Maintenance of Home Hyperalimentation in Patients With High-Output Jejunostomies

Grischkan, David M.; Steiger, Ezra; Fazio, Victor W.

doi:10.1001/archsurg.1979.01370310080014

Cited by 28 publications

(13 citation statements)

References 10 publications

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“…Most felt their leisure activity was restricted and missed the ability to participate in sports. They did not relate this restriction to HPN per se but either to tiredness (#2, 6,8,11,13) or pain (#5, 7,9). Twelve patients were married or cohabiting (Table IV); in 10, the relation dated back to the time before HPN, but 2 women (#1, 7) married healthy men after starting HPN.…”

Section: Resultsmentioning

confidence: 97%

“…One patient (#11) who owned a shop was able to continue some of her activity, especially the bookkeeping. None of the patients felt capable of managing a full-time job, an incapability related to a complexity of reasons: rapidly appearing tiredness (#1, 2, 3, 4, 6, 7, 10, 11, 12, 13), pain (#2, 5,8,9), diarrhea (#7, 13), frequent hospitalization (#1, 2,9), and the time-consuming therapy of HPN (#2, 7, 10, 13). Most patients attended to the housekeeping and were contented.…”

Section: Resultsmentioning

confidence: 99%

“…All patients who required permanent PN were trained for HPN during hospitalization and, in most patients, training was completed within 2-3 wk. Patients who lived within a short distance from the hospital (#1, 5,6,7,8,9,11,13) were clinically assessed as outpatients every 1 or 2 wk where they would come for the nutrient solutions which the hospital supplied. The remaining 5 who lived far from the hospital were assessed during a short-term hospitalization every 3 mon.…”

Section: Case Materials and Methodsmentioning

confidence: 99%

“…1-17 Many patients need HPN for only a limited period of time as an adjuvant or primary therapy for intestinal fistulas3, 4° 11° 15° ls or active Crohn's disease. 3,11,13,15,16 However, permanent HPN has made possible year-long survival in previously doomed patients with extensive small bowel resection, 1, 2,7,8,10,11 the majority of whom had Crohn's disease or were struck by mesenteric infarction. In general, there is a profound difference in the psychosocial basis for starting HPN in these 2 groups.…”

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confidence: 99%

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Quality of Life in Patients on Permanent Home Parenteral Nutrition

Ladefoged

1981

J Parenter Enteral Nutr

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A psychosocial survey of patients on permanent home parenteral nutrition (HPN) has been made to assess the quality of life in these patients. All patients on permanent HPN in the period August 1978 to August 1979, including 7 women and 6 men, age range 24-62 yr (median 53) were interviewed, as well as partners of 11 patients who were married or cohabiting. The duration of HPN ranged from 2-43 mon (median 24 mon). They were asked specific questions about physical symptoms, social and leisure activities, interpersonal relationships, sexuality, psychological problems, and feelings about HPN. None had an outside job, but 6 (46%) did most of the housekeeping. Some physical distress was recorded in almost all patients, but 9 (69%) considered themselves healthy or fairly healthy, whereas 4 (31%) felt diseased. Social and leisure activities were normal or only slightly impaired in most. Sexual activity had ceased completely in 5 above 55 yr, in association with onset of the disease; younger patients displayed normal and unchanged sexual activity. Psychological symptoms were recorded in 6 (46%), major symptoms in 4 (31%). Seven partners considered HPN to be a moderate or severe burden, mainly psychological changes in the patient that caused marital tension in 3 cases. Criteria for quality of life were: 1) no major physical distress, 2) no major psychological symptoms, 3) no substantial restriction of social and leisure activities, 4) ability to accept HPN, 5) overall satisfaction with conditions of life. Nine patients who fulfilled at least 3 of these criteria were considered to have a fair quality of life, 4 who complied with less than 3 of the criteria a poor quality of life. The interviews were repeated at intervals of 6-10 mon in 9 patients, and revealed no systematic improvement or deterioration of quality of life during HPN.

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Section: Resultsmentioning

confidence: 97%

Section: Resultsmentioning

confidence: 99%

Section: Case Materials and Methodsmentioning

confidence: 99%

mentioning

confidence: 99%

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Quality of Life in Patients on Permanent Home Parenteral Nutrition

Ladefoged

1981

J Parenter Enteral Nutr

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“…We managed thirst by limiting oral fluid intake to 1500 mL per day and adding more IV fluids. 23 When patients were sent home to gain weight in preparation for restorative GI tract surgery, it was noted that they required Ͼ40 kcal/kg/d and that the weight gain was in the form of fat and not lean body mass, although visceral protein status improved. 24 Establishing a goal weight before hospital discharge, adjusting kcal in the PN solutions to achieve desired weight, and adjusting amino acid content to achieve normal visceral protein status are important goals for HPN patient management.…”

Section: July-august 2007mentioning

confidence: 99%

Jonathan E. Rhoads Lecture: Experiences and Observations in the Management of Patients With Short Bowel Syndrome

Steiger

2007

J Parenter Enteral Nutr

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In an era before parenteral nutrition (PN) was made practical by Stanley Dudrick, MD, and his colleagues, patients with prolonged intestinal dysfunction or short bowel syndrome would often die of malnutrition or its sequelae. Over the past 4 decades, the treatment of patients with short bowel syndrome had progressed from PN in the hospital to small bowel transplantation. Multimodal therapies have evolved in the management of these patients, including specialized diets and enteral supplements, oral rehydration fluids, antisecretory medication, and the use of growth factors. Home PN is lifesaving when these modalities are ineffective and a surgical procedure to restore or enhance gastrointestinal tract length or absorptive potential is impossible. Small intestine transplantation had been used to salvage those patients who developed life-threatening complications of home PN, but as the survival after intestinal transplant has approached that of liver transplantation, it may soon be considered as primary therapy for patients with short bowel syndrome. This article presents the author's experiences and observations after a 4-decade experience in the management of patients with short bowel syndrome.

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Intestinal Failure Management at the Cleveland Clinic

Shatnawei

Parekh²,

Rhoda³

et al. 2010

Arch Surg

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The Cleveland Clinic institutional guidelines for the management of intestinal failure, including long-term or home parenteral nutrition and related complications, intestinal rehabilitation, and small bowel transplantation, were reviewed. PubMed was searched for relevant articles. The search was performed in November 2008; keywords used were home parenteral nutrition, short bowel syndrome, intestinal rehabilitation, and small-bowel transplantation. Randomized, prospective, observational, retrospective reviews and case report articles that contained relevant data for long-term parenteral nutrition, intestinal rehabilitation, and intestinal transplantation were selected. Researchers reviewed 67 selected articles that met our inclusion criteria. Our institution data registries for intestinal rehabilitation and home parenteral nutrition were also reviewed for relevant data. The survival of tens of thousands of children and adults with complicated gastrointestinal problems has been possible because of parenteral nutrition. In selected patients, a program of intestinal rehabilitation may avoid the need for long-term parenteral nutrition.

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Maintenance of Home Hyperalimentation in Patients With High-Output Jejunostomies

Cited by 28 publications

References 10 publications

Quality of Life in Patients on Permanent Home Parenteral Nutrition

Quality of Life in Patients on Permanent Home Parenteral Nutrition

Jonathan E. Rhoads Lecture: Experiences and Observations in the Management of Patients With Short Bowel Syndrome

Intestinal Failure Management at the Cleveland Clinic

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