Temporal Trends in the Use of Parenteral Nutrition in Critically Ill Patients

Gershengorn, Hayley B.; Kahn, Jeremy M.; Wunsch, Hannah

doi:10.1378/chest.13-1597

Cited by 11 publications

(9 citation statements)

References 47 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…First is the observational design of the study. Observational data, particularly in the field of ICU nutrition, should be interpreted with caution, since the clinical course can affect nutritional intake more than nutrition can affect outcomes [42]. However, we attempted to minimize this interference by adjusting the findings based on the severity of the illness at the time of the patient's evaluation rather than on admission scores.…”

Section: Patients Characteristics and Outcomesmentioning

confidence: 99%

Nutritional therapy and outcomes in underweight critically ill patients

et al. 2020

View full text Add to dashboard Cite

s u m m a r yBackground & aims: Critically ill patients with body mass index (BMI) < 20 kg/m 2 have worse outcomes than normal/overweight patients possibly because underweight is a marker of malnutrition. To assess the effects of nutrition therapy in this population during the first week of an ICU stay. Methods: Prospective, 2-centre, observational study. Nutritional evaluations were performed between days 2 and 3 (first) and between days 5 and 7 (second) of ICU admission. In the first evaluation, patients were divided into non-fed (without nutritional support) and early-fed (those already receiving nutritional support) groups. In the second evaluation, patients were divided according to caloric intake (or<20 kcal/kg) and protein intake (or<1.3 g of protein/kg). Results: Of the 4236 patients screened and 342 were included in the cohort. Mortality was 58.5% (median 21 [11e38.25] days of follow-up). Unadjusted patient survival was worse in the non-fed group than in the early-fed group (HR 1.66; 95%CI, 1.18 to 2.32). There was no difference in mortality between groups after adjusting for the SOFA score on the day of the evaluation. At the second evaluation, unadjusted analysis showed better in-hospital survival in patients with higher caloric (HR0.58; 95%CI, 0.40 to 0.86) and protein intake (HR0.59; 95%CI, 0.42 to 0.82); there was no association between mortality and caloric or protein intake after adjusting for the SOFA score on the day of the evaluation. Conclusion: Nutritional therapy in the first week of ICU stay did not affect vital outcome after adjusting for the SOFA score on the day of the evaluation in underweight critically ill patients. Clinical trial registry: ClinicalTrials.gov number NCT03398343.

show abstract

Section: Patients Characteristics and Outcomesmentioning

confidence: 99%

Nutritional therapy and outcomes in underweight critically ill patients

et al. 2020

View full text Add to dashboard Cite

show abstract

“…The steepest decline—from 0.24% to 0.19%—took place in adults aged 65 years or older. Additional data gathered in a large retrospective cohort study from 2001–2008 suggest that a decline in PN use occurred among critically ill adults in the years before the downward trend became evident in national database statistics 14 …”

Section: Introductionmentioning

confidence: 99%

“…No studies have examined the reasons underlying these trends, but a number of factors in today's healthcare environment could play a role, including greater adherence to guidelines and practice recommendations, changing perceptions regarding the risks and benefits of PN administration, cost‐containment efforts, drug shortages, and concern regarding the hazards of excess fluid administration in critically ill patients 12 , 14 . Although this information sheds some light on current trends in PN use, the available data address only PN administered in hospitals and do not include individuals who receive PN outside the acute care setting, which has expanded across the continuum of care to include long‐term acute care, skilled nursing facilities, rehabilitation centers, and home care.…”

Section: Introductionmentioning

confidence: 99%

When Is Parenteral Nutrition Appropriate?

Worthington

Balint

Bechtold

et al. 2017

J Parenter Enteral Nutr

180

202

View full text Add to dashboard Cite

Parenteral nutrition (PN) represents one of the most notable achievements of modern medicine, serving as a therapeutic modality for all age groups across the healthcare continuum. PN offers a life-sustaining option when intestinal failure prevents adequate oral or enteral nutrition. However, providing nutrients by vein is an expensive form of nutrition support, and serious adverse events can occur. In an effort to provide clinical guidance regarding PN therapy, the Board of Directors of the American Society for Parenteral and Enteral Nutrition (ASPEN) convened a task force to develop consensus recommendations regarding appropriate PN use. The recommendations contained in this document aim to delineate appropriate PN use and promote clinical benefits while minimizing the risks associated with the therapy. These consensus recommendations build on previous ASPEN clinical guidelines and consensus recommendations for PN safety. They are intended to guide evidence-based decisions regarding appropriate PN use for organizations and individual professionals, including physicians, nurses, dietitians, pharmacists, and other clinicians involved in providing PN. They not only support decisions related to initiating and managing PN but also serve as a guide for developing quality monitoring tools for PN and for identifying areas for further research. Finally, the recommendations contained within the document are also designed to inform decisions made by additional stakeholders, such as policy makers and third-party payers, by providing current perspectives regarding the use of PN in a variety of healthcare settings. (JPEN J Parenter Enteral Nutr. 2017;41:324-377) The etiology-based nutrition diagnoses in adults in clinical practice settings are as follows: Starvation-related malnutrition: Chronic starvation without inflammation (eg, anorexia nervosa). Chronic disease-related malnutrition: Inflammation is chronicand of mild to moderate degree (eg, organ failure, pancreatic cancer, rheumatoid arthritis, sarcopenic obesity). Acute disease or injury-related malnutrition:Inflammation is acute and of severe degree (eg, major infection burns, trauma, closed head injury). 2,3Malnutrition, pediatric: An imbalance between nutrient requirement and intake, resulting in cumulative deficits of energy, protein, or micronutrients that may negatively affect growth, development, and other relevant outcomes. It is recommended that growth charts based on a standard deviation z score system be used to track and assess nutrition status in children. 4,5Nutritionally-at-risk: Consider the individual nutritionally-atrisk if any of the following is present. Nutritionally-At-Risk Adult Summary of RecommendationsThese consensus recommendations are designed to identify best practices, guide day-to-day clinical decisions, reduce variations in practice, and enhance patient safety. They are not intended to supersede the judgment of the healthcare professional based on the circumstances of the individual patient.

show abstract

“…A recent high-quality survey of the evolution in PN use in the USA in almost 400, 000 ICU patients even showed a decline in the proportion of patients receiving PN, from 7.2 % in 2001-2002 to 5.5 % in [2007][2008]. However, in patients receiving PN it was started much earlier than suggested by the American guidelines; median 2 days (IQR 1-3) after admission [ 10 ].…”

Section: Feeding Policies In the Icu Until The Publication Of Recent mentioning

confidence: 99%