Perioperative Use of Total Parenteral Nutrition: Variations in Guidelines and Practice in Three Norwegian Hospitals

1995 ◽  
Vol 11 (4) ◽  
pp. 741-749 ◽  
Author(s):  
Marianne Mjaaland ◽  
Arthur Revhaug ◽  
Olav Helge Førde
Keyword(s):  
Retrospective Study ◽  
Parenteral Nutrition ◽  
Total Parenteral Nutrition ◽  
Gastrointestinal Surgery ◽  
Patient Characteristics ◽  
Substantial Part ◽  
Cross Sectional

AbstractIn a cross-sectional, retrospective study of 604 cases, variations among three Norwegian hospitals in use of perioperative parenteral nutrition (TPN) after gastrointestinal surgery was determined. Postoperative TPN rates were 25%, 34% (p =.05) and 56% (p <.0001). respectively. However, a substantial part of the variation was explained by differences in patient characteristics.

scholarly journals Total parenteral nutrition-induced Wernicke’s encephalopathy after oncologic gastrointestinal surgery

Open Medicine ◽  
2020 ◽  
Vol 15 (1) ◽  
pp. 709-713
Author(s):  
Piergiorgio Fedeli ◽  
Richard Justin Davies ◽  
Roberto Cirocchi ◽  
Georgi Popivanov ◽  
Paolo Bruzzone ◽  
...  
Keyword(s):  
Parenteral Nutrition ◽  
Total Parenteral Nutrition ◽  
Gastrointestinal Surgery ◽  
Vitamin B1 ◽  
Wernicke’S Encephalopathy ◽  
Wernicke's Encephalopathy ◽  
Vitamin Intake ◽  
Unbalanced Diet ◽  
Prolonged Hospital ◽  
Care Costs

AbstractCarl Wernicke described the disease bearing his name in 1881 and reported three cases characterized by the presence of mental confusion, ataxia, and ophthalmoplegia. Wernicke’s disease is mainly observed in alcoholic patients, due to decreased vitamin intake as a consequence of an unbalanced diet, and a reduction of absorption due to the effects of alcohol. Likewise, inadequate vitamin intake is prevalent in older patients. Wernicke’s encephalopathy due to inappropriate total parenteral nutrition (TPN) occurs infrequently; recently, there is an increase in the literature concerning Wernicke’s encephalopathy in patients after general and bariatric surgeries. We present two cases of Wernicke’s encephalopathy after oncologic gastrointestinal surgery by failure to administer vitamin B1 during TPN; to our knowledge, these are the first two cases of Wernicke’s encephalopathy after colorectal surgery for cancer. In our opinion, timely diagnosis and treatment are mandatory to avoid nonfunctional recovery and consequent malpractice legal actions as well as an increase in the health-care costs correlated with the prolonged hospital stay and with the nonfunctional recovery.

Total parenteral nutrition does not improve diaphragm development in premature baboons

1994 ◽  
Vol 77 (1) ◽  
pp. 43-50 ◽  
Author(s):  
L. C. Maxwell ◽  
T. J. Kuehl ◽  
K. Meredith ◽  
D. R. Gerstmann ◽  
R. A. Delemos
Keyword(s):  
Parenteral Nutrition ◽  
Total Parenteral Nutrition ◽  
Fiber Type ◽  
Isometric Tension ◽  
Cross Sectional Area ◽  
Diaphragm Muscle ◽  
Lower Percentage ◽  
Force Frequency ◽  
Sectional Area ◽  
Cross Sectional

