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Alfonso JE, Berlana D, Ukleja A, Boullata J. Clinical, Ergonomic, and Economic Outcomes With Multichamber Bags Compared With (Hospital) Pharmacy Compounded Bags and Multibottle Systems: A Systematic Literature Review. JPEN J Parenter Enteral Nutr 2016; 41:1162-1177. [DOI: 10.1177/0148607116657541] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
| | | | - Andrew Ukleja
- Gastroenterology, Cleveland Clinic, Weston, Florida, USA
| | - Joseph Boullata
- Hospital of the University of Pennsylvania, and Drexel University, Philadelphia, Pennsylvania, USA
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Park J, Kim YA, Han JY, Jin S, Ok SH, Sohn JT, Lee HK, Chung YK, Shin IW. Lipofundin® MCT/LCT 20% increase left ventricular systolic pressure in an ex vivo rat heart model via increase of intracellular calcium level. Korean J Anesthesiol 2016; 69:57-62. [PMID: 26885303 PMCID: PMC4754268 DOI: 10.4097/kjae.2016.69.1.57] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Revised: 11/19/2015] [Accepted: 11/19/2015] [Indexed: 02/07/2023] Open
Abstract
Background Lipid emulsions have been used to treat various drug toxicities and for total parenteral nutrition therapy. Their usefulness has also been confirmed in patients with local anesthetic-induced cardiac toxicity. The purpose of this study was to measure the hemodynamic and composition effects of lipid emulsions and to elucidate the mechanism associated with changes in intracellular calcium levels in myocardiocytes. Methods We measured hemodynamic effects using a digital analysis system after Intralipid® and Lipofundin® MCT/LCT were infused into hearts hanging in a Langendorff perfusion system. We measured the effects of the lipid emulsions on intracellular calcium levels in H9c2 cells by confocal microscopy. Results Infusion of Lipofundin® MCT/LCT 20% (1 ml/kg) resulted in a significant increase in left ventricular systolic pressure compared to that after infusing modified Krebs-Henseleit solution (1 ml/kg) (P = 0.003, 95% confidence interval [CI], 2.4–12.5). Lipofundin® MCT/LCT 20% had a more positive inotropic effect than that of Intralipid® 20% (P = 0.009, 95% CI, 1.4–11.6). Both lipid emulsion treatments increased intracellular calcium levels. Lipofundin® MCT/LCT (0.01%) increased intracellular calcium level more than that of 0.01% Intralipid® (P < 0.05, 95% CI, 0.0–1.9). Conclusions These two lipid emulsions had different inotropic effects depending on their triglyceride component. The inotropic effect of lipid emulsions could be related with intracellular calcium level.
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Affiliation(s)
- Jiyoung Park
- Department of Anesthesiology and Pain Medicine, Gyeongsang National University Hospital, Jinju, Korea
| | - Yeon A Kim
- Department of Anatomy and Cell biology, Dong-A University College of Medicine and Mitochondria Hub Regulation Center, Busan, Korea
| | - Jeong Yeol Han
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Sangkyu Jin
- Department of Anesthesiology and Pain Medicine, Gyeongsang National University Hospital, Jinju, Korea
| | - Seong-Ho Ok
- Department of Anesthesiology and Pain Medicine, Gyeongsang National University Hospital, Jinju, Korea.; Institute of Health Sciences, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Ju-Tae Sohn
- Department of Anesthesiology and Pain Medicine, Gyeongsang National University Hospital, Jinju, Korea.; Institute of Health Sciences, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Heon-Keun Lee
- Department of Anesthesiology and Pain Medicine, Gyeongsang National University Hospital, Jinju, Korea.; Institute of Health Sciences, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Young-Kyun Chung
- Department of Anesthesiology and Pain Medicine, Gyeongsang National University Hospital, Jinju, Korea.; Institute of Health Sciences, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Il-Woo Shin
- Department of Anesthesiology and Pain Medicine, Gyeongsang National University Hospital, Jinju, Korea.; Institute of Health Sciences, Gyeongsang National University School of Medicine, Jinju, Korea
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Blackmer AB, Partipilo ML. Three-in-one parenteral nutrition in neonates and pediatric patients: risks and benefits. Nutr Clin Pract 2015; 30:337-43. [PMID: 25857309 DOI: 10.1177/0884533615580596] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Parenteral nutrition (PN) is a life-sustaining therapy designed to deliver essential nutrients to patients unable to meet nutrition needs via the enteral route. PN may be delivered via a 2-in-1 system (one solution containing amino acids, dextrose, electrolytes, vitamins, minerals, and fluids and one solution containing intravenous fat emulsions [IVFEs]) or via a 3-in-1 system (all nutrients mixed in one container). Although the use of 3-in-1 PN solutions is not necessarily therapeutically advantageous, certain benefits may exist such as the potential to reduce the risk of contamination due to decreased manipulations; ease of administration, particularly in the home care setting; possible cost savings; and reduced IVFE wastage. However, the incorporation of IVFE in 3-in-1 solutions also presents unique risks for the neonatal and pediatric population such as decreased stability, increased lipid globule size, decreased sterility and the potential for increased microbial growth/infectious complications, the need to use a larger filter size, precipitation and compatibility risks, and an increased chance of catheter occlusion. This review outlines the unique issues and challenges to be considered when formulating neonatal and pediatric 3-in-1 PN admixtures. While 3-in-1 PN solutions may be advantageous for certain pediatric populations, specifically those dependent on home PN, the risks do not outweigh the benefits in neonatal patients, and use should be avoided in this population.
