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Relationship of delayed parenteral nutrition protocol with the clinical outcomes in a medical intensive care unit.

Lee H, Chung KS, Park MS, Na S, Kim YS - Clin Nutr Res (2014)

Bottom Line: There were no significant differences between the two groups when the age, gender, and admission Acute Physiology and Chronic Health Evaluation (APACHE) II scores were compared.By delaying initiation of PN, short-term clinical outcomes including incidence of CLA-BSI, antibiotic use, and ICU stay might be improved.Further research should be conducted to investigate the long-term effects of the decreased nutrient intake resulting from delayed PN.

View Article: PubMed Central - PubMed

Affiliation: Department of Nutrition and Dietetics, Severance Hospital, Yonsei University Health System, Seoul 120-752, Korea.

ABSTRACT
Although parenteral nutrition (PN) is an important treatment for patients who are unable to tolerate enteral nutrition (EN), recent international guidelines recommended that PN should be reserved and initiated only after 7 days in well-nourished patients. This retrospective study was conducted to analyze the effect on clinical outcomes of a PN protocol with PN starting 4 days after admission to the intensive care unit (ICU). Eighty-one patients who were admitted from January to March of 2012 were included in the pre-protocol group, and 74 patients who were admitted from April to June of 2012 were included in the post-protocol group. There were no significant differences between the two groups when the age, gender, and admission Acute Physiology and Chronic Health Evaluation (APACHE) II scores were compared. Significantly fewer patients in the post-protocol group were provided PN (58.1% vs. 81.3%, p = 0.002), which was initiated significantly later than in the pre-protocol group (2.7 ± 2.2 days vs. 1.9 ± 2.0 days, p = 0.046). Five patients (6.2%) in the pre-protocol group acquired central line-associated bloodstream infection (CLA-BSI) in the ICU, yet none of the patients in the post-protocol group developed CLA-BSI (p = 0.03). The duration of antibiotic therapy and ICU stay were significantly shorter in the post-protocol group than in the pre-protocol group. By delaying initiation of PN, short-term clinical outcomes including incidence of CLA-BSI, antibiotic use, and ICU stay might be improved. Further research should be conducted to investigate the long-term effects of the decreased nutrient intake resulting from delayed PN.

No MeSH data available.


Related in: MedlinePlus

Delayed Parenteral Nutrition Protocol. EN: enteral nutrition, PN: parenteral nutrition, ICU: intensive care unit.
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Figure 1: Delayed Parenteral Nutrition Protocol. EN: enteral nutrition, PN: parenteral nutrition, ICU: intensive care unit.

Mentions: A delayed PN protocol (PN start >72 h after ICU admission) was implemented in our medical ICU beginning in April, 2012 (Figure 1). Among those patients who were admitted to the ICU from January to June of 2012, we included 155 adult patients (≥20 years of age) who stayed in the ICU longer than 3 days. Among these patients, 81 patients who were admitted from January to March of 2012 were included in the pre-protocol group, and 74 patients who were admitted from April to June of 2012 were included in the post-protocol group. Data were collected retrospectively from electronic medical records. The patients who were able to start an oral diet were excluded from the study. We collected the following data: age, gender, Acute Physiology and Chronic Health Evaluation (APACHE) II score, reasons for ICU admission, and anthropometric measures (height, weight at admission and on the 10th day of ICU admission). Daily actual calorie and protein intake from PN and EN during the first 10 days of ICU admission were calculated from the nutrition progress notes. Changes in the patients' nutritional status were evaluated by changes in prealbumin and nitrogen balance measured on the first and 10th days of ICU admission. The duration of insulin and antibiotic therapy, ICU mortality, and the length of mechanical ventilation and ICU stay were also recorded.


Relationship of delayed parenteral nutrition protocol with the clinical outcomes in a medical intensive care unit.

Lee H, Chung KS, Park MS, Na S, Kim YS - Clin Nutr Res (2014)

Delayed Parenteral Nutrition Protocol. EN: enteral nutrition, PN: parenteral nutrition, ICU: intensive care unit.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3921293&req=5

Figure 1: Delayed Parenteral Nutrition Protocol. EN: enteral nutrition, PN: parenteral nutrition, ICU: intensive care unit.
Mentions: A delayed PN protocol (PN start >72 h after ICU admission) was implemented in our medical ICU beginning in April, 2012 (Figure 1). Among those patients who were admitted to the ICU from January to June of 2012, we included 155 adult patients (≥20 years of age) who stayed in the ICU longer than 3 days. Among these patients, 81 patients who were admitted from January to March of 2012 were included in the pre-protocol group, and 74 patients who were admitted from April to June of 2012 were included in the post-protocol group. Data were collected retrospectively from electronic medical records. The patients who were able to start an oral diet were excluded from the study. We collected the following data: age, gender, Acute Physiology and Chronic Health Evaluation (APACHE) II score, reasons for ICU admission, and anthropometric measures (height, weight at admission and on the 10th day of ICU admission). Daily actual calorie and protein intake from PN and EN during the first 10 days of ICU admission were calculated from the nutrition progress notes. Changes in the patients' nutritional status were evaluated by changes in prealbumin and nitrogen balance measured on the first and 10th days of ICU admission. The duration of insulin and antibiotic therapy, ICU mortality, and the length of mechanical ventilation and ICU stay were also recorded.

Bottom Line: There were no significant differences between the two groups when the age, gender, and admission Acute Physiology and Chronic Health Evaluation (APACHE) II scores were compared.By delaying initiation of PN, short-term clinical outcomes including incidence of CLA-BSI, antibiotic use, and ICU stay might be improved.Further research should be conducted to investigate the long-term effects of the decreased nutrient intake resulting from delayed PN.

View Article: PubMed Central - PubMed

Affiliation: Department of Nutrition and Dietetics, Severance Hospital, Yonsei University Health System, Seoul 120-752, Korea.

ABSTRACT
Although parenteral nutrition (PN) is an important treatment for patients who are unable to tolerate enteral nutrition (EN), recent international guidelines recommended that PN should be reserved and initiated only after 7 days in well-nourished patients. This retrospective study was conducted to analyze the effect on clinical outcomes of a PN protocol with PN starting 4 days after admission to the intensive care unit (ICU). Eighty-one patients who were admitted from January to March of 2012 were included in the pre-protocol group, and 74 patients who were admitted from April to June of 2012 were included in the post-protocol group. There were no significant differences between the two groups when the age, gender, and admission Acute Physiology and Chronic Health Evaluation (APACHE) II scores were compared. Significantly fewer patients in the post-protocol group were provided PN (58.1% vs. 81.3%, p = 0.002), which was initiated significantly later than in the pre-protocol group (2.7 ± 2.2 days vs. 1.9 ± 2.0 days, p = 0.046). Five patients (6.2%) in the pre-protocol group acquired central line-associated bloodstream infection (CLA-BSI) in the ICU, yet none of the patients in the post-protocol group developed CLA-BSI (p = 0.03). The duration of antibiotic therapy and ICU stay were significantly shorter in the post-protocol group than in the pre-protocol group. By delaying initiation of PN, short-term clinical outcomes including incidence of CLA-BSI, antibiotic use, and ICU stay might be improved. Further research should be conducted to investigate the long-term effects of the decreased nutrient intake resulting from delayed PN.

No MeSH data available.


Related in: MedlinePlus