Safety and efficacy of home parenteral nutrition for chronic intestinal failure: a 16-year experience at a single centre

Pironi, Loris; Paganelli, Federica; Labate, Antonio Maria Morselli; Merli, Cecilia; Guidetti, C.; Spinucci, Giulio; Miglioli, M.

doi:10.1016/s1590-8658(03)00074-4

Cited by 104 publications

(77 citation statements)

References 39 publications

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“…17,[82][83][84][85] The incidence of advanced liver disease (fibrosis or cirrhosis) varies between 0% and 50% of patients in retrospective cohorts on long-term PN, with an associated reported mortality rate of up to 22%. 17,[82][83][84][85] This discrepancy in the incidence in severe liver disease between different patient cohorts may reflect an increased use of parenteral lipid predisposing to higher rates of severe liver disease. 17 Patients with ultra-short bowel (<50 cm) are at greatest risk of severe liver disease, which this may, of course, reflect their greater calorie requirement.…”

Section: Liver Diseasementioning

confidence: 99%

“…46,48,49,83,152,[156][157][158] Survival is principally determined by underlying disease; patients with inflammatory bowel disease for example demonstrate a high 5-year survival of 92%, 157 whereas patients with motility disorders have the poorest 5-year survival at 48%. 157 Multivariate analysis of survival data from single centres has also demonstrated lower survival rates in patients with end-enterostomies 156,158 or a small bowel length of <50 cm.…”

Section: Survivalmentioning

confidence: 99%

See 1 more Smart Citation

Review article: the management of long‐term parenteral nutrition

Dibb

Teubner

Theis

et al. 2013

Aliment Pharmacol Ther

140

108

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SummaryBackgroundHome parenteral nutrition (HPN) is currently the management of choice for patients with chronic intestinal failure.AimTo summarise the major issues in delivering long‐term parenteral nutrition (>3 months) and assess outcome as per complications, mortality and quality of life. To assess the evidence for the therapeutic use of trophic factors such as teduglutide and to review evolving therapeutic options in the treatment of chronic intestinal failure.MethodsA literature search using PubMed and MEDLINE databases was performed.ResultsSafe delivery of HPN relies upon individualised formulations of parenteral nutrition administered via carefully maintained central venous catheters by trained patients or carers, supported by a skilled multidisciplinary team. Early diagnosis and treatment of complications including catheter‐associated blood stream infection (reported incidence 0.14–0.83 episodes/patient‐year on HPN) and central venous thrombosis (reported incidence 0.03 episodes/patient‐year) is important to minimise mortality and morbidity. There is a significant variation in the reported incidence of both hepatobiliary complications (19–75%) and advanced liver disease (0–50%). Five‐year survival rates in large centres are reported between 60% and 78% with survival primarily related to underlying diagnosis. Long‐term survival remains higher on HPN than with intestinal transplantation. The role of intestinal lengthening procedures is yet to be validated in adults.ConclusionsHome parenteral nutrition delivered by skilled nutrition teams has low incidences of catheter‐related complications. Most deaths relate to the underlying disease. Therapies such as teduglutide and small bowel transplantation appear promising, but home parenteral nutrition appears likely to remain the bedrock of management in the near term.

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Section: Liver Diseasementioning

confidence: 99%

Section: Survivalmentioning

confidence: 99%

Review article: the management of long‐term parenteral nutrition

Dibb

Teubner

Theis

et al. 2013

Aliment Pharmacol Ther

140

108

View full text Add to dashboard Cite

show abstract

“…[1][2][3][4][5] In an attempt to improve the quality of life of children and their families and promote normal development, home parenteral nutrition (HPN) is widely used in children with intestinal failure [6][7][8][9][10][11] and is considered a viable alternative to intestinal transplantation in these children. 12 However, utilization of PN is associated with a high incidence of catheter-associated bloodstream infections (CA-BSI).…”

Section: Introductionmentioning

confidence: 99%

Characterization of Posthospital Bloodstream Infections in Children Requiring Home Parenteral Nutrition