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Affiliation(s)
- Allison Beck Blackmer
- Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado Anschutz Medical Campus, Aurora, Colorado Children's Hospital Colorado, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - M Luisa Partipilo
- University of Michigan Health Systems, Ann Arbor, Michigan C. S. Mott Children's and Women's Hospital, Ann Arbor, Michigan
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Affiliation(s)
- Jane Gervasio
- Butler University College of Pharmacy and Health Sciences, Indianapolis, Indiana
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Chheng ML, Heidbreder C, Btaiche IF, Blackmer AB. Infectious Complications With Nondaily Versus Daily Infusion of Intravenous Fat Emulsions in Non–Critically Ill Adults. Nutr Clin Pract 2013; 28:737-44. [DOI: 10.1177/0884533613507085] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Mary Lou Chheng
- The University of Michigan College of Pharmacy, Ann Arbor, Michigan
| | | | - Imad F. Btaiche
- Lebanese American University, School of Pharmacy, Byblos, Lebanon
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Genton L, Jolliet P, Pichard C. Feeding the intensive care patient. Curr Opin Anaesthesiol 2001; 14:131-6. [PMID: 17016392 DOI: 10.1097/00001503-200104000-00002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The present review highlights recent findings (focusing on papers published between October 1999 and December 2000) in nutritional support of intensive care unit patients. During the past year, research focused on the use of enteral nutrition versus parenteral nutrition, and on the best composition of enteral nutrition and parenteral nutrition according to the clinical condition of the patient. With regard to enteral nutrition, the pH of nutritional support, the timing of administration and the technique of tube placement were debated. Immunomodulating agents and hormonal manipulations may improve outcomes of critically ill patients, but still warrant further research before they can be recommended for routine clinical use.
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Affiliation(s)
- L Genton
- Division of Clinical Nutrition, University Hospital, Geneva, Switzerland
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Gross T, Babst R, Juretic A, Herzog B, Stehle P, Filgueira L, Oberholzer M, Gudat F, Heberer M. Intralipid-based short-term total parenteral nutrition does not impair small intestinal mucosa-related cellular immune reactivity in the healthy rat. JPEN J Parenter Enteral Nutr 2000; 24:337-44. [PMID: 11071593 DOI: 10.1177/0148607100024006337] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The lipid component of total parenteral nutrition (TPN) has reportedly been associated with trophic effects on the intestinal mucosa and suppressive effects on the immune system. METHODS We have challenged these hypotheses using a 7-day TPN rodent model comparing the effects of isocaloric, isonitrogenous lipid-based (TPN-lipid, 50% of calories as long-chain triacylglycerol) and carbohydrate-based TPN (TPN-CH, 100% of calories as carbohydrates) on mucosal morphology and immune function. Enterally fed animals were included to establish a baseline for immunologic read-outs. The study was performed in healthy, metabolically stable animals to avoid interference by septic or trauma-related stress factors. RESULTS Both TPN regimens resulted in a significantly smaller weight gain (TPN-lipid, 29.8 +/- 4.0 g; TPN-CH, 30.3 +/- 4.4 g) compared with enterally fed reference animals (49.2 +/- 3.2 g; p = .007), with no difference in nitrogen balance between the TPN groups. Mucosal sucrase activity was significantly lower in both TPN groups (TPN-lipid, 8.8 +/- 1.0 x 10(-7) katal per gram (kat/g) of protein; CH: 11.9 +/- 1.6 x 10(-7) kat/g of protein) compared with enteral feeding (17.4 +/- 0.9 x 10(-7) kat/g of protein; ANOVA: p = .0007). Morphometric analysis of the small intestine revealed no differences between the two TPN groups although a significantly depressed villus height in the TPN-lipid group could be observed in comparison to enterally fed reference rats (TPN-lipid, 0.47 +/- 0.02; TPN-CH, 0.50 +/- 0.01; enteral, 0.56 +/- 0.02 mm; ANOVA: p = .0298). Light and electron microscopy revealed a normal surface architecture in all three groups of rats. Cellular immune reactivity was evaluated using a novel specific immunization protocol: animals were immunized against OVA 4 weeks before TPN. OVA-induced lymphoproliferative responses and phenotypic data from draining popliteal and mesenteric lymph nodes were evaluated after the different regimens. Results did not differ among the three groups. CONCLUSIONS In healthy rodents, short-term lipid-based and carbohydrate-based TPN regimens lead to limited mucosal atrophy with preserved surface architecture compared with enteral feeding. However, peripheral and mesenteric cellular immune responsiveness after both TPN regimens remained comparable to enterally fed reference animals. Therefore, mesenteric and systemic cellular immune reactivity does not appear to be impaired by lipid-based or carbohydrate-based TPN.
