1
|
Ait Hammou Taleb MH, Mahmutovic M, Michot N, Malgras A, Nguyen-Thi PL, Quilliot D. Effectiveness of salvage catheters in home parenteral nutrition: A single-center study and systematic literature review. Clin Nutr ESPEN 2023; 56:111-119. [PMID: 37344059 DOI: 10.1016/j.clnesp.2023.04.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 04/11/2023] [Accepted: 04/27/2023] [Indexed: 06/23/2023]
Abstract
BACKGROUND & AIMS There are sparse data regarding the rate of catheter salvage and long-term effectiveness of antibiotic lock treatment outcome after central line-associated bloodstream infections (CLABSI). Objectives were to analyze the effectiveness of central venous catheter (CVC) rescue strategy and its impact on catheter lifespan. Secondary objective included effectiveness of taurolidine+4% citrate in primary prevention, compared to a secondary prevention strategy, by analyzing infection incidence during two successive periods. METHOD Real-life 5-year observational study assessing CLABSI occurrence and CVC salvage outcomes in adult patients requiring Home Parenteral Nutrition (HPN) managed in a single-center Intestinal Failure Unit. RESULTS Over the 5-year period, there were 106 confirmed infections (63/143 patients (44%)). Infection incidence was 0.92/1000 catheter-days. Incidence was 1.02/1000 catheter-days during the taurolidine+4% citrate period while lower at 0.84/1000 catheter-days (p = 0.034) during the systematic taurolidine lock period. Of the total number of infections, 89 CVCs were immediately removed and 17 were salvaged. The success rate of catheter salvage with antibiotic lock was 82.4%, with 53% remaining CLABSI-free at one year. The salvage strategy extended catheter lifespan by a median 165 days (IQR 50-214). However, the rate of new infection was significantly higher in instances of salvage (71.4%) vs. removal (36%). Parenteral Nutrition (PN) ≥12 months (p = 0.002), PN (vs. hydroelectrolytic support) (p = 0.028) and self-management by patients (p = 0.049) were independent risk factors of CLABSI. CONCLUSION Catheter salvage appears to be an effective long-term strategy with >50% of CVCs remaining CLABSI-free at one year and a prolonged catheter life, although may expose to a more frequent and earlier infection recurrence. CLINICAL TRIAL REGISTRATION Cohort approved by the French CNIL (National Committee for Data Protection, authorization number CNIL 2015-25). referred to as "observational research", "non-interventional", or « non-RIPH ».
Collapse
Affiliation(s)
- Marie-Héloïse Ait Hammou Taleb
- Nutrition Support Unit, Department of Endocrinology, Diabetology and Nutrition, University of Lorraine, CHRU Nancy, Brabois Hospital, Nancy, France
| | - Meliha Mahmutovic
- Nutrition Support Unit, Department of Endocrinology, Diabetology and Nutrition, University of Lorraine, CHRU Nancy, Brabois Hospital, Nancy, France
| | - Niasha Michot
- Nutrition Support Unit, Department of Endocrinology, Diabetology and Nutrition, University of Lorraine, CHRU Nancy, Brabois Hospital, Nancy, France
| | - Aurélie Malgras
- Nutrition Support Unit, Department of Endocrinology, Diabetology and Nutrition, University of Lorraine, CHRU Nancy, Brabois Hospital, Nancy, France
| | - Phi-Linh Nguyen-Thi
- Medical Evaluation Department, Department of Clinical Research Support PARC, University of Lorraine, CHU Nancy, Nancy, France
| | - Didier Quilliot
- Nutrition Support Unit, Department of Endocrinology, Diabetology and Nutrition, University of Lorraine, CHRU Nancy, Brabois Hospital, Nancy, France; Department of Visceral, Metabolic and Cancer Surgery (CVMC), Multidisciplinary Unit for Obesity Surgery (UMCO), University of Lorraine, CHRU Nancy, Brabois Hospital, Vandoeuvre-lès-Nancy, France; INSERM U1256, Nutrition, Genetics, Environmental Risks, Faculty of Medicine, University of Lorraine, Nancy, France.
| |
Collapse
|
2
|
Deutsch L, Cloutier A, Leahy G, Teubner A, Abraham A, Taylor M, Paine P, Lal S. Factors associated with strong opioid use for noncancer pain in patients with chronic intestinal failure. Nutr Clin Pract 2023; 38:129-137. [PMID: 36184884 PMCID: PMC10092843 DOI: 10.1002/ncp.10916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 08/08/2022] [Accepted: 09/02/2022] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Chronic analgesic use is described in home parenteral nutrition (HPN)-dependent patients, but there are limited data on factors associated with opioid use for noncancerous pain. METHODS Patients attending a national UK intestinal failure reference center were divided in two groups according to strong opioid (SO) usage; risk factors for SO usage were analyzed using logistic regression. RESULTS A total of 168 HPN-dependent patients were included. During the study period, 73 patients (43.5%) had documented SO usage (SO group), whereas the remainder did not (No-SO group). The prevalence of Crohn's disease among the No-SO group was twofold higher than among the SO group (43.2% vs 24.7%; P = 0.013), whereas those with surgical complications were twice as prevalent among the SO group (19.2% vs 8.4%, respectively; P = 0.04). The rate of working-age unemployment was significantly higher in the SO group (90.6%) than the No-SO group (55.6%; P = 0.001). Multivariate regression showed unemployment as an independent risk factor for SO usage (OR, 6.005; 95% CI, 1.435-25.134), whereas Crohn's disease (OR, 0.284; 95% CI, 0.09-0.898) and <4 intravenous support (IVS) nights per week (OR, 0.113; 95% CI, 0.012-1.009) were protective factors. The life-long incidence of catheter-related bloodstream infection (CRBSI) was comparable between groups (34.2% SO vs 27.4% No-SO; P = 0.336). CONCLUSION SO use is frequent among HPN-dependent patients and associated with high rates of unemployment and ≥4 IVS nights per week, but not with increased rate of CRBSI. The reduced usage among patients with Crohn's disease warrants further evaluation but might be due to the chronicity as compared with other IF etiologies.
Collapse
Affiliation(s)
- Liat Deutsch
- Intestinal Failure Unit, Salford Royal NHS Foundation TrustSalfordUK
- Department of Gastroenterology and Liver Diseases, Tel‐Aviv Sourasky Medical Centre, affiliated to Sackler Faculty of MedicineTel‐Aviv UniversityTel‐AvivIsrael
| | - Anabelle Cloutier
- Intestinal Failure Unit, Salford Royal NHS Foundation TrustSalfordUK
- CHU de QuébecUniversité LavalQuébecCanada
| | - Gavin Leahy
- Intestinal Failure Unit, Salford Royal NHS Foundation TrustSalfordUK
| | - Antje Teubner
- Intestinal Failure Unit, Salford Royal NHS Foundation TrustSalfordUK
| | - Arun Abraham
- Intestinal Failure Unit, Salford Royal NHS Foundation TrustSalfordUK
| | - Michael Taylor
- Intestinal Failure Unit, Salford Royal NHS Foundation TrustSalfordUK
| | - Peter Paine
- Department of Gastroenterology, Salford Royal NHS Foundation TrustSalfordUK
| | - Simon Lal
- Intestinal Failure Unit, Salford Royal NHS Foundation TrustSalfordUK
- Academic Health Sciences CentreUniversity of ManchesterManchesterUK
| |
Collapse
|
3
|
Rudziński M, Ławiński M, Gradowski Ł, Antoniewicz AA, Słodkowski M, Bedyńska S, Kostro J, Singer P. Kidney stones are common in patients with short-bowel syndrome receiving long-term parenteral nutrition: A predictive model for urolithiasis. JPEN J Parenter Enteral Nutr 2022; 46:671-677. [PMID: 33938015 DOI: 10.1002/jpen.2133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND In short-bowel syndrome (SBS) treated with parenteral nutrition (PN), multiple complications can occur. The etiology of kidney stones may be linked to the underlying disease thrombosis, surgical complications, complications of therapy for cancer, Crohn's disease, metabolic abnormalities resulting from morphological and functional changes in the gastrointestinal tract, and to treatment used. We analyzed all these parameters in a large cohort of patients receiving home PN (HPN), to define the incidence of stones and groups of patients particularly at risk of stone formation. One of the objectiveswas to develop a predictive model of urolithiasis. METHODS This observational retrospective study included 459 patients with SBS recieving HPN in a single center. Patient records were evaluated for demographics, SBS etiology, and underlying disease, anatomy of the gastrointestinal tract, intestinal failure classification, nutrition regimen, and presence of urolithiasis. RESULTS Kidney stones were diagnosed in 24% of patients. Nodifferences in incidence were noted between the various etiologic groups. The incidence in patients with a colon in continuity and those with an end stoma was similar. The length of residual small bowel did not play a role in stone formation. There were no differences between patients according to the severity of intestinal failure. In patients treated with PN and limited oral feeding, the risk of urolithiasis was twice as high as in patients receiving PN only. CONCLUSIONS Patients developed urolithiasis with no relation to the SBS etiology. The risk of kidney stone formation was higher in patients recieving PN with oral feeding.
