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Article: Impact of enteral nutrition interruptions on underfeeding in intensive care unit

Salciute-Simene, Erika / Stasiunaitis, Raimundas / Ambrasas, Eduardas / Tutkus, Jonas / Milkevicius, Ignas / Sostakaite, Gintare / Klimasauskas, Andrius / Kekstas, Gintautas

Clinical nutrition. 2020 Aug. 15,

2020

Abstract: Malnutrition leads to poor outcomes for critically ill patients; however, underfeeding remains a prevalent issue in the intensive care unit (ICU). One of the reasons for underfeeding is enteral nutrition interruption (ENI). Our aim was to investigate the ...

Abstract	Malnutrition leads to poor outcomes for critically ill patients; however, underfeeding remains a prevalent issue in the intensive care unit (ICU). One of the reasons for underfeeding is enteral nutrition interruption (ENI). Our aim was to investigate the causes, frequency, and duration of ENIs and their association with underfeeding in critical care.This was a prospective observational study conducted at the Vilnius University Hospital Santaros Clinics, Lithuania, between December 2017 and February 2018. It included adult medical and surgical ICU patients who received enteral nutrition (EN). Data on ENIs and caloric, as well as protein intake were collected during the entire ICU stay. Nutritional goals were assessed using indirect calorimetry, where available.In total 73 patients were enrolled in the study. Data from 1023 trial days and 131 ENI episodes were collected; 68% of the patients experienced ENI during the ICU stay, and EN was interrupted during 35% of the trial days. The main reasons for ENIs were haemodynamic instability (20%), high gastric residual volume (GRV) (17%), tracheostomy (16%), or other surgical interventions (16%). The median duration of ENI was 12 [6–24] h, and the longest ENIs were due to patient-related factors (22 [12–42] h). The rate of underfeeding was 54% vs. 15% in the trial days with and without ENI (p < 0.001), respectively. Feeding goal was achieved in 26% of the days with ENI vs. 45% of days without ENI (p < 0.001). The daily average caloric provision was 77 ± 36% vs. 106 ± 29% in the trial days with and without ENI (p < 0.001) and protein provision was 0.96 ± 0.5 vs. 1.3 ± 0.5 g/kg, respectively (p < 0.001).The episodes of ENI in critically ill patients are frequent and prolonged, often leading to underfeeding. Similar observations have been reported by other studies; however, the causes and duration of ENI vary, mainly because of different practices worldwide. Hence, safe and internationally recognised reduced-fasting guidelines and protocols for critically ill patients are needed in order to minimise ENI-related underfeeding and malnutrition.
Keywords	adults ; calorimetry ; clinical nutrition ; duration ; enteral feeding ; frequency ; hemodynamics ; hospitals ; malnutrition ; objectives ; observational studies ; patients ; protein intake ; protocols ; restricted feeding ; volume ; Lithuania
Language	English
Dates of publication	2020-0815
Publishing place	Elsevier Ltd
Document type	Article
Note	NAL-light ; Pre-press version
ZDB-ID	604812-2
ISSN	1532-1983 ; 0261-5614
ISSN (online)	1532-1983
ISSN	0261-5614
DOI	10.1016/j.clnu.2020.08.014
Database	NAL-Catalogue (AGRICOLA)

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Article ; Online: Impact of enteral nutrition interruptions on underfeeding in intensive care unit.

Salciute-Simene, Erika / Stasiunaitis, Raimundas / Ambrasas, Eduardas / Tutkus, Jonas / Milkevicius, Ignas / Sostakaite, Gintare / Klimasauskas, Andrius / Kekstas, Gintautas

Clinical nutrition (Edinburgh, Scotland)

2020 Volume 40, Issue 3, Page(s) 1310–1317

Abstract: Background & aims: Malnutrition leads to poor outcomes for critically ill patients; however, underfeeding remains a prevalent issue in the intensive care unit (ICU). One of the reasons for underfeeding is enteral nutrition interruption (ENI). Our aim ... ...