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Affiliation(s)
- T Gross
- Department of Surgery of the University of Basel, Kantonsspital, Switzerland.
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Pichard C, Schwarz G, Frei A, Kyle U, Jolliet P, Morel P, Romand JA, Sierro C. Economic investigation of the use of three-compartment total parenteral nutrition bag: prospective randomized unblinded controlled study. Clin Nutr 2000; 19:245-51. [PMID: 10952795 DOI: 10.1054/clnu.2000.0106] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Optimal strategy for total parenteral nutrition (TPN) administration is essential both in terms of clinical effectiveness and economic efficiency. The aim of the present economic analysis was to provide a systematic and comprehensive cost comparison of the application of three currently available TPN systems: Separate Bottles (SB), Hospital-Compounded Bags (HCB) and Three-Compartment Bags (TCB). Sixty patients, admitted to the Geneva University Hospital and requiring TPN, were randomly assigned to one of the three systems. Three standard TPN formulas were prescribed to meet the patients' protein energy needs. TPN-related activities of medical, nursing and pharmacy staff were timed for the 24 hours of TPN administration. Manpower, nutrient solutions and medical supplies costs were calculated on the basis of mean Swiss salaries and hospital prices. TCB was the least expensive TPN system. SB and HCB systems' application costs were 120 and 150% of TCB cost, respectively. All intersystems cost comparisons were statistically significant (ANOVA p < or = 0.01). SB system required more items and manipulations, resulting in higher nurses manpower cost. Pharmacy overhead cost due to compounding was responsible for the higher cost of HCB system. Detailed manpower data presented in this study allow for an estimation of TPN application costs in other hospitals, using local salaries, specific product prices and compounding costs.
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Affiliation(s)
- C Pichard
- Department of Clinical Nutrition, Geneva University Hospital, Geneva, Switzerland
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Galica LA. PARENTERAL NUTRITION. Nurs Clin North Am 1997. [DOI: 10.1016/s0029-6465(22)02686-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Michaels MR, Stauffer GL, Haas DP. Propofol compatibility with other intravenous drug products: two new methods of evaluating IV emulsion compatibility. Ann Pharmacother 1996; 30:228-32. [PMID: 8833555 DOI: 10.1177/106002809603000303] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
OBJECTIVE To determine the physical compatibility of propofol injection with 77 other drug products using two methods not previously reported. DESIGN Each of 77 drug products were mixed with (1) an equal volume of propofol injection, (2) an equal volume of propofol injection with methylene blue added, and (3) an equal volume of the separated aqueous phase of propofol injection. The mixtures were observed for physical changes, and the turbidity of the aqueous phase mixtures was measured by nephelometry. SETTING A university-affiliated urban teaching hospital. MAIN OUTCOME MEASURES Observed physical changes or changes in turbidity. RESULT Of the 77 drugs tested, 69 showed immediate evidence of physical change, and the other 8 were found incompatible within 72 hours. CONCLUSIONS Practitioners should not mix the immediately incompatible products with propofol by administering them in the same intravenous line. Caution should be used in simultaneous administration of the other drugs. The new methods were useful in detecting incompatibilities in emulsions.
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Affiliation(s)
- M R Michaels
- Department of Pharmacy, Ohio State University Medical Center, Columbus 43210, USA
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Mattox TW, Bertch KE, Mirtallo JM, Strausberg KM, Cuddy PG. Recent advances: parenteral nutrition support. Ann Pharmacother 1995; 29:174-80. [PMID: 7756717 DOI: 10.1177/106002809502900213] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Even though there is an abundance of research related to the clinical and physiologic effects of parenteral nutrition and specific nutritional substrates, few new products have been released for clinical use. This review illustrates some of the directions being taken in the future development of parenteral nutrition products and some new perspectives related to the current effects (or lack of effects) of TPN. When considering the individual effects of specific nutrient substrates (arginine, glutamine, LCTs, MCTs, SCFAs) as reviewed here, it becomes apparent that the infusion of parenteral nutrition has the potential to produce a variety of metabolic responses that could be both beneficial and harmful. These effects depend on the type and quantity of substance infused as well as the disease and clinical condition of the patient. This also is true for those substances (GH, IGF-1) being evaluated to direct the effects of TPN infusions in a manner that improves protein accretion and supports the immunologic response of the body. At best, these investigations are producing a great amount of new and more specific information about the metabolic response to illness and the effects of TPN and individual substrate on that response.
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Affiliation(s)
- T W Mattox
- H. Lee Moffitt Cancer Center and Research Institute, Colleges of Pharmacy, University of Florida, Tampa, USA
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