Mohammed

Zhao

Shane

et al. 2011

J Parenter Enteral Nutr

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Background: Home parenteral nutrition (HPN) is lifesaving for children with intestinal failure. Catheter‐associated bloodstream infections (CA‐BSI) are common in hospitalized patients receiving parenteral nutrition (PN), but data evaluating CA‐BSI in children receiving HPN are limited. Objective: To determine the incidence and characteristics of CA‐BSI in children receiving HPN. Methods: Medical records of 44 children receiving HPN during a 3‐year period were reviewed. End points were CA‐BSI during the initial 6 months after discharge. CA‐BSI was defined as isolation of pathogens from blood requiring antimicrobial therapy. Results: The primary indication for HPN was short bowel syndrome (46%), and 59 BSI were documented during the initial 6 months of HPN in 29 (66%) children. Of CA‐BSI, polymicrobial infections accounted for 52%; gram‐positive, 29%; gram‐negative, 17%; and fungal, 2%. CA‐BSI incidence per 1000 catheter‐days was highest during the first month posthospital discharge (72 episodes; 95% confidence interval [CI], 45.4–109.6). CA‐BSI incidence density ratio for children receiving HPN for >90 days compared with those receiving HPN for <30 days was 2.2 (P < .05). Logistic regression revealed that Medicaid insurance and age <1 year were associated with increased risk for CA‐BSI (odds ratio [OR], 4.4 [95% CI, 1.13–16.99] and 6.6 [1.50–28.49], respectively; P < .05). Conclusions: The incidence of CA‐BSI in children receiving HPN is highest during the first month posthospital discharge. Strategies to address care in the immediate posthospital discharge period may reduce the burden of infectious complications of HPN.

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“…They re- ported incidences of 0.82-3.86 catheter infections per 1,000 catheter days whereas only one [9] reported an overall incidence of CVC complications (5.56/1,000 catheter days). Moreover, the majority of publications reported on series from single centres with specialised expertise in HPN [9][10][11][14][15][16][17][18]. They documented the expert standard of specialised centres that may not be generalisable to the setting of everyday care provided by general practitioners and unspecialised outpatient nursing services.…”

Section: Discussionmentioning

confidence: 99%

Central Venous Catheter Complications during Home Parenteral Nutrition: A Prospective Pilot Study of 481 Patients with More than 30,000 Catheter Days

et al. 2008

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Background: Home parenteral nutrition (HPN) has been shown to delay deterioration in cancer patients with malnutrition. Its risk-benefit ratio, however, is determined by the threat of central venous catheter (CVC) complications. Only few prospective studies on this subject exist, most of them based on small samples. The objective of this study was to provide reliable estimates of incidence rates of CVC complications in everyday HPN patient care in Germany. Patients and Methods: Aiming for a large prospective cohort study, we cooperated with a service provider caring for HPN patients nationwide. Between July 1 and November 30, 2006, all consecutive adult patients with more than 10 infusion days and no previous history of HPN were recruited. Follow-up ended on January 31, 2007. Data were collected in a standardised way by the provider’s staff. To prevent underreporting, we used computer-assisted telephone interviews with medical caregivers as a provider-independent data source. Results: 481 patients met the inclusion criteria, contributing a total of 31,337 catheter days. 52 patients experienced a total of 63 CVC complications, resulting in an incidence rate of 2.01 CVC complications per 1,000 catheter days including 1.02 CVC infections per 1,000 catheter days. Conclusion: HPN administration can be safely performed with a relatively low rate of CVC complications.

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Safety and efficacy of home parenteral nutrition for chronic intestinal failure: a 16-year experience at a single centre

Cited by 104 publications

References 39 publications

Review article: the management of long‐term parenteral nutrition

Review article: the management of long‐term parenteral nutrition

Characterization of Posthospital Bloodstream Infections in Children Requiring Home Parenteral Nutrition

Central Venous Catheter Complications during Home Parenteral Nutrition: A Prospective Pilot Study of 481 Patients with More than 30,000 Catheter Days

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