Abstract	Background & aims: Malnutrition leads to poor outcomes for critically ill patients; however, underfeeding remains a prevalent issue in the intensive care unit (ICU). One of the reasons for underfeeding is enteral nutrition interruption (ENI). Our aim was to investigate the causes, frequency, and duration of ENIs and their association with underfeeding in critical care. Methods: This was a prospective observational study conducted at the Vilnius University Hospital Santaros Clinics, Lithuania, between December 2017 and February 2018. It included adult medical and surgical ICU patients who received enteral nutrition (EN). Data on ENIs and caloric, as well as protein intake were collected during the entire ICU stay. Nutritional goals were assessed using indirect calorimetry, where available. Results: In total 73 patients were enrolled in the study. Data from 1023 trial days and 131 ENI episodes were collected; 68% of the patients experienced ENI during the ICU stay, and EN was interrupted during 35% of the trial days. The main reasons for ENIs were haemodynamic instability (20%), high gastric residual volume (GRV) (17%), tracheostomy (16%), or other surgical interventions (16%). The median duration of ENI was 12 [6-24] h, and the longest ENIs were due to patient-related factors (22 [12-42] h). The rate of underfeeding was 54% vs. 15% in the trial days with and without ENI (p < 0.001), respectively. Feeding goal was achieved in 26% of the days with ENI vs. 45% of days without ENI (p < 0.001). The daily average caloric provision was 77 ± 36% vs. 106 ± 29% in the trial days with and without ENI (p < 0.001) and protein provision was 0.96 ± 0.5 vs. 1.3 ± 0.5 g/kg, respectively (p < 0.001). Conclusions: The episodes of ENI in critically ill patients are frequent and prolonged, often leading to underfeeding. Similar observations have been reported by other studies; however, the causes and duration of ENI vary, mainly because of different practices worldwide. Hence, safe and internationally recognised reduced-fasting guidelines and protocols for critically ill patients are needed in order to minimise ENI-related underfeeding and malnutrition.
MeSH term(s)	Adult ; Aged ; Aged, 80 and over ; Critical Care/methods ; Critical Illness/therapy ; Energy Intake/physiology ; Enteral Nutrition/methods ; Female ; Humans ; Intensive Care Units ; Lithuania ; Male ; Malnutrition/etiology ; Middle Aged ; Nutritional Requirements ; Prospective Studies
Language	English
Publishing date	2020-08-27
Publishing country	England
Document type	Journal Article ; Observational Study
ZDB-ID	604812-2
ISSN	1532-1983 ; 0261-5614
ISSN (online)	1532-1983
ISSN	0261-5614
DOI	10.1016/j.clnu.2020.08.014
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Article ; Online: Two dog-related infections leading to death: overwhelming Capnocytophaga canimorsus sepsis in a patient with cystic echinococcosis.

Matulionytė, Raimonda / Lisauskienė, Ingrida / Kėkštas, Gintautas / Ambrozaitis, Arvydas

Medicina (Kaunas, Lithuania)

2012 Volume 48, Issue 2, Page(s) 112–115

Abstract: Capnocytophaga canimorsus is a fastidious, capnophilic, fusiform, and filamentous gram-negative rod. It is part of the normal oral flora of dogs and cats and can cause an infection in humans, but is of generally low virulence in healthy individuals. A ... ...

Abstract	Capnocytophaga canimorsus is a fastidious, capnophilic, fusiform, and filamentous gram-negative rod. It is part of the normal oral flora of dogs and cats and can cause an infection in humans, but is of generally low virulence in healthy individuals. A case of fatal sepsis due to Capnocytophaga canimorsus in a 46-year-old woman with clinically silent cystic echinococcosis discovered postmortem is present. She had been bitten by a dog 3 days before the symptoms appeared. The family had owned the dog for 4 years. A preliminary diagnosis of septic shock of unknown etiology with multisystem organ failure was established. Despite all the efforts, the patient died on the seventh day of hospitalization. Laboratory findings received postmortem showed Capnocytophaga canimorsus isolated from the blood culture after 7 incubation days. Autopsy showed a cyst in the liver with a fibrotic wall and necrotic eosinophilic interiors containing fragments of Echinococcus granulosus scolices. In conclusion, an interaction possibly established long ago between the host and Echinococcus granulosus conditioned immunosuppression mechanisms developed by the parasite in this case, which can explain such an aggressive course of the infection with Capnocytophaga. Two dog-related infections were fatal in the middle-aged dog owner considered healthy before this hospitalization. Vigilance concerning recent exposure to dogs or cats and potential immunosuppression risk factors must be maintained in a patient presenting with clinical features of fulminant sepsis.
MeSH term(s)	Animals ; Bites and Stings/microbiology ; Capnocytophaga/isolation & purification ; Dogs ; Echinococcosis/complications ; Echinococcosis/immunology ; Fatal Outcome ; Female ; Gram-Negative Bacterial Infections/complications ; Gram-Negative Bacterial Infections/diagnosis ; Gram-Negative Bacterial Infections/microbiology ; Humans ; Immune Tolerance ; Kidney/microbiology ; Kidney/pathology ; Liver/microbiology ; Liver/pathology ; Middle Aged ; Multiple Organ Failure/complications ; Multiple Organ Failure/diagnosis ; Multiple Organ Failure/microbiology ; Necrosis ; Sepsis/complications ; Sepsis/diagnosis ; Sepsis/microbiology
Language	English
Publishing date	2012
Publishing country	Netherlands
Document type	Case Reports ; Journal Article
ZDB-ID	2188113-3
ISSN	1648-9144 ; 1010-660X
ISSN (online)	1648-9144
ISSN	1010-660X
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Article ; Online: The impact of medical conditions on the quality of life of survivors at discharge from intensive care unit.