We hypothesized that total parenteral nutrition accelerates growth and development of diaphragm muscle (DPH) in prematurely delivered baboons (140 days gestation). For 10 days after delivery by cesarean section, we administered parenteral nutrition containing glucose, electrolytes, and water or total parenteral nutrition containing lipids, amino acids, glucose, vitamins, and electrolytes. After 10 days of care, dorsolateral and ventrolateral (VL) costal DPH were sampled for histochemically determined mean fiber area (MFA) and fiber type percentages. We determined isolated bundle isometric tension (normalized for cross-sectional area), time to peak tension, half-relaxation time, force-frequency relationship, and fatigability. Neither sex nor nutritional treatment affected contractile properties. Differences among sexes and muscle sites, but not among nutritional treatments, were observed for histochemical characteristics. In females, the VL DPH had a lower percentage of type IIo fibers and a greater MFA of type IIc fibers than the dorsolateral DPH and a lower percentage of type IIo fibers and greater MFA of type IIc and IIo fibers than the VL DPH in males. Mean fiber cross-sectional area of VL DPH was significantly greater in females than males. The larger fibers in females than males suggest a stronger DPH in females. Earlier growth of type II fibers in females could contribute to a better outcome for female than male premature infants with hyaline membrane disease.

scholarly journals Re-evaluating Safe Osmolarity for Peripheral Parenteral Nutrition in Neonatal Intensive Care Patients

2021 ◽  
Vol 26 (6) ◽  
pp. 632-637
Author(s):  
Amber G. Fessler ◽  
Catherine E. Rejrat
Keyword(s):  
Intensive Care ◽  
Retrospective Study ◽  
Enteral Nutrition ◽  
Parenteral Nutrition ◽  
Neonatal Intensive Care ◽  
Patient Characteristics ◽  
State Health ◽  
Intensive Care Patients ◽  
Penn State ◽  
American Society

OBJECTIVE To reach nutrition goals for neonatal patients, institutions often exceed the American Society for Parenteral and Enteral Nutrition recommended maximum of 900 mOsm/L for peripheral parenteral nutrition (PPN). Evidence is limited regarding the safety of PPN osmolarities above this maximum, specifically in neonatal patients. The purpose of this study was to determine if PPN with osmolarities ≥ 1000 mOsm/L is associated with an increased rate of line-related complications. METHODS This retrospective study included infants admitted to the Penn State Health Children's Hospital NICU from January 1, 2013, through July 31, 2018, who were receiving PPN, to assess if solutions with osmolarities ≥ 1000 mOsm/L versus &lt; 1000 mOsm/L are associated with increased rates of line-related complications. RESULTS A total of 200 patients were included in the study, and 618 individual PPN days were analyzed. Baseline patient characteristics were similar between groups. The PPN osmolarities ranged from 610 to 1267 mOsm/L. Overall, the incidence of line-related complications for PPN &lt; 1000 (n = 342 PPN days) and ≥ 1000 mOsm/L (n = 276 PPN days) was 28.9% and 29.0%, respectively (OR 1.00 [95% CI 0.72–1.40, p = 0.99]). Irrespective of PPN osmolarity, infants weighing &gt; 1.5 kg had significantly greater odds of experiencing line complications compared with patients &lt; 1 kg, but showed no difference compared with patients weighing 1 to 1.5 kg. CONCLUSIONS AND RECOMMENDATIONS There were no significant differences in the incidence of line-related complications in NICU patients receiving PPN with osmolarities 1000 to 1250 versus &lt; 1000 mOsm/L.

scholarly journals Canadian Home Total Parenteral Nutrition Registry: Preliminary Data on the Patient Population

2007 ◽  
Vol 21 (10) ◽  
pp. 643-648 ◽  
Author(s):  
Maitreyi Raman ◽  
Leah Gramlich ◽  
Scott Whittaker ◽  
Johane P Allard
Keyword(s):  
Parenteral Nutrition ◽  
Total Parenteral Nutrition ◽  
Population Sample ◽  
Intestinal Failure ◽  
Care Utilization ◽  
Future Research ◽  
Karnofsky Score ◽  
Cross Sectional ◽  
Primary Indication ◽  
The Mean

