophil intracellular amino-and α-keto acid concentrations or important neutrophil immune functions [released myeloperoxidase (MPO), the formation of superoxide anions ( ) 2 − O and hydrogen peroxide (H 2 O 2 )]. In summary, the interesting first results presented here showed, that any damage of specific metabolic pathways or mechanisms, which seem directly or indirectly to be involved in relevant pyruvate dependent granulocytic nutrient content or specific cellular tasks, could lead to therapeutically desired, but also to unexpected or even fatal consequences for the affected cells. We therefore continue to believe that pyruvate, irrespective of which exact biochemical mechanisms were involved, in neutrophils may satisfy the substantial metabolic demands for a potent intracellular nutrient.

show abstract

Enteral and Parenteral Nutrition in the Perioperative Period: State of the Art

Cited by 115 publications

References 61 publications

Delayed gastric emptying following pancreaticoduodenectomy: Incidence, risk factors, and healthcare utilization

Delayed gastric emptying following pancreaticoduodenectomy: Incidence, risk factors, and healthcare utilization

A multicentre, randomised controlled trial comparing the clinical effectiveness and cost-effectiveness of early nutritional support via the parenteral versus the enteral route in critically ill patients (CALORIES)

Pyruvate-Dependent Changes in Neutrophil Amino- and Alpha-Keto Acid Profiles or Immunity: Which Mechanisms Are Involved?

Contact Info

Product

Resources

About