Klimašauskas, Andrius / Sereikė, Ieva / Klimašauskienė, Aušra / Kėkštas, Gintautas / Ivaškevičius, Juozas

Medicina (Kaunas, Lithuania)

2011 Volume 47, Issue 5, Page(s) 270–277

Abstract: Background and objective: Impaired health-related quality of life (HRQOL) is one of the possible outcomes after discharge from an intensive care unit (ICU). Evaluation of patient health status on discharge from the ICU would help identify factors ... ...

Abstract	Background and objective: Impaired health-related quality of life (HRQOL) is one of the possible outcomes after discharge from an intensive care unit (ICU). Evaluation of patient health status on discharge from the ICU would help identify factors influencing changes in HRQOL after ICU discharge. The objective of the study was to identify whether health state on discharge from prolonged stay in the ICU has any influence on survivors' HRQOL 6 months after intensive care. Material and methods: A prospective study of patients with the prolonged length of stay (exceeding 7 days) in the ICU was conducted. The study covered the impact of organ system dysfunction (SOFA score), number of therapeutic interventions (TISS-28 score), and critical illness neuromuscular abnormalities (CINMA) on discharge from the ICU on HRQOL 6 months following ICU discharge. Results: In total, 137 patients were included in the study. The SOFA score on the last day in the ICU was 2.91 (SD, 1.57); the TISS-28 score on the last day in the ICU was 21.79 (SD, 4.53). Decreased physical functioning (PF) and role physical (RP) were identified. Circulatory impairment on discharge from the ICU had an impact on decreased PF (P=0.016), role physical (P=0.066), and role emotional (P=0.001). Patients with dysfunction in more than one organ system on ICU discharge had decreased role emotional (P=0.016). Severe CINMA was diagnosed in 18 patients. They had decreased PF (P=0.007) and RP (P=0.019). Patients with the TISS-28 score above or equal to 20 points showed lower HRQOL in the PF domain (P=0.077) and general health (P=0.038). Conclusions: HRQOL in patients with prolonged stay in the ICU is particularly impaired in the domains of physical functioning and role physical. It is associated with circulatory impairment, CINMA, and greater number of therapeutic interventions on discharge from the ICU.
MeSH term(s)	Adult ; Aged ; Aged, 80 and over ; Female ; Health Status Indicators ; Humans ; Intensive Care Units ; Length of Stay ; Male ; Middle Aged ; Patient Discharge ; Prospective Studies ; Quality of Life ; Survivors/psychology ; Young Adult
Language	Lithuanian
Publishing date	2011
Publishing country	Netherlands
Document type	Journal Article
ZDB-ID	2188113-3
ISSN	1648-9144 ; 1010-660X
ISSN (online)	1648-9144
ISSN	1010-660X
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Article ; Online: Fat-free mass at admission predicts 28-day mortality in intensive care unit patients: the international prospective observational study Phase Angle Project.