BACKGROUND: Long-term administration of home total parenteral nutrition (HTPN) has permitted patients with chronic intestinal failure to survive for prolonged periods of time. However, HTPN is associated with numerous complications, all of which increase morbidity and mortality. In Canada, a comprehensive review of the HTPN population has never been performed.OBJECTIVES: To report on the demographics, current HTPN practice and related complications in the Canadian HTPN population.METHODS: This was a cross-sectional study. Five HTPN programs in Canada participated. Patients’ data were entered by the programs’ TPN team into a Web site-based registry. A unique confidential record was created for each patient. Data were then downloaded into a Microsoft Excel (Microsoft Corp, USA) spreadsheet and imported into SPSS (SPSS Inc, USA) for statistical analysis.RESULTS: One hundred fifty patients were entered into the registry (37.9% men and 62.1% women). The mean (± SD) age was 53.0±14 years and the duration requiring HTPN was 70.1±78.1 months. The mean body mass index before the onset of HTPN was 19.8±5.0 kg/m2. The primary indication for HTPN was short bowel syndrome (60%) secondary to Crohn’s disease (51.1%), followed by mesenteric ischemia (23.9%). Complications: over one year, 62.7% of patients were hospitalized at least once, with 44% of hospitalizations related to TPN. In addition, 28.6% of patients had at least one catheter sepsis (double-lumen more than single-lumen; P=0.025) and 50% had at least one catheter change. Abnormal liver enzymes were documented in 27.4% of patients and metabolic bone disease in 60% of patients, and the mean Karnofsky score was 63.CONCLUSIONS: In the present population sample, the data suggest that HTPN is associated with significant complications and health care utilization. These results support the use of a Canadian HTPN registry to better define the HTPN population, and to monitor complications for quality assurance and future research.

A cross-sectional study of catheter-related thrombosis in children receiving total parenteral nutrition at home

1995 ◽  
Vol 126 (3) ◽  
pp. 358-363 ◽  
Author(s):  
Maureen Andrew ◽  
Velma Marzinotto ◽  
Paul Pencharz ◽  
Stanley Zlotkin ◽  
Patricia Burrows ◽  
...  
Keyword(s):  
Parenteral Nutrition ◽  
Total Parenteral Nutrition ◽  
Cross Sectional Study ◽  
Sectional Study ◽  
Cross Sectional ◽  
Catheter Related Thrombosis ◽  
At Home

scholarly journals General Practitioners Records Are Epidemiological Predictors of Comorbidities: An Analytical Cross-Sectional 10-Year Retrospective Study

2018 ◽  
Vol 7 (8) ◽  
pp. 184 ◽  
Author(s):  
Pierpaolo Cavallo ◽  
Sergio Pagano ◽  
Mario De Santis ◽  
Enrico Capobianco
Keyword(s):  
Retrospective Study ◽  
Patient Characteristics ◽  
Administrative Database ◽  
Diabetic Patients ◽  
Prescription Data ◽  
Data Types ◽  
Cross Sectional ◽  
Family Doctors ◽  
Large Populations ◽  
Diabetic Population

Background. Comorbidity represents the co-occurrence of pathological conditions in the same individual, and presents with very complex patterns. In most cases, reference data for the study of various types of comorbidities linked to complex diseases are those of hospitalized patients. Such patients may likely require cure due to acute conditions. We consider the emerging role of EHR (Electronic Healthcare Records), and study comorbidity patterns in a general population, focusing on diabetic and non-diabetic patients. Methods. We propose a cross-sectional 10-year retrospective study of 14,958 patients and 1,728,736 prescriptions obtained from family doctors, and thus refer to these data as General Practitioner Records (GPR). We then choose networks as the tools to analyze the diabetes comorbidity patterns, distinguished by both prescription type and main patient characteristics (age, gender). Results. As expected, comorbidity increases with patients’ age, and the network representations allow the assessment of associations between morbidity groups. The specific morbidities present in the diabetic population justify the higher comorbidity patterns observed in the target group compared to the non-diabetic population. Conclusions. GPR are usually combined with other data types in EHR studies, but we have shown that prescription data have value as standalone predictive tools, useful to anticipate trends observed at epidemiological level on large populations. This study is thus relevant to policy makers seeking inference tools for an efficient use of massive administrative database resources, and suggests a strategy for detecting comorbidities and investigating their evolution.

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