Parenteral Nutrition Combined with Enteral Nutrition for Severe Acute Pancreatitis

Abstract

Background and Aims. Nutritional support in severe acute pancreatitis (SAP) is controversial concerning the merits of enteral or parenteral nutrition in the management of patients with severe acute pancreatitis. Here, we assess the therapeutic efficacy of gradually combined treatment of parenteral nutrition (PN) with enteral nutrition (EN) for SAP. Methods. The clinical data of 130 cases of SAP were analyzed retrospectively. Of them, 59 cases were treated by general method of nutritional support (Group I) and the other 71 cases were treated by PN gradually combined with EN (Group II). Results. The APACHE II score and the level of IL-6 in Group II were significantly lower than Group I (P < 0.05). Complications, mortality, mean hospital stay, and the cost of hospitalization in Group II were 39.4 percent, 12.7 percent, 32 ± 9 days, and 30869.4 ± 12794.6 Chinese Yuan, respectively, which were significantly lower than those in Group I. The cure rate of Group II was 81.7 percent which is obviously higher than that of 59.3% in Group I (P < 0.05). Conclusions. This study indicates that the combination of PN with EN not only can improve the natural history of pancreatitis but also can reduce the incidence of complication and mortality.

Guidelines for the Provision and Assessment of Nutrition Support Therapy in the Adult Critically Ill Patient

“…Rationale: Three RCTs comparing gastric with jejunal feeding in severe acute pancreatitis showed no significant differences between the 2 levels of EN infusion within the GI tract with regard to tolerance or clinical outcome 354 . ‐ 356 A meta‐analysis by Chang et al showed that there was no difference between the levels of infusion with regard to pain sensation, diarrhea, or energy balance (energy provision) 357 …”

1HNMR-based metabolomic profile of rats with experimental acute pancreatitis

“…During an intense workout or under conditions of hypoxia, an insufficient oxygen supply can reduce Krebs cycle reactions, produce less ATP, and enhance glycolysis, resulting in decreased removal ability of the liver and kidneys and ultimately to the accumulation of lactate in plasma [ 24 , 25 ]. The increased levels of lactate and succinic acid in the AP group were likely because of anaerobic glycolysis, which was enhanced by the increased energy consumption and oxygen deficit during early stages of AP [ 26 ]. Since lactate concentration is influenced by oxygen supply and fluid resuscitation, this elevation was not detected in urine samples from patients with pancreatitis [ 27 ].…”

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

“…[57] showed that combining TPN with EN after day 4 of ICU admission in patients for whom EN is insufficient to meet their nutritional goals have reduced nosocomial infections and improved their clinical outcomes [57]. A small retrospective study showed that combined enteralparenteral nutrition in patients with severe acute pancreatitis not only can improve the natural history of pancreatitis but also can reduce the incidence of complication and mortality [58]. In another small retrospective study by Hsu et al .…”