Thibault, Ronan / Makhlouf, Anne-Marie / Mulliez, Aurélien / Cristina Gonzalez, M / Kekstas, Gintautas / Kozjek, Nada Rotovnik / Preiser, Jean-Charles / Rozalen, Isabel Ceniceros / Dadet, Sylvain / Krznaric, Zeljko / Kupczyk, Kinga / Tamion, Fabienne / Cano, Noël / Pichard, Claude

Intensive care medicine

2016 Volume 42, Issue 9, Page(s) 1445–1453

Abstract: Purpose: Phase angle as measured by bioelectrical impedance analysis reflects fat-free mass. Fat-free mass loss relates to worse prognosis in chronic diseases. Primary aim of this study was: to determine the association between fat-free mass at ... ...

Abstract	Purpose: Phase angle as measured by bioelectrical impedance analysis reflects fat-free mass. Fat-free mass loss relates to worse prognosis in chronic diseases. Primary aim of this study was: to determine the association between fat-free mass at intensive care unit admission and 28-day mortality. Methods: Ten centres in nine countries participated in this multicentre prospective observational study. The inclusion criteria were age >18 years; expected length of stay >48 h; absence of pacemaker, heart defibrillator implant, pregnancy and lactation. Fat-free mass was assessed by measurement of the 50-kHz phase angle at admission. The primary endpoint was 28-day mortality. The area under the receiver operating characteristic curve (AUC) was used to assess prediction of 28-day mortality by fat-free mass at ICU admission. The variables associated with 28-day mortality were analysed by means of multivariable logistic regression. Results: Of the 3605 patients screened, 931 were analysed: age 61 ± 16 years, male 60 %, APACHE II 19 ± 9, body mass index 26 ± 6, day 1 phase angle 4.5° ± 1.9°. Day 1 phase angle was lower in patients who eventually died than in survivors (4.1° ± 2.0° vs. 4.6° ± 1.8°, P = 0.001). The day 1 phase angle AUC for 28-day mortality was 0.63 [0.58-0.67]. In multivariable analysis, the following were independently associated with 28-day mortality: age (adjusted odds ratio (aOR) 1.014 [95 % confidence interval 1.002-1.027], P = 0.03), day 1 phase angle (aOR 0.86 [0.78-0.96], P = 0.008), APACHE II (aOR 1.08 [1.06-1.11], P < 0.001), surgical patient (aOR 0.51 [0.33-0.79], P = 0.002), and admission for other diagnosis (aOR 0.39 [0.21-0.72], P = 0.003). A multivariable combined score improved the predictability of 28-day mortality: AUC = 0.79 [0.75-0.82]. Conclusion: Low fat-free mass at ICU admission is associated with 28-day mortality. A combined score improves mortality predictability. Trial registration: NCT01907347 ( http://www.clinicaltrials.gov ).
MeSH term(s)	APACHE ; Adult ; Aged ; Aged, 80 and over ; Area Under Curve ; Body Composition ; Body Mass Index ; Critical Illness/mortality ; Electric Impedance ; Female ; Hospital Mortality ; Humans ; Intensive Care Units/statistics & numerical data ; Male ; Middle Aged ; Predictive Value of Tests ; Prospective Studies ; Risk Assessment ; Risk Factors ; Severity of Illness Index ; Simplified Acute Physiology Score ; Time Factors
Language	English
Publishing date	2016-09
Publishing country	United States
Document type	Journal Article ; Multicenter Study ; Observational Study
ZDB-ID	80387-x
ISSN	1432-1238 ; 0340-0964 ; 0342-4642 ; 0935-1701
ISSN (online)	1432-1238
ISSN	0340-0964 ; 0342-4642 ; 0935-1701
DOI	10.1007/s00134-016-4468-3
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Article: Prevalence of malnutrition in various political, economic, and geographic settings.

Klek, Stanislaw / Krznaric, Zeljko / Gundogdu, Riza Haldun / Chourdakis, Michael / Kekstas, Gintautas / Jakobson, Triin / Paluszkiewicz, Piotr / Vranesic Bender, Darija / Uyar, Mehmet / Demirag, Kubilay / Poulia, Kalliopi Anna / Klimasauskas, Andrius / Starkopf, Joel / Galas, Aleksander

JPEN. Journal of parenteral and enteral nutrition

2015 Volume 39, Issue 2, Page(s) 200–210

Abstract: Background: Disease-related malnutrition (DRM) represents a critical public health concern. Therefore, Fight Against Malnutrition (FAM) should be a state priority, but the degree to which this is true appears to differ considerably among European ... ...