Collapse
Affiliation(s)
- Marcin Rudziński
- Department of Urology, Multidisciplinary Hospital Międzylesie, Warsaw, Poland
| | - Michał Ławiński
- Department of General Surgery, Gastroenterology and Oncology, Medical University of Warsaw, Warsaw, Poland
- Institute of Genetics and Animal Biotechnology Polish Academy of Sciences, Jastrzębiec, Poland
| | - Łukasz Gradowski
- SWPS University of Social Sciences and Humanities, Warsaw, Poland
| | - Artur A Antoniewicz
- Department of Urology, Multidisciplinary Hospital Międzylesie, Warsaw, Poland
| | - Maciej Słodkowski
- Department of General Surgery, Gastroenterology and Oncology, Medical University of Warsaw, Warsaw, Poland
| | - Sylwia Bedyńska
- SWPS University of Social Sciences and Humanities, Warsaw, Poland
| | - Justyna Kostro
- Department of General, Endocrine and Transplant Surgery, Medical University of Gdańsk, Gdańsk, Poland
| | - Pierre Singer
- Department of General Intensive Care and Institute for Nutrition Research, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Tel Aviv University, Tel Aviv, Israel
| |
Collapse
|
4
|
Reber E, Staub K, Schönenberger KA, Stanga A, Leuenberger M, Pichard C, Schuetz P, Mühlebach S, Stanga Z. Management of Home Parenteral Nutrition: Complications and Survival. ANNALS OF NUTRITION AND METABOLISM 2021; 77:46-55. [PMID: 33887736 DOI: 10.1159/000515057] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 01/20/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND AND AIMS Parenteral nutrition (PN) has become an efficient, safe, and convenient treatment over years for patients suffering from intestinal failure. Home PN (HPN) enables the patients to have a high quality of life in their own environment. The therapy management however implies many restrictions and potentially severe lethal complications. Prevention and therapy of the latter are therefore of utmost importance. This study aims to assess and characterize the situation of patients with HPN focusing on prevalence of catheter-related complications and mortality. METHODS Swiss multicentre prospective observational study collecting demographic, anthropometric, and catheter-related data by means of questionnaires every sixth month from 2017 to 2019 (24 months), focusing on survival and complications. Data were analysed using descriptive statistics. Logistic regression models were fitted to investigate association between infection and potential co-factors. RESULTS Seventy adult patients (50% women) on HPN were included (≈5 patients/million adult inhabitants/year). The most common underlying diseases were cancer (23%), bariatric surgery (11%), and Crohn's disease (10%). The most prevalent indication was short bowel syndrome (30%). During the study period, 47% of the patients were weaned off PN; mortality rate reached 7% for a median treatment duration of 1.31 years. The rate of catheter-related infection was 0.66/1,000 catheter-days (0.28/catheter-year) while the rate of central venous thrombosis was 0.13/1,000 catheter-days (0.05/catheter-year). CONCLUSION This prospective study gives a comprehensive overview of the adult Swiss HPN patient population. The collected data are prerequisite for evaluation, comparison, and improvement of recommendations to ensure best treatment quality and safety.
Collapse
Affiliation(s)
- Emilie Reber
- Department of Diabetes, Endocrinology, Nutritional Medicine and Metabolism, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
| | - Kaspar Staub
- Institute for Evolutionary Medicine, University of Zürich, Zürich, Switzerland
| | - Katja A Schönenberger
- Department of Diabetes, Endocrinology, Nutritional Medicine and Metabolism, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
| | - Anastasia Stanga
- Department of Diabetes, Endocrinology, Nutritional Medicine and Metabolism, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
| | - Michèle Leuenberger
- Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Claude Pichard
- Clinical Nutrition, Geneva University Hospital, Geneva, Switzerland
| | - Philipp Schuetz
- Division of General Internal and Emergency Medicine, Medical University Department, Kantonsspital Aarau, Aarau, Switzerland
| | - Stefan Mühlebach
- Department of Clinical Pharmacy and Epidemiology, University of Basel, Basel, Switzerland
| | - Zeno Stanga
- Department of Diabetes, Endocrinology, Nutritional Medicine and Metabolism, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
| |
Collapse
|
5
|
Daoud DC, Cartagena EMS, Schwenger KJP, Somlaw N, Gramlich L, Whittaker S, Armstrong D, Jurewitsch B, Raman M, Duerksen DR, McHattie JD, Allard JP. Home parenteral nutrition in older vs younger patients: Clinical characteristics and outcomes. JPEN J Parenter Enteral Nutr 2021; 46:348-356. [PMID: 33811677 DOI: 10.1002/jpen.2117] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND There is a demographic shift toward older patients receiving home parenteral nutrition (HPN), but data on clinical outcomes are limited. The objective of this study was to determine differences between older and younger HPN patients in regard to HPN indications, prescriptions, and outcomes over the first 2 years receiving HPN. METHODS This was a retrospective analysis of prospectively collected data from HPN adult patients entered in the Canadian HPN Registry. New HPN patients enrolled between 2003 and 2017 and receiving HPN for at least 2 years were selected. Data included demographics, PN prescriptions, catheter-related bloodstream infections (CRBSIs) over the past year, survival, and quality of life based on Karnofsky Performance Status (KPS). RESULTS Four hundred two patients were included: 184 patients were ≥60 years old, and 219 patients were between 18 and 59 years old. There were no differences in the main indications for HPN, body mass index (BMI), and PN prescriptions at baseline. At 2 years, younger patients received more energy from PN than older patients (27.9 vs 19.6 kcal/kg; P < .001), but BMI remained comparable. There were fewer CRBSIs in the older group (20% vs 36%, P = .0023), but 78% of younger patients remained alive vs 69% in the older group (P = .0401). In those alive, the proportion of patients continuing to receive HPN was comparable and the proportion of patients with a KPS ≥60. CONCLUSIONS Older HPN patients have similar clinical characteristics as younger patients but have fewer CRBSIs and higher 2-year mortality.
Collapse
Affiliation(s)
- Dane Christina Daoud
- Department of Medicine, Division of Gastroenterology, Centre Hospitalier de l'Université de Montréal (CHUM), University of Montreal, Montreal, Quebec, Canada
| | - Elena M S Cartagena
- Department of Medicine, Division of Gastroenterology, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Katherine J P Schwenger
- Department of Medicine, Division of Gastroenterology, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Nicha Somlaw
- Department of Medicine, The Thai Red Cross Society, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Leah Gramlich
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Scott Whittaker
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - David Armstrong
- Division of Gastroenterology and Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Brian Jurewitsch
- Department of Pharmacy, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Matreyi Raman
- Division of Gastroenterology and Hepatology, University of Calgary, Alberta, Canada
| | - Donald R Duerksen
- Department of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | | | - Johane P Allard
- Department of Medicine, Division of Gastroenterology, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
6
|
Cloutier A, Deutsch L, Miller B, Leahy G, Ablett J, Healey A, Twist K, Teubner A, Abraham A, Taylor M, Pironi L, Lal S. Factors affecting antidepressant use by patients requiring home parenteral nutrition. JPEN J Parenter Enteral Nutr 2021; 46:153-159. [PMID: 33615504 DOI: 10.1002/jpen.2090] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Revised: 01/25/2021] [Accepted: 02/12/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND Home parenteral nutrition (HPN) is a life-saving therapy for patients with chronic intestinal failure but can be associated with a degree of psychological distress. The factors associated with the need for antidepressants (ADs) in this cohort have not yet been described. METHODS The study involved prospective data collection from patients attending an HPN clinic at a national intestinal failure referral center. Patients requiring HPN as a result of active malignancy were excluded. Patients were divided in 2 groups according to AD usage; demographic, anthropometric, socioeconomic characteristics, and intravenous supplementation (IVS) regimens were compared between groups. RESULTS A total of 184 patients were recruited between July 2018 and April 2019, with an overall prevalence of AD use of 41.7% (70/168 patients). Daily mean IVS volume was significantly higher among patients taking AD ("AD" group; 2125.48 ± 991.8 ml/day, "no-AD" group; 1828.54 ± 847.0 ml/day, P = .039), with the proportion of patients needing high-volume IVS (≥3000 ml/day) being 3 times higher in the AD group (20.0%(14/70 patients) vs 6.1% (6/98 patients), P = .006). The average energy IVS infusion per day was similar between the groups. CONCLUSION This is the first study to demonstrate that AD use correlates with higher IVS volume rather than energy requirements in HPN patients, suggesting that high IVS volume requirements may be better associated with the patient's disease burden. Early and tailored mental health intervention may be beneficial in those with high IVS volume requirements.
