Management of Glucose Control in Noncritically Ill, Hospitalized Patients Receiving Parenteral and/or Enteral Nutrition: A Systematic Review

Laesser, Céline Isabelle; Cumming, Paul; Reber, Emilie; Stanga, Zeno; Muka, Taulant; Bally, Lia

doi:10.3390/jcm8070935

Cited by 23 publications

(23 citation statements)

References 55 publications

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“…In the medical nutrition setting, nutritional enteral formula for people with diabetes (Diabetes-Specific Formula: DSF) are available, aiming at limiting glycemic peaks and variability. Systematic reviews and meta-analyses in non-critically ill patients have indicated that DSF may improve hyperglycemia and glucose excursions in patients with T2DM [164,165]. It should be pointed out that no demonstration of improved hard outcomes, including mortality, is available, and that evidence does not include sufficient rigorous randomized controlled studies [164,165].…”

Section: Hospitalized Persons With Obesity With Covid-19 Withmentioning

confidence: 99%

Nutritional management of individuals with obesity and COVID-19: ESPEN expert statements and practical guidance

et al. 2022

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The COVID-19 pandemics has created unprecedented challenges and threats to patients and healthcare systems worldwide. Acute respiratory complications that require intensive care unit (ICU) management are a major cause of morbidity and mortality in COVID-19 patients. Among other important risk factors for severe COVID-19 outcomes, obesity has emerged along with undernutrition-malnutrition as a strong predictor of disease risk and severity. Obesity-related excessive body fat may lead to respiratory, metabolic and immune derangements potentially favoring the onset of COVID-19 complications. In addition, patients with obesity may be at risk for loss of skeletal muscle mass, reflecting a state of hidden malnutrition with a strong negative health impact in all clinical settings. Also importantly, obesity is commonly associated with micronutrient deficiencies that directly influence immune function and infection risk. Finally, the pandemic-related lockdown, deleterious lifestyle changes and other numerous psychosocial consequences may worsen eating behaviors, sedentarity, body weight regulation, ultimately leading to further increments of obesity-associated metabolic complications with loss of skeletal muscle mass and higher non-communicable disease risk. Therefore, prevention, diagnosis and treatment of malnutrition and micronutrient deficiencies should be routinely included in the management of COVID-19 patients in the presence of obesity; lockdown-induced health risks should also be specifically monitored and prevented in this population. In the current document, the European Society for Clinical Nutrition and Metabolism (ESPEN) aims at providing clinical practice guidance for nutritional management of COVID-19 patients with obesity in various clinical settings.

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Section: Hospitalized Persons With Obesity With Covid-19 Withmentioning

confidence: 99%

Nutritional management of individuals with obesity and COVID-19: ESPEN expert statements and practical guidance

et al. 2022

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“…The initiation of a nutritional therapy in complex clinical situations and its proper documentation are also tasks of an NST [69]. An NST ensures the quality and safety of nutritional interventions, especially artificial nutrition, which helps to reduce potential mechanical and metabolic complications (e.g., blood glucose issues and refeeding syndrome) as well as infections [70]. The NST has a consultative role for the treating medical staff in the hospital and takes over the management of the nutritional therapy in outpatients.…”

