Total parenteral nutrition usage trends in the United States.

INTRODUCTION: This study examined how total parenteral nutrition (TPN) usage has changed in recent years, and whether a difference exists between teaching and non-teaching institutions. MATERIALS AND METHODS: Using the National Inpatient Sample (NIS) database, total discharges of patients who received TPN (ICD-9 99.15) from 2001 to 2014 were determined. The cohort was dichotomized for teaching and non-teaching institutions, and analyzed using the Z-test statistic. RESULTS: Annual patients receiving TPN at all institutions increased significantly from 25,075 in 2001 to 33,435 in 2014 (P<0.0001), peaking at 43,350 in 2012. Annual patients receiving TPN at teaching institutions increased significantly from 13,231 in 2001 to 24,630 in 2014 (P<0.0001), peaking at 26,935 in 2012. Annual patients receiving TPN at non-teaching institutions decreased significantly from 11,844 in 2001 to 8805 in 2014 (P<0.0001), peaking at 17,920 in 2011. DISCUSSION: It is unclear why TPN usage trended upward in United States hospitals, and why TPN usage peaked and subsequently decreased in non-teaching institutions while continuing to uptrend in teaching institutions. Further inquiry is indicated to determine the etiology of this discrepancy. CONCLUSIONS: Utilization of TPN increased in the United States between 2001 and 2014, eventually decreasing in non-teaching institutions but not in teaching institutions.

Antecedentes, objetivos y metodología / Background, objectives, and methods

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Current trends and future challenges in neonatal parenteral nutrition.

A number of adaptations in total parenteral nutrition (TPN) protocols and practices for preterm neonates have been realized in the past several years, resulting in better survival and developmental outcomes. The early provision of appropriate concentrations of amino acids and energy are now recommended in evidence-based guidelines. Standardized TPN formulations are now available for many patients and may be associated with cost savings and improved adherence to guidelines. Several advantages of these preparations, including promotion of safer administration, consistent adherence to guidelines, and overall best practices, have been well documented. However, careful monitoring is still required to optimize nutrition for individual patients and to support overall safety as TPN practices continue to change. Additional research is needed to develop new lipid formulations that are tailored for safe use by very low birth weight (VLBW) and extremely low birth weight (ELBW) infants. This review presents recent research and improvements to guidelines, as well as future product needs for VLBW and ELBW neonates.

[Recent advances in nutritional support and postnatal growth in premature infants]. / Nouvelles perspectives pour l'alimentation des prématurés et leur croissance postnatale.

Nutrition has always been described as challenging in premature infants, especially in very low birth weight (VLBW, < 1500 g) infants. Therefore, postnatal malnutrition is frequently observed in these infants and most develop a severe postnatal growth restriction with a very high incidence of hypotrophy at term corrected age. Otherwise, both insufficient nutritional intakes and postnatal growth restriction during the perinatal period have been associated with adverse developmental outcomes. In this article, an optimized nutritional policy characterized by a standardization of nutritional support is discussed. This policy implies the use of one standardized parenteral nutrition solution and a rapidly enriched feeding regimen. Recent studies in VLBW infants have demonstrated that this approach is associated with significant improvement of nutritional support, postnatal growth and biological homeostasis. Only 6% of appropriate for gestational age infants at birth were described small for gestational age at discharge. This policy has recently been reproduced by the industry that developed the first manufactured triple-chamber parenteral nutrition bags specifically designed for premature infants. It represents a great opportunity for premature infants to improve their development and long-term outcomes.

Organización y modelo de funcionamiento de las estructuras de investigación biomédica. Situación y retos de futuro / Organization and functioning model of biomedical research structures. Situation and future challenges

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What happened to total parenteral nutrition? The disappearance of its use in a trauma intensive care unit.