Collapse
Affiliation(s)
- Anabelle Cloutier
- Intestinal Failure Unit, Salford Royal NHS Foundation Trust, Salford, and Manchester, UK.,CHU de Québec-Université Laval, Québec, Canada
| | - Liat Deutsch
- Intestinal Failure Unit, Salford Royal NHS Foundation Trust, Salford, and Manchester, UK.,The Department of Gastroenterology and Liver Diseases, Tel-Aviv Sourasky Medical Centre and Sackler Faculty of Medicine, Tel-Aviv University, Israel
| | - Bethany Miller
- Intestinal Failure Unit, Salford Royal NHS Foundation Trust, Salford, and Manchester, UK
| | - Gavin Leahy
- Intestinal Failure Unit, Salford Royal NHS Foundation Trust, Salford, and Manchester, UK
| | - Joanne Ablett
- Intestinal Failure Unit, Salford Royal NHS Foundation Trust, Salford, and Manchester, UK
| | - Andrew Healey
- Intestinal Failure Unit, Salford Royal NHS Foundation Trust, Salford, and Manchester, UK
| | - Katherine Twist
- Intestinal Failure Unit, Salford Royal NHS Foundation Trust, Salford, and Manchester, UK
| | - Antje Teubner
- Intestinal Failure Unit, Salford Royal NHS Foundation Trust, Salford, and Manchester, UK
| | - Arun Abraham
- Intestinal Failure Unit, Salford Royal NHS Foundation Trust, Salford, and Manchester, UK
| | - Michael Taylor
- Intestinal Failure Unit, Salford Royal NHS Foundation Trust, Salford, and Manchester, UK
| | - Loris Pironi
- Centre for Chronic Intestinal Failure, Department of Digestive System, St. Orsola-Malpighi University Hospital, Bologna, Italy
| | - Simon Lal
- Intestinal Failure Unit, Salford Royal NHS Foundation Trust, Salford, and Manchester, UK.,Academic Health Sciences Centre, University of Manchester, Manchester, UK
| |
Collapse
|
7
|
Etiology of and predictive factors for chronic intestinal failure requiring long term parenteral support in the last two decades: A retrospective study. Clin Nutr ESPEN 2020; 37:168-172. [DOI: 10.1016/j.clnesp.2020.02.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Revised: 02/18/2020] [Accepted: 02/23/2020] [Indexed: 11/23/2022]
|
8
|
Lauro A, Cirocchi R, Cautero N, Dazzi A, Pironi D, Di Matteo FM, Santoro A, Pironi L, Pinna AD. Reconnection surgery in adult post-operative short bowel syndrome < 100 cm: is colonic continuity sufficient to achieve enteral autonomy without autologous gastrointestinal reconstruction? Report from a single center and systematic review of literature. G Chir 2019; 38:163-175. [PMID: 29182898 DOI: 10.11138/gchir/2017.38.4.163] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
A systematic bibliographic research concerning patients operated on for SBS was performed: inclusion criteria were adult age, reconnection surgery and SBS < 100 cm. Autologous gastrointestinal reconstruction represented an exclusion criteria. The outcomes of interest were the rate of total parenteral nutrition (TPN) independence and the length of follow-up (minimum 1 year) after surgery. We reviewed our experience from 2003 to 2013 with minimum 1-year follow-up, dealing with reconnection surgery in 13 adults affected by < 100 cm SBS after massive small bowel resection: autologous gastrointestinal reconstruction was not feasible. Three (out of 5168 screened papers) non randomized controlled trials with 116 adult patients were analysed showing weaning from TPN (40%, 50% and 90% respectively) after reconnection surgery without autologous gastrointestinal reconstruction. Among our 13 adults, mean age was 54.1 years (53.8 % ASA III): 69.2 % had a high stomal output (> 500 cc/day) and TPN dependence was 100%. We performed a jejuno-colonic anastomosis (SBS type II) in 53.8%, in 46.1% of cases without ileo-cecal valve, leaving a mean residual small bowel length of 75.7 cm. In-hospital mortality was 0%. After a minimum period of 1 year of intestinal rehabilitation, all our patients (100%) went back to oral intake and 69.2% were off TPN (9 patients). No one was listed for transplantation. A residual small bowel length of minimum 75 cm, even if reconnected to part of the colon, seems able to produce a TPN independence without autologous gastrointestinal reconstruction after a minimum period of 1 year of intestinal rehabilitation.
Collapse
|
9
|
Koelfat KVK, Huijbers A, Schaap FG, van Kuijk SMJ, Lenicek M, Soeters MR, Wanten GJA, Olde Damink SWM. Low circulating concentrations of citrulline and FGF19 predict chronic cholestasis and poor survival in adult patients with chronic intestinal failure: development of a Model for End-Stage Intestinal Failure (MESIF risk score). Am J Clin Nutr 2019; 109:1620-1629. [PMID: 31075790 DOI: 10.1093/ajcn/nqz036] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Accepted: 02/21/2019] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Patients with chronic intestinal failure (CIF) often develop cholestatic liver injury, which may lead to liver failure and need for organ transplantation. OBJECTIVES The aim of this study was to investigate whether citrulline (CIT) and the enterokine fibroblast growth factor 19 (FGF19) are associated with chronic cholestasis and survival in adult CIF patients, and to develop a risk score to predict their survival. METHODS We studied 135 adult CIF patients on intravenous supplementation (>3 mo). Associations of plasma CIT and FGF19 with chronic cholestasis and survival were estimated by logistic and Cox regression models. A predictive risk score was developed and validated internally. RESULTS Patients with chronic cholestasis (17%) had a reduced 5-y survival rate compared with patients without chronic cholestasis (38% and 62%, respectively). In multivariable analysis, low FGF19, low CIT, and female sex were associated with chronic cholestasis. Patients with low rather than high CIT or FGF19 also had reduced 5-y survival rates (29% compared with 69%; 54% compared with 66%, respectively). Risk factors identified in multivariable analysis of survival were low FGF19 (HR: 3.4), low CIT (HR: 3.3), and number of intravenous infusions per week (HR: 1.4). These 3 predictors were incorporated in a risk model of survival termed Model for End-Stage Intestinal Failure (MESIF) (C-statistic 0.78). The 5-y survival rates for patients with MESIF scores of 0 to <20 (n = 47), 20-40 (n = 75), and >40 (n = 13) were 80%, 58%, and 14%, respectively. CONCLUSIONS CIT and FGF19 predict chronic cholestasis and survival in this cohort of adult CIF patients, and the derived MESIF score is associated with their survival. Pending external validation, the MESIF score may help to identify patients for closer clinical monitoring or earlier referral to intestinal transplantation centers.
Collapse
Affiliation(s)
- Kiran V K Koelfat
- Department of Surgery, Maastricht, Netherlands.,NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, Netherlands
| | - Angelique Huijbers
- Department of Gastroenterology & Hepatology, Radboud University Medical Center, Nijmegen, Netherlands
| | - Frank G Schaap
- Department of Surgery, Maastricht, Netherlands.,NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, Netherlands.,Department of General, Visceral and Transplantation Surgery, RWTH University Hospital Aachen, Aachen, Germany
| | - Sander M J van Kuijk
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Center, Maastricht, Netherlands
| | - Martin Lenicek
- Department of Medical Biochemistry and Laboratory Diagnostics, 1st Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Maarten R Soeters
- Department of Endocrinology and Metabolism, Amsterdam University Medical Centers, location AMC, Amsterdam, Netherlands
| | - Geert J A Wanten
- Department of Gastroenterology & Hepatology, Radboud University Medical Center, Nijmegen, Netherlands
| | - Steven W M Olde Damink
- Department of Surgery, Maastricht, Netherlands.,NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, Netherlands.,Department of General, Visceral and Transplantation Surgery, RWTH University Hospital Aachen, Aachen, Germany
| |
Collapse
|
10
|
Santarpia L, Viceconte G, Foggia M, Alfonsi L, Tosone G, Camera L, Pagano MC, De Simone G, Contaldo F, Pasanisi F. Home Parenteral Nutrition in Patients with Intestinal Failure: Possible Undetected Complications. Nutrients 2019; 11:nu11030581. [PMID: 30857281 PMCID: PMC6471421 DOI: 10.3390/nu11030581] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 03/02/2019] [Accepted: 03/05/2019] [Indexed: 11/27/2022] Open
Abstract
Background: Septic pulmonary embolism (SPE) may be a frequently undetected complication of central venous catheter (CVC)-related bloodstream infections (CRBSIs). Materials and Methods: The incidence of SPE was evaluated in a cohort of non-oncological patients on home parenteral nutrition (HPN) who were hospitalized for a CRBSI from January 2013 to December 2017. The main clinical, microbiological, and radiological features and the therapeutic approach were also described. Results: Twenty-three infections over 51,563 days of HPN therapy were observed, corresponding to an infection rate of 0.45/1000. In 10 out of the 23 cases (43.5%), pulmonary lesions compatible with SPE were identified. Conclusion: Our results demonstrated that a CRBSI can produce asymptomatic SPE with lung infiltrates in 43.5% of the cases, suggesting the need to check for secondary lung infections to choose the most appropriate antimicrobial therapy.
Collapse
Affiliation(s)
- Lidia Santarpia
- Internal Medicine and Clinical Nutrition, Department of Clinical Medicine and Surgery, Federico II University of Naples, 80131 Naples, Italy.
| | - Giulio Viceconte
- Infectious Disease, Department of Clinical Medicine and Surgery, Federico II University of Naples, 80131 Naples, Italy.
| | - Maria Foggia
- Infectious Disease, Department of Clinical Medicine and Surgery, Federico II University of Naples, 80131 Naples, Italy.
| | - Lucia Alfonsi
- Internal Medicine and Clinical Nutrition, Department of Clinical Medicine and Surgery, Federico II University of Naples, 80131 Naples, Italy.
| | - Grazia Tosone
- Infectious Disease, Department of Clinical Medicine and Surgery, Federico II University of Naples, 80131 Naples, Italy.
| | - Luigi Camera
- Radiology, Department of Advanced Biomedical Sciences, Federico II University of Naples, 80131 Naples, Italy.
| | - Maria Carmen Pagano
- Internal Medicine and Clinical Nutrition, Department of Clinical Medicine and Surgery, Federico II University of Naples, 80131 Naples, Italy.
| | - Giuseppe De Simone
- Anesthesiology and Intensive Care Unit, Department of Neurosciences, Federico II University, 80131 Naples, Italy.
| | - Franco Contaldo
- Internal Medicine and Clinical Nutrition, Department of Clinical Medicine and Surgery, Federico II University of Naples, 80131 Naples, Italy.
| | - Fabrizio Pasanisi
- Internal Medicine and Clinical Nutrition, Department of Clinical Medicine and Surgery, Federico II University of Naples, 80131 Naples, Italy.