Abstract	Background: Disease-related malnutrition (DRM) represents a critical public health concern. Therefore, Fight Against Malnutrition (FAM) should be a state priority, but the degree to which this is true appears to differ considerably among European countries. The aim of this study was to put the problem into perspective by comparing the prevalence of malnutrition in countries from opposite parts of the continent. Methods: Six countries-Croatia, Estonia, Greece, Lithuania, Poland, and Turkey-participated in the study. A short questionnaire was used to assess DRM: its prevalence, the current situation in hospitals, regulations for reimbursement, and general healthcare circumstances. Data from ESPEN's NutritionDay 2006 were used to broaden the perspective. Results: At admission in October 2012, 4068 patients were assessed. The study was performed in 160 hospitals and 225 units with 9143 beds. The highest proportions of patients with 3 or more points on the Nutritional Risk Screening 2002 were observed in Estonia (80.4%) and Turkey (39.4%), whereas the lowest were in Lithuania (14.2%). The provision of nutrition support was best in Turkey (39.4% required intervention, 34.4% received intervention) and Poland (21.9% and 27.8%, respectively). Nutrition support teams (NSTs) are active in some countries, whereas in others they virtually do not exist. Conclusion: The prevalence of malnutrition was quite high in some countries, and the nutrition approach differed among them. It could be the result of the lack of reimbursement, inactive or nonexistent NSTs, and low nutrition awareness. Those facts confirmed that the continuation of FAM activities is necessary.
MeSH term(s)	Adult ; Croatia/epidemiology ; Estonia/epidemiology ; Female ; Greece/epidemiology ; Hospitalization ; Humans ; Lithuania/epidemiology ; Male ; Malnutrition/diagnosis ; Malnutrition/economics ; Malnutrition/epidemiology ; Malnutrition/ethnology ; Malnutrition/etiology ; Malnutrition/therapy ; Middle Aged ; Nutrition Assessment ; Nutritional Status ; Poland/epidemiology ; Politics ; Prevalence ; Risk Assessment ; Surveys and Questionnaires ; Turkey/epidemiology
Language	English
Publishing date	2015-02
Publishing country	United States
Document type	Journal Article
ZDB-ID	800861-9
ISSN	0148-6071
ISSN	0148-6071
DOI	10.1177/0148607113505860
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Article ; Online: Characteristics of adult patients with chronic intestinal failure due to short bowel syndrome: An international multicenter survey.

Pironi, Loris / Steiger, Ezra / Joly, Francisca / Jeppesen, Palle B / Wanten, Geert / Sasdelli, Anna S / Chambrier, Cecile / Aimasso, Umberto / Mundi, Manpreet S / Szczepanek, Kinga / Jukes, Amelia / Theilla, Miriam / Kunecki, Marek / Daniels, Joanne / Serlie, Mireille / Poullenot, Florian / Cooper, Sheldon C / Rasmussen, Henrik H / Compher, Charlene /

Seguy, David / Crivelli, Adriana / Santarpia, Lidia / Guglielmi, Francesco W / Kozjek, Nada Rotovnik / Schneider, Stéphane M / Ellegard, Lars / Thibault, Ronan / Matras, Przemysław / Matysiak, Konrad / Van Gossum, Andrè / Forbes, Alastair / Wyer, Nicola / Taus, Marina / Virgili, Nuria M / O'Callaghan, Margie / Chapman, Brooke / Osland, Emma / Cuerda, Cristina / Udvarhelyi, Gábor / Jones, Lynn / Won Lee, Andre D / Masconale, Luisa / Orlandoni, Paolo / Spaggiari, Corrado / Díez, Marta Bueno / Doitchinova-Simeonova, Maryana / Serralde-Zúñiga, Aurora E / Olveira, Gabriel / Krznaric, Zeljko / Czako, Laszlo / Kekstas, Gintautas / Sanz-Paris, Alejandro / Jáuregui, Mª Estrella Petrina / Murillo, Ana Zugasti / Schafer, Eszter / Arends, Jann / Suárez-Llanos, José P / Youssef, Nader N / Brillanti, Giorgia / Nardi, Elena / Lal, Simon

Clinical nutrition ESPEN

2021 Volume 45, Page(s) 433–441

Abstract: Background and aims: The case-mix of patients with intestinal failure due to short bowel syndrome (SBS-IF) can differ among centres and may also be affected by the timeframe of data collection. Therefore, the ESPEN international multicenter cross- ... ...