Section: Tasks and Challenges Of Nstsmentioning

confidence: 99%

Efficacy and Efficiency of Nutritional Support Teams

Reber

Strahm

Bally

et al. 2019

JCM

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Malnutrition is frequent in patients during a hospital admission and may further worsen during the hospital stay without appropriate nutritional support. Malnutrition causes greater complication rates, morbidity, and mortality rates, which increases the length of hospital stay and prolongs rehabilitation. Early recognition of individual nutritional risk and timely initiation of a tailored nutritional therapy are crucial. Recent evidence from large-scale trials suggests that efficient nutritional management not only improves the nutritional status, but also prevents negative clinical outcomes and increases patients’ quality of life. Multifaceted clinical knowledge is required to ensure optimal nutritional support, according to a patient’s individual situation and to avoid potential complications. Furthermore, clear definition of responsibilities and structuring of patient, and work processes are indispensable. Interdisciplinary and multiprofessional nutritional support teams have been built up to ensure and improve the quality and safety of nutritional treatments. These teams continuously check and optimize the quality of procedures in the core areas of nutritional management by implementing nutritional screening processes using a validated tool, nutritional status assessment, an adequate nutritional care plan development, prompt and targeted nutritional treatment delivery, and provision of accurate monitoring to oversee all aspects of care, from catering to artificial nutrition. The foundation of any nutritional care plan is the identification of patients at risk. The aim of this narrative review is to provide an overview about composition, tasks, and challenges of nutritional support teams, and to discuss the current evidence regarding their efficiency and efficacy in terms of clinical outcome and cost effectiveness.

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“…Hyperglycemia is another early and frequent complication affecting up to 50% of the patients upon PN initiation. Appropriate and initially frequent glycaemia testing is mandatory, since hyperglycemia has been linked with increased morbidity and mortality, especially in critically ill patients [30]. The targeted blood glucose level lies between 7.8 and 10.0 mM, (normoglycemia: 4.4–8.1 mM; 80–145 mg/100 mL) [31].…”

Section: Complications Of Parenteral Nutritionmentioning

confidence: 99%

“…The targeted blood glucose level lies between 7.8 and 10.0 mM, (normoglycemia: 4.4–8.1 mM; 80–145 mg/100 mL) [31]. Insulin administration, optimally pump-assisted and in parallel to PN, may be necessary to control glycaemia (there is a dedicated specific article on this topic in this special issue [30]).…”

Section: Complications Of Parenteral Nutritionmentioning

confidence: 99%

Pharmaceutical Aspects of Artificial Nutrition

Reber

Messerli

Stanga

et al. 2019

JCM

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Artificial nutrition, including enteral (EN) and parenteral (PN) nutrition, is indicated whenever adequate oral nutrition fails to sufficiently supply the necessary nutrients to the body. It is a convenient, efficacious, safe, and well-tolerated form of clinical nutrition in the hospital and home setting. EN is administered via nasogastric tube or ostomies while PN usually requires a central venous access for administration, straight into the blood stream. The infused nutrients can then be taken up directly by the different organs. PN is targeted as a single daily portion formulated as an oil-in-water emulsion providing the necessary substrates for the catabolic and anabolic metabolism including macro- and micronutrients and fluids. PN has a complex pharmaceutical composition—all-in-one admixture—and its compounding or ready-to-use preparation. The use of PN is more challenging and more expensive compare to the use of EN, commercially available as ready-to-use formulations. EN and concomitant medication is highly challenging. Upon incorrect handling and administration, PN is associated with potentially severe or even fatal complications, mostly relating to the central venous access (e.g., catheter-related sepsis) or to a metabolic intolerance (e.g., hyperglycemia, refeeding syndrome) because of inappropriate administration. A correct order of admixing, correct dosing, and administration of the artificial is crucial for safety and efficacy; clinical and biochemical monitoring of the patient and treatment regimen adaption are necessary. The high number of reactive solutes allow only limited stability of a ready-to-use PN admixture. The potential for numerous incompatibilities and interactions renders PN admixtures generally unsuitable as drug vehicle. Laboratory compatibility and stability testing and pharmaceutical expertise are a prerequisite to define the PN composition including nutrients or even drugs admixed to define the appropriate and individualized nutrition and medication regimen. The aim of this narrative review is to present the actual state-of-the-art to deliver best quality artificial nutrition with special regard on pharmaceutical aspects such as instabilities, incompatibilities, and concomitant co-medication.

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Management of Glucose Control in Noncritically Ill, Hospitalized Patients Receiving Parenteral and/or Enteral Nutrition: A Systematic Review

Cited by 23 publications

References 55 publications

Nutritional management of individuals with obesity and COVID-19: ESPEN expert statements and practical guidance

Nutritional management of individuals with obesity and COVID-19: ESPEN expert statements and practical guidance

Efficacy and Efficiency of Nutritional Support Teams

Pharmaceutical Aspects of Artificial Nutrition

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