| |
Collapse
|
11
|
The impact of home parenteral nutrition on the burden of disease including morbidity, mortality and rate of hospitalisations. Clin Nutr ESPEN 2018; 28:222-227. [DOI: 10.1016/j.clnesp.2018.07.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Revised: 07/06/2018] [Accepted: 07/20/2018] [Indexed: 11/20/2022]
|
12
|
Cheung YW, Barco S, Mathôt RA, van den Dool EJ, Stroobants AK, Serlie MJ, Middeldorp S, Coppens M. Pharmacokinetics of dabigatran etexilate and rivaroxaban in patients with short bowel syndrome requiring parenteral nutrition: The PDER PAN study. Thromb Res 2017; 160:76-82. [DOI: 10.1016/j.thromres.2017.10.025] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2017] [Revised: 08/23/2017] [Accepted: 10/31/2017] [Indexed: 12/21/2022]
|
13
|
Pediatric Chronic Intestinal Failure in Italy: Report from the 2016 Survey on Behalf of Italian Society for Gastroenterology, Hepatology and Nutrition (SIGENP). Nutrients 2017; 9:nu9111217. [PMID: 29113094 PMCID: PMC5707689 DOI: 10.3390/nu9111217] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Revised: 10/25/2017] [Accepted: 10/27/2017] [Indexed: 11/20/2022] Open
Abstract
Background: Intestinal failure (IF) is the reduction in functioning gut mass below the minimal level necessary for adequate digestion and absorption of nutrients and fluids for weight maintenance in adults or for growth in children. There is a paucity of epidemiologic data on pediatric IF. The purpose of this study was to determine the prevalence, incidence, regional distribution and underlying diagnosis of pediatric chronic IF (CIF) requiring home parenteral nutrition (HPN) in Italy. Methods: Local investigators were selected in 19 Italian centers either of reference for pediatric HPN or having pediatric gastroenterologists or surgeons on staff and already collaborating with the Italian Society for Pediatric Gastroenterology, Hepatology and Nutrition with regard to IF. Data requested in this survey for children at home on Parenteral Nutrition (PN) on 1 December 2016 included patient initials, year of birth, gender, family’s place of residence and underlying diagnosis determining IF. Results: We recorded 145 CIF patients on HPN aged ≤19 years. The overall prevalence was 14.12/million inhabitants (95% CI: 9.20–18.93); the overall incidence was 1.41/million inhabitant years (95% CI: 0.53–2.20). Conclusion: Our survey provides new epidemiological data on pediatric CIF in Italy; these data may be quantitatively useful in developing IF care strategy plans in all developed countries.
Collapse
|
14
|
Neonatal Soft Tissue Reconstruction Using a Bioengineered Skin Substitute. J Craniofac Surg 2017; 28:489-491. [DOI: 10.1097/scs.0000000000003346] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
|
15
|
Matarese LE, O'Keefe SJ, Kandil HM, Bond G, Costa G, Abu-Elmagd K. Short Bowel Syndrome: Clinical Guidelines for Nutrition Management. Nutr Clin Pract 2017; 20:493-502. [PMID: 16207689 DOI: 10.1177/0115426505020005493] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Intestinal failure is a condition in which inadequate digestion or absorption of fluid, electrolytes, and nutrients leads to dehydration or malnutrition. The most common cause of intestinal failure is short bowel syndrome (SBS) defined as <200 cm of functional small intestine. SBS may result from congenital abnormalities or from surgical resection. For the past 3 decades, patients with severe SBS were managed with home parenteral nutrition (HPN). With the emergence of new therapies, the clinician now has multiple options to treat these patients. These include intestinal rehabilitation regimens whereby patients are treated with specialized oral diets, soluble fiber, oral rehydration solutions (ORS), and trophic factors to enhance absorption. There are also a variety of surgical techniques available to preserve intestinal length. Small bowel and multivisceral transplantation has evolved during the last decade to be a valid therapeutic option for those patients who cannot be rehabilitated or who fail HPN. These are interrelated services designed to offer the patient the best therapeutic options to meet their individual needs. This article reviews the principles associated with the nutrition management of this very complex and diverse group of patients.
Collapse
Affiliation(s)
- Laura E Matarese
- Intestinal Rehabilitation and Transplant Center, Thomas E. Starzl Transplantation Institute, UPMC Montefiore, 7 South, 3459 Fifth Avenue, Pittsburgh, PA 15213, USA.
| | | | | | | | | | | |
Collapse
|
16
|
Bern M. Observations on Possible Effects of Daily Vitamin K Replacement, Especially Upon Warfarin Therapy. JPEN J Parenter Enteral Nutr 2017; 28:388-98. [PMID: 15568285 DOI: 10.1177/0148607104028006388] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Daily parenteral vitamin K supplement is now recommended by the U.S. Food and Drug Administration (FDA) for patients receiving IV hyperalimentation. This is considered as preferable to the previous recommendations of weekly parenteral or oral supplement, or as in some cases no supplement at all. Supplemental vitamin K1 will ensure adequate supplies for hepatic saturation and thus the production of clotting factors II, VII, IX, and X, plus the anticoagulants protein C, protein S, and protein Z. But this is not the entire story. This recommended supplement will affect other physiologic systems that also use vitamin K-dependent gamma-carboxylation. Vitamin K is not 1 molecule but rather 2 natural substances, vitamin K1 and K2, and the synthetic K3's. It is not understood, what, if any, effect may occur because of the saturation or competition from the vitamin K1 upon the functioning of vitamins K2 and the derivatives of K3 in vivo upon bone mineralization, cell growth, and blood vessel health, all known to be influenced by the vitamins K. There are probably other physiologic systems yet to be studied relative to vitamins K and gamma-carboxylation. This review also considers the available research upon warfarin when given to patients receiving hyperalimentation and what effects the vitamin K supplements may have. Because studies to date have not controlled for vitamin K intake, consideration is given to whether one should expect any change in previously reported outcomes when using low-dose warfarin for prophylaxis against central vein thrombosis. Also considered are possible positive or negative effects that chronic warfarin therapy may have upon the other vitamin K-dependent systems under discussion. This review offers a platform for further discussion and derived clinical research provoked by this new FDA recommendation.
Collapse
Affiliation(s)
- Murray Bern
- Cancer Center of Boston, New England Baptist Hospital, Harvard Medical School, Boston, Massachusetts, USA.
| |
Collapse
|
17
|
Fairman J, Compher C, Morris J, Mullen JL. Living Long With Short Bowel Syndrome: A Historical Case of Twenty-Nine Years of Living With Home Parenteral Nutrition. JPEN J Parenter Enteral Nutr 2017; 31:127-34. [PMID: 17308253 DOI: 10.1177/0148607107031002127] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND This paper traces the 29-year survival of Robert Thomas, who received home parenteral nutrition (PN), and contrasts his oral narrative with the clinical history of PN. METHODS Interviews, chart review, review of the literature, and historical analysis. RESULTS Bobby Thomas was part of an early group of patients scattered throughout the country who, with their medical team, provided the foundation for more successful survival with home PN. They learned together and taught numerous nutrition support clinicians the intricacies of patient management. The importance of the patient to the teaching function of new and experienced practitioners is highly critical. Patients like Robert Thomas gave practitioners firsthand evidence of both the tenacity of the human spirit and the complexity and difficulties of chronic illness and its treatments. CONCLUSIONS While Bobby struggled with the complications and difficulties that came with the disease and the treatment keeping him alive, his own experiences over 29 years, as told to his medical team during his treatment and to informed interviewers before he died, tell a story that is both intersecting and parallel to the medical history. Pioneering patients like Bobby Thomas confirm the possibility of survival. They also, through their own negotiations to maintain a sense of control, can live lives they themselves help define.
Collapse
Affiliation(s)
- Julie Fairman
- University of Pennsylvania-School of Nursing, Philadelphia, Pennsylvania 19104-6096, USA.
| | | | | | | |
Collapse
|
18
|
Santarpia L, Buonomo A, Pagano MC, Alfonsi L, Foggia M, Mottola M, Marinosci GZ, Contaldo F, Pasanisi F. Central venous catheter related bloodstream infections in adult patients on home parenteral nutrition: Prevalence, predictive factors, therapeutic outcome. Clin Nutr 2016; 35:1394-1398. [DOI: 10.1016/j.clnu.2016.03.009] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Revised: 03/10/2016] [Accepted: 03/14/2016] [Indexed: 02/07/2023]
|
19
|
Anticoagulants for the prevention and treatment of catheter-related thrombosis in adults and children on parenteral nutrition: a systematic review and critical appraisal. BLOOD TRANSFUSION = TRASFUSIONE DEL SANGUE 2016; 15:369-377. [PMID: 27483479 DOI: 10.2450/2016.0031-16] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Accepted: 05/11/2016] [Indexed: 12/26/2022]
Abstract
BACKGROUND Patients on parenteral nutrition require a central venous access and are at risk of catheter-related thrombosis, pulmonary embolism, and vena cava syndrome. Parenteral nutrition guidelines suggest anticoagulation for the primary prevention of catheter-related thrombosis during long-term parenteral nutrition. We conducted a systematic review of the efficacy, safety and feasibility of anticoagulant use for preventing and treating catheter-related thrombosis during parenteral nutrition. MATERIALS AND METHODS We searched for interventional and observational studies on adults and children receiving systemic anticoagulants during either short- or long-term parenteral nutrition delivered via central venous access. Primary outcomes were: objectively-confirmed catheter-related thrombosis, pulmonary embolism and bleeding. Secondary outcomes were: heparin-induced thrombocytopenia, prevalence of anticoagulation, and quality of International Normalised Ratio management in vitamin K antagonist-treated patients. RESULTS We identified 1,199 studies, of which 23 were included. Seven interventional studies of short-term parenteral nutrition (adult population, n=5) were classified as low-quality: in those, intravenous unfractionated heparin did not prevent catheter-related thrombosis if compared to saline. No interventional studies were conducted in patients on long-term parenteral nutrition. Observational data were sparse, rarely focusing on anticoagulation, and overall of low quality. The reported use of anticoagulants was between 22 and 66% in recent multicentre cohorts. DISCUSSION The amount and quality of data in this area are very suboptimal: most studies are outdated and involved heterogeneous populations. Currently, there is insufficient evidence to allow conclusions to be reached regarding the efficacy and safety of anticoagulants in this setting.