BACKGROUND: Total parenteral nutrition (TPN) is associated with known costs, including the use of invasive procedures, which may be necessary to optimize care. Our purpose was to document TPN use in trauma patients over time as well as concurrent changes in TPN-associated complications. METHODS: Retrospective analysis of all consecutive trauma patients admitted to the surgical intensive care unit during a period of 6 years from a Level I trauma center. Comparative cohorts and the matched case-control approaches were used to analyze the difference in outcomes between patients with and without TPN during hospitalization. Logistic regression model was used to compare the outcomes of the two groups of patients adjusting for significant risk factors. The McNemar's test was used to assess the differences in outcomes between the cases and their matched controls. RESULTS: There were 2,964 patients admitted to the surgical intensive care unit during the 6-year period and 464 patients received TPN during their hospital course. TPN use decreased significantly from 26% in the year 2000 to 3% in 2005 (p < 0.0001). Excluding those who died in the first 72 hours, the mortality rate was significantly lower (5.4% no TPN vs. 10.2% TPN, p = 0.001) in patients who were managed without TPN. Complication rates (wound infection, dehiscence, line sepsis, bacteremia, sepsis, pneumonia, renal failure, acute respiratory distress syndrome, multiple organ dysfunction syndrome, deep venous thrombosis, pulmonary embolism) were significantly higher in patients that were managed with TPN. Multivariate analysis adjusting for abbreviated injury score, injury severity score, mechanism, admission year, dialysis, ventilator use, hollow viscous injury, and solid organ injury found that TPN use was still an independent risk factor for increased complications but not death. The matched case-control approach confirmed this finding. TPN use was also associated with increase intensive care unit and hospital length of stay. CONCLUSIONS: The rate of TPN use has declined significantly from 26% to 3% during the 6-year period. The change in practice of minimizing TPN was concurrent with decreased complications and less hospital resource utilization without negatively impacting mortality.

XXII Congreso Nacional SENPE: Sevilla, 30 de mayo - 1 de junio de 2007 / No disponible

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A review of the trends in the use of enteral and parenteral nutrition support.

This is a review article that discusses the trends in the use of enteral and parenteral nutrition support. Although enteral nutrition has existed longer than parenteral nutrition, only recent data would suggest a clinical benefit of enteral nutrition compared with parenteral nutrition. In this article, indications for parenteral nutrition are listed. Also, data comparing bacterial translocation and complications associated with both forms of nutritional support are discussed. Clinical outcome in specific gastrointestinal diseases is also discussed.

Compounding TPN admixtures: then and now.

Compounding TPN admixtures has significantly developed since the first clinical reports by Dr. Dudrick and colleagues from the University of Pennsylvania approximately 35 years ago. Today, the responsibility for the compounding of sage parenteral nutrition admixtures for patients incapable of oral or enteral nutrition primarily rests with the pharmacy department. Although others may influence the desirable components to be contained therin, no one is more qualified to deal with the physicochemical issues and aseptic technique compounding requirements than a registered pharmacist. In fact, the United States Pharmacopeia (USP) , the official drug compendium in the US since 1906, has published Chapter 797 entitled "Pharmaceutical Compounding--Sterile Preparations", enforceable by the FDA, and makes clear the role of the pharmacist in the compounding of safe parenteral admixtures. Ultimately, after careful pharmaceutical review of the final formulation, the composition of the final admixture for infusion will be determined based on the ability to safely compound the prescribed additives in the desired quantities of a specified volume of sterile fluid. There will always be instances, where, for example the patient's needs cannot be safely met through the TPN admixture, primarily because of stability, compatibility and/or sterility issues. When this occurs, suitable alternative methods of delivering the additives in question must be sought so as not to compromise the safety issues of the final TPN infusion. Although there have been many advances in the development of nutritional additives, compounding devices, and containers, significant safety issues continue to arise necessitating further modification of paretneral nutrition protocols. ASPEN, through periodic reviews of tis published guidelines, such as the 1998 Safe Practices for Parenteral Nutrition Formulations, is in a key position to keep nutrition support clinicians abreast of the central issues affecting the safety of TPN therapy.(Journal of Parenteral and Enteral Nutrition

[Changes in perioperative treatment for elective colorectal resections in Germany 1991 and 2001/2002]. / Wandel der perioperativen Therapie bei elektiven kolorektalen Resektionen in Deutschland 1991 und 2001/2002.