Collapse
|
20
|
Brandt CF, Hvistendahl M, Naimi RM, Tribler S, Staun M, Brøbech P, Jeppesen PB. Home Parenteral Nutrition in Adult Patients With Chronic Intestinal Failure: The Evolution Over 4 Decades in a Tertiary Referral Center. JPEN J Parenter Enteral Nutr 2016; 41:1178-1187. [DOI: 10.1177/0148607116655449] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Christopher Filtenborg Brandt
- Department of Medical Gastroenterology CA 2-12-1, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Mark Hvistendahl
- Department of Medical Gastroenterology CA 2-12-1, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Rahim M. Naimi
- Department of Medical Gastroenterology CA 2-12-1, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Siri Tribler
- Department of Medical Gastroenterology CA 2-12-1, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Michael Staun
- Department of Medical Gastroenterology CA 2-12-1, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Per Brøbech
- Department of Medical Gastroenterology CA 2-12-1, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Palle Bekker Jeppesen
- Department of Medical Gastroenterology CA 2-12-1, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| |
Collapse
|
21
|
Braga CBM, Ferreira IMDL, Marchini JS, Cunha SFDCD. Copper and magnesium deficiencies in patients with short bowel syndrome receiving parenteral nutrition or oral feeding. ARQUIVOS DE GASTROENTEROLOGIA 2016; 52:94-9. [PMID: 26039825 DOI: 10.1590/s0004-28032015000200004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/18/2014] [Accepted: 11/28/2014] [Indexed: 11/22/2022]
Abstract
BACKGROUND Patients with short bowel syndrome have significant fluid and electrolytes loss. OBJECTIVE Evaluate the mineral and electrolyte status in short bowel syndrome patients receiving intermittent parenteral nutrition or oral feeding. METHODS Twenty two adults with short bowel syndrome, of whom 11 were parenteral nutrition dependent (PN group), and the 11 remaining had been weaned off parenteral nutrition for at least 1 year and received all nutrients by oral feeding (OF group). The study also included 14 healthy volunteers paired by age and gender (control group). Food ingestion, anthropometry, serum or plasma levels of sodium, potassium, phosphorus, magnesium, calcium, zinc, iron and copper were evaluated. PN group subjects were evaluated before starting a new parenteral nutrition cycle. RESULTS The levels of sodium, potassium, phosphorus, calcium and zinc were similar between the groups. The magnesium value was lower in the PN group (1.0 ± 0.4 mEq /L) than other groups. Furthermore, this electrolyte was lower in the OF group (1.4 ± 0.3 mEq /L) when compared to the Control group (1.8 ± 0.1 mEq/L). Lower values of copper (69±24 vs 73±26 vs 109±16 µg/dL) were documented, respectively, for the PN and OF groups when compared to the control group. CONCLUSION Hypomagnesemia and hypocupremia are electrolyte disturbances commonly observed in short bowel syndrome. Patients with massive intestinal resection require monitoring and supplementation in order to prevent magnesium and copper deficiencies.
Collapse
|
22
|
Meira Filho SP, Guardia BD, Evangelista AS, Matielo CEL, Neves DB, Pandullo FL, Felga GEG, Alves JADS, Curvelo LA, Diaz LGG, Rusi MB, Viveiros MDM, Almeida MDD, Epstein MG, Pedroso PT, Salvalaggio P, Meirelles Júnior RF, Rocco RA, Almeida SSD, Rezende MBD. Intestinal and multivisceral transplantation. EINSTEIN-SAO PAULO 2015; 13:136-41. [PMID: 25993080 PMCID: PMC4977588 DOI: 10.1590/s1679-45082015rw3155] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2014] [Accepted: 02/08/2015] [Indexed: 11/28/2022] Open
Abstract
Intestinal transplantation has shown exceptional growth over the past 10 years. At the end of the 1990’s, intestinal transplantation moved out of the experimental realm to become a routine practice in treating patients with severe complications related to total parenteral nutrition and intestinal failure. In the last years, several centers reported an increasing improvement in survival outcomes (about 80%), during the first 12 months after surgery, but long-term survival is still a challenge. Several advances led to clinical application of transplants. Immunosuppression involved in intestinal and multivisceral transplantation was the biggest gain for this procedure in the past decade due to tacrolimus, and new inducing drugs, mono- and polyclonal anti-lymphocyte antibodies. Despite the advancement of rigid immunosuppression protocols, rejection is still very frequent in the first 12 months, and can result in long-term graft loss. The future of intestinal transplantation and multivisceral transplantation appears promising. The major challenge is early recognition of acute rejection in order to prevent graft loss, opportunistic infections associated to complications, post-transplant lymphoproliferative disease and graft versus host disease; and consequently, improve results in the long run.
Collapse
|
23
|
Home parenteral nutrition program and referral of potential candidates for intestinal and multivisceral transplantation in a single Brazilian center. Transplant Proc 2015; 46:1839-41. [PMID: 25131049 DOI: 10.1016/j.transproceed.2014.05.056] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Intestinal failure is a multifaceted condition that may require high-complexity treatment and a multidisciplinary program, including home parenteral nutrition therapy (HPNT) and intestinal transplantation. In this article, we profile a Brazilian single-center experience with 128 cases of HTPN followed for the last 30 years and appraise the referral for potential intestinal and multivisceral transplantation.
Collapse
|
24
|
Gastrointestinal Manifestations, Malnutrition, and Role of Enteral and Parenteral Nutrition in Patients With Scleroderma. J Clin Gastroenterol 2015; 49:559-64. [PMID: 25992813 DOI: 10.1097/mcg.0000000000000334] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Scleroderma (systemic sclerosis) is an autoimmune disease that can affect multiple organ systems. Gastrointestinal (GI) involvement is the most common organ system involved in scleroderma. Complications of GI involvement including gastroesophageal reflux disease, small intestinal bacterial overgrowth, and chronic intestinal pseudoobstruction secondary to extensive fibrosis may lead to nutritional deficiencies in these patients. Here, we discuss pathophysiology, progression of GI manifestations, and malnutrition secondary to scleroderma, and the use of enteral and parenteral nutrition to reverse severe nutritional deficiencies. Increased mortality in patients with concurrent malnutrition in systemic sclerosis, as well as the refractory nature of this malnutrition to pharmacologic therapies compels clinicians to provide novel and more invasive interventions in reversing these nutritional deficiencies. Enteral and parenteral nutrition have important implications for patients who are severely malnourished or have compromised GI function as they are relatively safe and have substantial retrospective evidence of success. Increased awareness of these therapeutic options is important when treating scleroderma-associated malnutrition.
Collapse
|
25
|
Braga CBM, Bizari L, Suen VMM, Marchini JS, Paula FJAD, Cunha SFDCD. Bone mineral density in short bowel syndrome: correlation with BMI and serum vitamins C, E and K. ARCHIVES OF ENDOCRINOLOGY AND METABOLISM 2015; 59:252-8. [DOI: 10.1590/2359-3997000000046] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/18/2014] [Accepted: 11/22/2014] [Indexed: 11/22/2022]
|
26
|
Durkin MJ, Dukes JL, Reeds DN, Mazuski JE, Camins BC. A Descriptive Study of the Risk Factors Associated With Catheter-Related Bloodstream Infections in the Home Parenteral Nutrition Population. JPEN J Parenter Enteral Nutr 2015; 40:1006-13. [PMID: 25596210 DOI: 10.1177/0148607114567899] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2014] [Accepted: 12/10/2014] [Indexed: 11/15/2022]
Abstract
BACKGROUND Home parenteral nutrition (HPN) is increasingly used for nutrition support after patients are discharged from the hospital. Catheter-related bloodstream infections (CR-BSI) are a common and potentially fatal complication of HPN. The risk factors for development of CR-BSI in the outpatient setting are poorly understood. METHODS We conducted an observational, retrospective study of 225 patients discharged from Barnes-Jewish Hospital on HPN between January 1, 2007, and December 31, 2009. HPN complications were defined as any cause that led to either premature discontinuation of HPN therapy or catheter replacement. CR-BSI events were identified by provider documentation. We calculated the overall complication rate and the complication rate specifically due to CR-BSI. Backward stepwise Cox regression analyses were used to assess for independent predictors of catheter-related complications. RESULTS In total, 111 of 225 patients (49%) developed complications while receiving HPN (incidence = 5.06 episodes/1000 catheter days). Sixty-eight of 225 patients (30%) required catheter removal for CR-BSI (incidence = 3.10 episodes/1000 catheter days). Independent predictors of line removal specifically due to infection included anticoagulant use, ulcer or open wound, and Medicare or Medicaid insurance. The following risk factors were associated with catheter-associated complications and/or CR-BSI: the presence of ulcers, the use of systemic anticoagulants, public insurance (Medicare or Medicaid), and patient age. Independent predictors of line removal for any complication included age and anticoagulant use. CONCLUSION Catheter-related complications were extremely common in patients receiving HPN. Healthcare providers caring for individuals who require HPN should be aware of risk factors for complications.
Collapse
Affiliation(s)
- Michael J Durkin
- Department of Medicine, Division of Hospital Medicine, Washington University in St Louis, St Louis, Missouri, USA
| | - Jonathan L Dukes
- Department of Obstetrics and Gynecology, Washington University in St Louis, St Louis, Missouri, USA
| | - Dominic N Reeds
- Department of Medicine, Division of Geriatrics and Nutritional Science, Washington University in St Louis, St Louis, Missouri, USA
| | - John E Mazuski
- Department of Surgery, Section of Acute and Critical Care Surgery, Washington University in St Louis, St Louis, Missouri, USA
| | - Bernard C Camins
- Department of Medicine, Division of Infectious Diseases, Washington University in St Louis, St Louis, Missouri, USA
| |
Collapse
|
27
|
Abstract
OBJECTIVE As data about prevalence and standard of care in short bowel syndrome (SBS) are not available for Germany, this study estimated the prevalence and assessed the medical infrastructure to potentially improve care of SBS patients. METHODS In a validated approach for prevalence estimation in rare diseases, a randomized census of 478 size-stratified hospitals with surgical, internal medicine and pediatric departments was conducted to estimate SBS prevalence. The number of SBS patients, specialized outpatient clinics and caregiver expertise were assessed. RESULTS The response rate was 85 % of randomized hospitals (405/478). Strata-derived estimation yielded a total of 2,808 SBS patients in Germany for 2011/2012 (95 % CI: 1750.3865), translating into a prevalence estimation for 34/million inhabitants (95 % CI: 21.47). Overall expertise in SBS treatment was only rated "satisfactory" by most caregivers. While 86 specialized outpatient clinics were identified, there was no central registry to access these resources. CONCLUSION Short bowel syndrome, with a newly estimated prevalence of 34/million inhabitants is not a very rare medical condition in Germany. The interdisciplinary approach needed for optimal care for SBS patients would be greatly facilitated by a central registry.
Collapse
|
28
|
ESPEN endorsed recommendations. Definition and classification of intestinal failure in adults. Clin Nutr 2014; 34:171-80. [PMID: 25311444 DOI: 10.1016/j.clnu.2014.08.017] [Citation(s) in RCA: 361] [Impact Index Per Article: 36.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2014] [Revised: 08/20/2014] [Accepted: 08/23/2014] [Indexed: 12/11/2022]
Abstract
BACKGROUND & AIMS Intestinal failure (IF) is not included in the list of PubMed Mesh terms, as failure is the term describing a state of non functioning of other organs, and as such is not well recognized. No scientific society has yet devised a formal definition and classification of IF. The European Society for Clinical Nutrition and Metabolism guideline committee endorsed its "home artificial nutrition and chronic IF" and "acute IF" special interest groups to write recommendations on these issues. METHODS After a Medline Search, in December 2013, for "intestinal failure" and "review"[Publication Type], the project was developed using the Delphi round methodology. The final consensus was reached on March 2014, after 5 Delphi rounds and two live meetings. RESULTS The recommendations comprise the definition of IF, a functional and a pathophysiological classification for both acute and chronic IF and a clinical classification of chronic IF. IF was defined as "the reduction of gut function below the minimum necessary for the absorption of macronutrients and/or water and electrolytes, such that intravenous supplementation is required to maintain health and/or growth". CONCLUSIONS This formal definition and classification of IF, will facilitate communication and cooperation among professionals in clinical practice, organization and management, and research.
Collapse
|
29
|
Soin AS, Mohanka R, Saraf N, Rastogi A, Goja S, Menon B, Vohra V, Saigal S, Sud R, Kumar D, Bhangui P, Ramachandra S, Singla P, Shetty G, Raghvendra K, Elmagd KMA. India's first successful intestinal transplant: the road traveled and the lessons learnt. Indian J Gastroenterol 2014; 33:104-13. [PMID: 24500752 DOI: 10.1007/s12664-013-0437-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2013] [Accepted: 12/14/2013] [Indexed: 02/04/2023]
Abstract
Intestinal transplant is a therapeutic challenge not just surgically but also logistically because of the multidisciplinary expertise and resources required. A large proportion of patients who undergo massive bowel resection and develop intestinal failure have poor outcome, because of inability to sustain long-term parenteral nutrition and limited availability of intestinal and multi-visceral transplantation facilities. We report the first successful isolated intestinal transplant from India.
Collapse
Affiliation(s)
- A S Soin
- Medanta Institute of Liver Diseases and Transplantation, Medanta-The Medicity, Sector 38, Gurgaon, Haryana, 122 001, India,
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
30
|
Santarpia L, Pagano MC, Pasanisi F, Contaldo F. Home artificial nutrition: an update seven years after the regional regulation. Clin Nutr 2013; 33:872-8. [PMID: 24182767 DOI: 10.1016/j.clnu.2013.10.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2013] [Revised: 08/10/2013] [Accepted: 10/08/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND & AIMS Home Artificial Nutrition (HAN) is a well established extra-hospital therapy, contributing to decreased health care costs, by reducing the number and length of hospitalizations. The knowledge of the epidemiology of HAN helps plan health-care funding and in analyze the factors that can improve HAN service. SUBJECTS AND METHODS An update on the prevalence of Home Artificial Nutrition (HAN) in the Campania region (Southern Italy) and patients clinical characteristics has been regularly carried out in the past seven years after a specific regional regulation issued in 2005. RESULTS Total number of patients on HAN has increased from 355 in April 2005 to 1165 in April 2012 (+228.2%); in particular, patients on Home Parenteral Nutrition (HPN) increased from 156 in April 2005 to 306 in April 2012 (+96.2%) and patients on Home Enteral Nutrition (HEN) from 199 to 838 (+321.1%) respectively. HEN/HPN ratio in adults has changed from 1.3/1 in April 2005 to 2.7/1 in April 2012, gradually nearing the expected national mean ratio of 5/1 as observed in the 2005 national survey. CONCLUSIONS The specific regional regulation in Campania has contributed to increase the prescription of HAN and to ameliorate its indications; in particular, through the years, HEN is gradually nearing national standards.
Collapse
Affiliation(s)
- Lidia Santarpia
- Regional Coordinator Center, Internal Medicine and Clinical Nutrition Unit, Department of Clinical Medicine and Surgery, Federico II University Hospital, Naples, Italy.
| | - Maria Carmen Pagano
- Regional Coordinator Center, Internal Medicine and Clinical Nutrition Unit, Department of Clinical Medicine and Surgery, Federico II University Hospital, Naples, Italy
| | - Fabrizio Pasanisi
- Regional Coordinator Center, Internal Medicine and Clinical Nutrition Unit, Department of Clinical Medicine and Surgery, Federico II University Hospital, Naples, Italy
| | - Franco Contaldo
- Regional Coordinator Center, Internal Medicine and Clinical Nutrition Unit, Department of Clinical Medicine and Surgery, Federico II University Hospital, Naples, Italy
| |
Collapse
|
31
|
Schliefert E, Carey S. Nutritional status and quality of life in a cohort of Australian home parenteral nutrition patients: A pilot study. Nutr Diet 2013. [DOI: 10.1111/1747-0080.12078] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Affiliation(s)
- Emma Schliefert
- Clinical Nutrition Unit; University of Sydney; Sydney New South Wales Australia
| | - Sharon Carey
- Clinical Nutrition Unit; University of Sydney; Sydney New South Wales Australia
- Department of Nutrition and Dietetics; Royal Prince Alfred Hospital; Sydney New South Wales Australia
| |
Collapse
|
32
|
Nielsen XC, Chen M, Hellesøe AMB, Jeppesen PB, Gyldenlykke J, Tvede M, Andersen LP. Etiology and epidemiology of catheter related bloodstream infections in patients receiving home parenteral nutrition in a gastromedical center at a tertiary hospital in denmark. Open Microbiol J 2012; 6:98-101. [PMID: 23248717 PMCID: PMC3520033 DOI: 10.2174/1874285801206010098] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2012] [Revised: 09/18/2012] [Accepted: 10/05/2012] [Indexed: 11/22/2022] Open
Abstract
We conducted a retrospective epidemiologic study of catheter related bloodstream infections (CRBSI) in patients receiving long-term home parenteral nutrition (HPN) from January 2002 to December 2005. Our results showed that coagulase negative staphylococci (CoNS) were the most prevalent pathogens (44.7% of all CRBSI episodes), followed by Enterobacteriaceae (33.2%). Prevalence for candidemia and Enterococcus bacteremia was relatively high (14.4% and 10.8%, respectively). Cefuroxime resistance was observed in 65.4% CoNS and 31.5% Enterobacteriaceae. Based on the results from the study, a new empiric antimicrobial treatment regiment was suggested.