BACKGROUND: To assess changes in perioperative treatment of patients undergoing elective colorectal resections, surveys were sent to all German surgical departments in 1991 and 2001/2002. METHODS: 1,207 chairmen of departments for general or visceral surgery were asked to answer a survey concerning the principles of perioperative treatment of patients undergoing elective colorectal resection. The results of this questionnaire were compared to a survey that had been performed in 1991. RESULTS: 616 chairmen (51.0%) responded to the survey (1991: 76.4%). In 2001/2002 preoperative parenteral alimentation was utilized routinely in only 10.3% (1991: 40.0%) of all hospitals. Preoperative i.v.-pyelography was used only in 24.7% of the hospitals (1991: 79.7%). Intraoperative testing of colorectal anastomoses was more common in 2001/2002 (63.7%) than in 1991 (40.1%). At the same time the incidence of "single-shot"-antibiotic prophylaxis increased from 24.0% to 70.4 %. Orthograde bowel lavage, perioperative antibiotic prophylaxis and postoperative parenteral alimentation were use as often in 2001/2002 as in 1991. Intraperitoneal drains were routinely inserted in most of the surgical departments after left-sided colonic resections (2001/2002: 86.2%; 1991: 88.2%) or rectal resections (2001/2002: 90.5%; 1991: 94.4%). CONCLUSION: During the last decade, perioperative therapy for patients undergoing elective colorectal resection has changed substantially. Most of these changes occurred in the perioperative medical treatment. However, surgical traditions like intraperitoneal drainage are still very frequently utilized.

New developments in total parenteral nutrition for children.

The field of parenteral nutrition continues to evolve along two major paths: prevention of complications and refining of nutritional needs. Parenteral nutrition-associated liver disease remains a vexing problem. No single factor is to blame; rather, it requires a number of "hits." In the infant, the liver disease primarily appears to be related to prematurity of bile flow and production, infection, lack of enteral feedings, and most recently appreciated, perhaps free radicals. We are able to meet the nutritional needs of our patients, but our knowledge of actual nutritional requirements remains incomplete. Future studies need to define better appropriate intakes and to rigorously test the utility of proposed nutrients such as glutamine.

[Total parenteral nutrition. History. Present time. Future]. / Calkowite zywienie pozajelitowe. Historia. Terazniejszosc. Przyszlosc.

Total parenteral nutrition (TPN) has been available for only 30 years. However, history in this field goes back more than 350 years with the first landmark being the description of general blood circulation by William Harvey in 1628. His discovery is the anatomical basis for intravenous infusions. Many investigations were performed during the following centuries showing that solutions containing electrolytes and glucose could be given intravenously in man. The accumulated knowledge of protein metabolism formed the basis for studies on intravenous nutrition with protein hydrolysates, peptides and amino acids. The observation in the late 30-s by Robert Elman that amino acids in the form of protein hydrolysate could be safely administered intravenously in man was the first major step toward TPN. During the following years, major efforts were made to find methods to prepare infusion solutions with a high energy content and low osmotic pressure. The most realistic alternative seemed to be fat in the form of an emulsion. Many studies of a large number of various fat emulsions were made however, all of these emulsions caused severe adverse reactions in man. The first safe fat emulsion, intralipid, was made available in the early 60s. This was the second major step toward TPN. It was then no problem to include vitamins, electrolytes and trace elements in the fat emulsions and the solutions of amino acids and glucose. A few years later it was shown that a central venous catheter could be used to administer the infusion fluid intravenously. Many clinical investigations and reports have shown that the newly developed intravenous nutritional regimens are adequate alternatives to the ordinary diet. In this way it has been possible to maintain or obtain a good nutritional condition in most situations when oral or tube feeding can not be used. TPN has been shown to be of very great clinical importance to prevent and treat starvation often related to high morbidity and mortality.

Avances en Nutrición Parenteral Total Pediátrica

Muchos niños se han beneficiado con el uso de la nutrición parenteral, la cual mejora su calidad de vida. La nutrición parenteral total contribuye significativamente al cuidado de los niños. En el presente artículo se describen algunos estudios relacionados con el desarrollo de formularios para ordenar la nutrición parenteral, la suplementación de nuevos componentes endovenosos, las nuevas técnicas para la inserción de catéteres venosos centrales, el tratamiento de la oclusión de los catéteres venosos centrales, la prevención de complicaciones como la colestasis por el uso prolongado de nutrición parenteral, el uso de emulsiones lipídicas y la utilización de la nutrición parenteral total ciclada

Hiperalimentación parenteral: Seguridad y eficacia

No se debe permitir que un enfermo caiga en desnutrición clínica significativa mientras se halla hospitalizado. se evita esta situación con la administración de nutrición intravenosa prescrita por médicos preparados con vigilancia diaria en aquellas situaciones en las que la nutrición enteral no es posible.