Collapse
Affiliation(s)
- Xiaohui Chen Nielsen
- Department of Clinical Microbiology, Slagelse Hospital, Slagelse, Denmark ; Department of Clinical Microbiology, University Hospital of Copenhagen, Denmark
| | | | | | | | | | | | | |
Collapse
|
33
|
Home-based nutritional therapy. Rev Assoc Med Bras (1992) 2012. [DOI: 10.1016/s0104-4230(12)70220-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
|
34
|
|
35
|
Reyes García R, Jódar Gimeno E, García Martín A, Romero Muñoz M, Gómez Sáez JM, Luque Fernández I, Varsavsky M, Guadalix Iglesias S, Cano Rodriguez I, Ballesteros Pomar MD, Vidal Casariego A, Rozas Moreno P, Cortés Berdonces M, Fernández García D, Calleja Canelas A, Palma Moya M, Martínez Díaz-Guerra G, Jimenez Moleón JJ, Muñoz Torres M. [Clinical practice guidelines for evaluation and treatment of osteoporosis associated to endocrine and nutritional conditions. Bone Metabolism Working Group of the Spanish Society of Endocrinology]. ACTA ACUST UNITED AC 2012; 59:174-96. [PMID: 22321561 DOI: 10.1016/j.endonu.2012.01.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2012] [Accepted: 01/10/2012] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To provide practical recommendations for evaluation and treatment of osteoporosis associated to endocrine diseases and nutritional conditions. PARTICIPANTS Members of the Bone Metabolism Working Group of the Spanish Society of Endocrinology, a methodologist, and a documentalist. METHODS Recommendations were formulated according to the GRADE system (Grading of Recommendations, Assessment, Development, and Evaluation) to describe both the strength of recommendations and the quality of evidence. A systematic search was made in MEDLINE (Pubmed), using the following terms associated to the name of each condition: AND "osteoporosis", "fractures", "bone mineral density", and "treatment". Papers in English with publication date before 18 October 2011 were included. Current evidence for each disease was reviewed by two group members, and doubts related to the review process or development of recommendations were resolved by the methodologist. Finally, recommendations were discussed in a meeting of the Working Group. CONCLUSIONS The document provides evidence-based practical recommendations for evaluation and management of endocrine and nutritional diseases associated to low bone mass or an increased risk of fracture. For each disease, the associated risk of low bone mass and fragility fractures is given, recommendations for bone mass assessment are provided, and treatment options that have shown to be effective for increasing bone mass and/or to decreasing fragility fractures are listed.
Collapse
|
36
|
Vegting IL, Tabbers MM, Benninga MA, Wilde JC, Serlie MJ, Tas TA, Jonkers CF, van Ommen CH. Prophylactic Anticoagulation Decreases Catheter-Related Thrombosis and Occlusion in Children With Home Parenteral Nutrition. JPEN J Parenter Enteral Nutr 2012; 36:456-62. [DOI: 10.1177/0148607111416482] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- I. L. Vegting
- Department of Pediatric Gastroenterology and Nutrition, Emma Children’s Hospital / Academic Medical Center, Amsterdam, Netherlands
| | - M. M. Tabbers
- Department of Pediatric Gastroenterology and Nutrition, Emma Children’s Hospital / Academic Medical Center, Amsterdam, Netherlands
| | - M. A. Benninga
- Department of Pediatric Gastroenterology and Nutrition, Emma Children’s Hospital / Academic Medical Center, Amsterdam, Netherlands
| | - J. C. Wilde
- Department of Pediatric Surgery, Emma Children’s Hospital / Academic Medical Center, Amsterdam, Netherlands
| | - M. J. Serlie
- Nutrition Support Team, Emma Children’s Hospital / Academic Medical Center, Amsterdam, Netherlands
| | - T. A. Tas
- Nutrition Support Team, Emma Children’s Hospital / Academic Medical Center, Amsterdam, Netherlands
| | - C. F. Jonkers
- Nutrition Support Team, Emma Children’s Hospital / Academic Medical Center, Amsterdam, Netherlands
| | - C. H. van Ommen
- Department of Pediatric Hematology, Emma Children’s Hospital / Academic Medical Center, Amsterdam, Netherlands
| |
Collapse
|
37
|
Mohammed A, Grant FK, Zhao VM, Shane AL, Ziegler TR, Cole CR. Characterization of Posthospital Bloodstream Infections in Children Requiring Home Parenteral Nutrition. JPEN J Parenter Enteral Nutr 2011; 35:581-7. [DOI: 10.1177/0148607111413597] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
| | - Frederick K. Grant
- Graduate Division of Biological and Biomedical Sciences, Emory University, Atlanta, Georgia
| | | | - Andi L. Shane
- Emory University School of Medicine, Atlanta, Georgia
| | - Thomas R. Ziegler
- Emory University School of Medicine, Atlanta, Georgia
- Graduate Division of Biological and Biomedical Sciences, Emory University, Atlanta, Georgia
| | - Conrad R. Cole
- Emory University School of Medicine, Atlanta, Georgia
- Graduate Division of Biological and Biomedical Sciences, Emory University, Atlanta, Georgia
- Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| |
Collapse
|
38
|
Braga CBM, Vannucchi H, Freire CMM, Marchini JS, Jordão AA, da Cunha SFDC. Serum vitamins in adult patients with short bowel syndrome receiving intermittent parenteral nutrition. JPEN J Parenter Enteral Nutr 2011; 35:493-8. [PMID: 21628608 DOI: 10.1177/0148607110386964] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Short bowel syndrome (SBS) occurs after massive intestinal resection, and parenteral nutrition (PN) therapy may be necessary even after a period of adaptation. The purpose of this study was to determine the vitamin status in adults with SBS receiving intermittent PN. METHODS The study was conducted on hospitalized adults with SBS who were receiving intermittent PN therapy (n = 8). Nine healthy volunteers, paired by age and sex, served as controls. Food ingestion, anthropometry, plasma folic acid, and vitamins B(12), C, A, D, E, and K were evaluated. RESULTS The levels of vitamins A, D, and B(12) in both groups were similar. SBS patients presented higher values of folic acid (21.3 ± 4.4 vs 14.4 ± 5.2, P = .01) and lower values of vitamin C (0.9 ± 0.4 vs 1.2 ± 0.3 mg/dL, P = .03), α-tocopherol (16.3 ± 3.4 vs 24.1 ± 2.7 µmol/L, P < .001), and phylloquinone (0.6 ± 0.2 vs 1.0 ± 0.5 nmol/L, P < .03). Eight-seven percent of patients had vitamin D deficiency, and all patients presented with serum vitamin E levels below reference values. CONCLUSIONS Despite all efforts to offer all the nutrients mentioned above, SBS patients had lower serum levels of vitamins C, E, and K, similar to those observed in patients on home PN. These findings suggest that the administered vitamins were not sufficient for the intermittent PN scheme and that individual adjustments are needed depending on the patient's vitamin status.
Collapse
Affiliation(s)
- Camila Bitu Moreno Braga
- Department of Internal Medicine, Faculty of Medicine of Ribeirao Preto, University of Sao Paulo, Ribeirao Preto, Sao Paulo, Brazil
| | | | | | | | | | | |
Collapse
|
39
|
Catheter-related thrombosis in children with intestinal failure and long-term parenteral nutrition: How to treat and to prevent? Thromb Res 2010; 126:465-70. [DOI: 10.1016/j.thromres.2010.08.027] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2009] [Revised: 07/05/2010] [Accepted: 08/26/2010] [Indexed: 11/19/2022]
|
40
|
Abstract
Parenteral nutrition liver disease (PNLD) develops in 40-60% of infants who require long-term PN for intestinal failure. The clinical spectrum includes hepatic steatosis, cholestasis, cholelithiasis, and hepatic fibrosis. Progression to biliary cirrhosis and the development of portal hypertension and liver failure occurs in a minority who require combined liver and intestinal transplantation. The pathogenesis is multifactorial and is related to prematurity, low birth weight, duration of PN, short bowel syndrome requiring multiple laparotomies and recurrent sepsis. Other important mechanisms include lack of enteral feeding which leads to reduced gut hormone secretion, reduction of bile flow and biliary stasis which leads to the development of cholestasis, biliary sludge and gallstones, which exacerbate hepatic dysfunction, especially in premature neonates with immature hepatic function. The use of lipid emulsions, particularly soy bean emulsions have been associated with hepatic cholestasis in children, although there are little data now to support toxicity from other PN components. Management strategies for the prevention of parenteral nutrition liver disease include consideration of early enteral feeding, a multidisciplinary approach to the management of parenteral nutrition with a specialized nutritional care team and aseptic catheter techniques to reduce sepsis. The use of specialized lipid emulsions such as fish oil emulsions and or SMOF (Soy bean/Medium Chain Triglyceride/Olive Oil/Fish oil) improves established cholestasis and may prevent the onset. Oral administration of ursodeoxycholic acid may improve bile flow and reduce gall bladder stasis, although there is little data to suggest that prophylactic use prevents the onset of PNLD. Survival following either isolated small bowel or combined liver and small bowel transplantation is approximately 50% at 5 years making this an acceptable therapeutic option in children with irreversible liver and intestinal failure.
Collapse
|
41
|
Winkler MF, Wetle T, Smith C, Hagan E, O'Sullivan Maillet J, Touger-Decker R. The Meaning of Food and Eating among Home Parenteral Nutrition–Dependent Adults with Intestinal Failure: A Qualitative Inquiry. ACTA ACUST UNITED AC 2010; 110:1676-83. [DOI: 10.1016/j.jada.2010.08.002] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2009] [Accepted: 11/03/2009] [Indexed: 10/18/2022]
|
42
|
Santarpia L, Alfonsi L, Tiseo D, Creti R, Baldassarri L, Pasanisi F, Contaldo F. Central venous catheter infections and antibiotic therapy during long-term home parenteral nutrition: an 11-year follow-up study. JPEN J Parenter Enteral Nutr 2010; 34:254-62. [PMID: 20467007 DOI: 10.1177/0148607110362900] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Catheter-related bloodstream infections are a serious and common complication in patients receiving home parenteral nutrition (HPN). METHODS Prevalence of infections, type of agents, and effectiveness of antibiotic therapy were evaluated in 296 patients (133 males, 163 females; mean age 58.2 +/- 13.5 years) receiving HPN for at least 3 months, from January 1995 to December 2006. Patients underwent 99,969 (331 +/- 552; minimum 91, maximum 4353) days of catheterization, corresponding to 93,236 (311 +/- 489; minimum 52, maximum 4353) days of HPN. RESULTS Fifty-two patients (24 males and 28 females; 35 oncological and 17 nononcological) were diagnosed with 169 infections. The overall corresponding infection rate was 2.0 per 1000 days of catheterization, with a progressive, regular decrease with time. In 30 cases, immediate central venous catheter removal was necessary. Infections were eradicated in 103 of 139 (74%) cases. As to the most common causative agent, 86 (51%) infections were due to Staphylococcus epidermidis. Of these, 64 were treated from 1995 to 2004, 57 of them (89%) successfully; 22 were treated from 2005 onward, only 7 of them (32%) successfully. CONCLUSIONS Although the global infection rate has progressively decreased over the years, S epidermidis has shown an alarming increase in resistance to antibiotic treatment in the last 2 years, suggesting the need for strategies to prevent central venous catheter infection.
Collapse
Affiliation(s)
- Lidia Santarpia
- Department of Clinical and Experimental Medicine, Federico II University, Naples, Italy.
| | | | | | | | | | | | | |
Collapse
|
43
|
Mario Ferrario B, Javier Ormazabal B, Erwin Buckel G. Protocolos de selección y estudio del donante y receptor aplicables a la práctica chilena, en trasplante de intestino. REVISTA MÉDICA CLÍNICA LAS CONDES 2010. [DOI: 10.1016/s0716-8640(10)70526-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
|
44
|
Évaluation des cinq premières années de gestion de la nutrition parentérale à domicile par un prestataire de services en région Limousin. NUTR CLIN METAB 2010. [DOI: 10.1016/j.nupar.2009.11.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
|
45
|
Bischoff SC, Kester L, Meier R, Radziwill R, Schwab D, Thul P. Organisation, regulations, preparation and logistics of parenteral nutrition in hospitals and homes; the role of the nutrition support team - Guidelines on Parenteral Nutrition, Chapter 8. GERMAN MEDICAL SCIENCE : GMS E-JOURNAL 2009; 7:Doc20. [PMID: 20049081 PMCID: PMC2795381 DOI: 10.3205/000079] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/14/2009] [Indexed: 01/05/2023]
Abstract
PN (parenteral nutrition) should be standardised to ensure quality and to reduce complications, and it should be carried out in consultation with a specialised nutrition support team whenever possible. Interdisciplinary nutrition support teams should be established in all hospitals because effectiveness and efficiency in the implementation of PN are increased. The tasks of the team include improvements of quality of care as well as enhancing the benefit to cost ratio. Therapeutic decisions must be taken by attending physicians, who should collaborate with the nutrition support team. “All-in-One” bags are generally preferred for PN in hospitals and may be industrially manufactured, industrially manufactured with the necessity to add micronutrients, or be prepared “on-demand” within or outside the hospital according to a standardised or individual composition and under consideration of sterile and aseptic conditions. A standardised procedure should be established for introduction and advancement of enteral or oral nutrition. Home PN may be indicated if the expected duration of when PN exceeds 4 weeks. Home PN is a well established method for providing long-term PN, which should be indicated by the attending physician and be reviewed by the nutrition support team. The care of home PN patients should be standardised whenever possible. The indication for home PN should be regularly reviewed during the course of PN.
Collapse
Affiliation(s)
- S C Bischoff
- Dept. Nutritional Medicine and Prevention, University Stuttgart-Hohenheim, Germany
| | | | | | | | | | | | | |
Collapse
|
46
|
Abstract
Only 50 years ago intestinal failure was considered incompatible with life. Since then, developments in parenteral nutrition, and, more recently, small intestinal transplantation, have provided new therapeutic options with the potential to offer long-term survival with a good quality of life. Current medical and surgical strategies are aimed at enhancing intestinal adaptation, improving absorption to achieve nutritional independence, and minimizing the complications of parenteral nutrition therapy. An integrated, multidisciplinary approach to the management of patients with intestinal failure, closely linked to a transplantation program to facilitate early referral, is recognized as a key factor in optimizing patient outcomes.
Collapse
Affiliation(s)
- Julie E Bines
- Department of Pediatrics, University of Melbourne, Flemington Road, Parkville, Vic. 3052, Australia.
| |
Collapse
|
47
|
Affiliation(s)
- Thomas M Fishbein
- Georgetown Transplant Institute, Georgetown University Hospital, Washington, DC 20007, USA.
| |
Collapse
|
48
|
Van Gossum A, Cabre E, Hébuterne X, Jeppesen P, Krznaric Z, Messing B, Powell-Tuck J, Staun M, Nightingale J. ESPEN Guidelines on Parenteral Nutrition: gastroenterology. Clin Nutr 2009; 28:415-27. [PMID: 19515465 DOI: 10.1016/j.clnu.2009.04.022] [Citation(s) in RCA: 77] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2009] [Accepted: 04/29/2009] [Indexed: 12/14/2022]
Abstract
Undernutrition as well as specific nutrient deficiencies has been described in patients with Crohn's disease (CD), ulcerative colitis (UC) and short bowel syndrome. In the latter, water and electrolytes disturbances may be a major problem. The present guidelines provide evidence-based recommendations for the indications, application and type of parenteral formula to be used in acute and chronic phases of illness. Parenteral nutrition is not recommended as a primary treatment in CD and UC. The use of parenteral nutrition is however reliable when oral/enteral feeding is not possible. There is a lack of data supporting specific nutrients in these conditions. Parenteral nutrition is mandatory in case of intestinal failure, at least in the acute period. In patients with short bowel, specific attention should be paid to water and electrolyte supplementation. Currently, the use of growth hormone, glutamine and GLP-2 cannot be recommended in patients with short bowel.
Collapse
Affiliation(s)
- André Van Gossum
- Hôpital Erasme, Clinic of Intestinal Diseases and Nutrition Support, Brussels, Belgium
| | | | | | | | | | | | | | | | | | | |
Collapse
|
49
|
Futó J, Harsányi L, Sahin P, Dárdai E, Aradán A, Darvas K. Home parenteral nutrition. May it be performed in Hungary, too? Orv Hetil 2009; 150:225-30. [DOI: 10.1556/oh.2009.28525] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
A bélelégtelenségben szenvedő betegek az 1960-as évek vége óta részesülhetnek tartós otthoni parenteralis táplálásban a világ számos országában. Hazánkban a jelenleg is érvényben lévő jogi szabályozás és finanszírozási rendszer a bélelégtelenségben szenvedő, de családi körben élni tudó, sőt megfelelő körülmények között akár munkaképes betegeknek ez az ellátása kizárólag fekvőbeteg-ellátási körben lehetséges. A rendszer ezért rendkívül gazdaságtalan, szükségtelenül foglal le kórházi ágyakat, és ellentétes az európai gyakorlattal. Az elmúlt évek publikációi alapján a szerzők áttekintik a tartós otthoni parenteralis táplálásban részesülő betegek várható élettartamát, életminőségét, a parenteralis tápláláshoz kapcsolódó szövődményeket, illetve a világszerte alkalmazott rendszereket. A tartós táplálás költségeit a nemzetközi adatok alapján magyar viszonyokra vetítve becsülik meg. Az otthoni parenteralis tápláláshoz szükséges szaktudás Magyarországon is maradéktalanul rendelkezésre áll; a szükséges készítmények, technikai felszerelések a magyar piacon is hozzáférhetők. A táplálásterápia iránt elkötelezett hazai szakemberek ezért hivatalos szakmaközi együttműködést kezdeményeztek a tartós otthoni parenteralis táplálás eddig mostohán kezelt kérdésének rendezése érdekében, a rutinszerű otthoni parenteralis táplálás rendszerének kialakítására.
Collapse
Affiliation(s)
- Judit Futó
- 1 Fővárosi Önkormányzat Szent Imre Kórház, Sürgősségi Betegellátási Centrum Központi Műtő és Aneszteziológiai Szolgálat Budapest Tétényi út 12–15. 1115
| | - László Harsányi
- 2 Semmelweis Egyetem, Általános Orvostudományi Kar I. Sebészeti Klinika Budapest
| | - Péter Sahin
- 3 Fővárosi Önkormányzat Szent Imre Kórház Belgyógyászati Szakmák Mátrix Szervezete, Gasztroenterológiai Profil Budapest
| | - Ernő Dárdai
- 4 Fővárosi Önkormányzat Egyesített Szent István és Szent László Kórház és Rendelőintézet Központi Aneszteziológiai és Intenzív Betegellátó Osztály Budapest
| | - Attiláné Aradán
- 3 Fővárosi Önkormányzat Szent Imre Kórház Belgyógyászati Szakmák Mátrix Szervezete, Gasztroenterológiai Profil Budapest
| | - Katalin Darvas
- 2 Semmelweis Egyetem, Általános Orvostudományi Kar I. Sebészeti Klinika Budapest
| |
Collapse
|
50
|
Hydrochloric acid and urokinase as a treatment for recurrent catheter-related bloodstream infections in patients on home parenteral nutrition. Proc Nutr Soc 2009. [DOI: 10.1017/s0029665109002043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
|