Abstract	Background and aims: The case-mix of patients with intestinal failure due to short bowel syndrome (SBS-IF) can differ among centres and may also be affected by the timeframe of data collection. Therefore, the ESPEN international multicenter cross-sectional survey was analyzed to compare the characteristics of SBS-IF cohorts collected within the same timeframe in different countries. Methods: The study included 1880 adult SBS-IF patients collected in 2015 by 65 centres from 22 countries. The demographic, nutritional, SBS type (end jejunostomy, SBS-J; jejuno-colic anastomosis, SBS-JC; jejunoileal anastomosis with an intact colon and ileocecal valve, SBS-JIC), underlying disease and intravenous supplementation (IVS) characteristics were analyzed. IVS was classified as fluid and electrolyte alone (FE) or parenteral nutrition admixture (PN). The mean daily IVS volume, calculated on a weekly basis, was categorized as <1, 1-2, 2-3 and >3 L/day. Results: In the entire group: 60.7% were females and SBS-J comprised 60% of cases, while mesenteric ischaemia (MI) and Crohn' disease (CD) were the main underlying diseases. IVS dependency was longer than 3 years in around 50% of cases; IVS was infused ≥5 days/week in 75% and FE in 10% of cases. Within the SBS-IF cohort: CD was twice and thrice more frequent in SBS-J than SBS-JC and SBS-JIC, respectively, while MI was more frequent in SBS-JC and SBS-JIC. Within countries: SBS-J represented 75% or more of patients in UK and Denmark and 50-60% in the other countries, except Poland where SBS-JC prevailed. CD was the main underlying disease in UK, USA, Denmark and The Netherlands, while MI prevailed in France, Italy and Poland. Conclusions: SBS-IF type is primarily determined by the underlying disease, with significant variation between countries. These novel data will be useful for planning and managing both clinical activity and research studies on SBS.
MeSH term(s)	Adult ; Cross-Sectional Studies ; Female ; Humans ; Intestinal Diseases/epidemiology ; Intestinal Diseases/therapy ; Intestines ; Parenteral Nutrition ; Short Bowel Syndrome/epidemiology ; Short Bowel Syndrome/therapy
Language	English
Publishing date	2021-07-28
Publishing country	England
Document type	Journal Article ; Multicenter Study ; Research Support, Non-U.S. Gov't
ISSN	2405-4577
ISSN (online)	2405-4577
DOI	10.1016/j.clnesp.2021.07.004
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Article: Home parenteral nutrition provision modalities for chronic intestinal failure in adult patients: An international survey

Pironi, Loris / Steiger, Ezra / Brandt, Chrisoffer / Joly, Francisca / Wanten, Geert / Chambrier, Cecile / Aimasso, Umberto / Sasdelli, Anna Simona / Zeraschi, Sarah / Kelly, Darlene / Szczepanek, Kinga / Jukes, Amelia / Di Caro, Simona / Theilla, Miriam / Kunecki, Marek / Daniels, Joanne / Serlie, Mireille / Poullenot, Florian / Wu, Jian /

Cooper, Sheldon C / Rasmussen, Henrik H / Compher, Charlene / Seguy, David / Crivelli, Adriana / Pagano, Maria C / Hughes, Sarah-Jane / Guglielmi, Francesco W / Kozjek, Nada Rotovnik / Schneider, Stéphane M / Gillanders, Lyn / Ellegard, Lars / Thibault, Ronan / Matras, Przemysław / Zmarzly, Anna / Matysiak, Konrad / Van Gossum, Andrè / Forbes, Alastair / Wyer, Nicola / Taus, Marina / Virgili, Nuria M / O'Callaghan, Margie / Chapman, Brooke / Osland, Emma / Cuerda, Cristina / Sahin, Peter / Jones, Lynn / Won Lee, Andre Dong / Masconale, Luisa / Orlandoni, Paolo / Izbéki, Ferenc / Spaggiari, Corrado / Bueno, Marta / Doitchinova-Simeonova, Maryana / Garde, Carmen / Serralde-Zúñiga, Aurora E / Olveira, Gabriel / Krznaric, Zeljko / Czako, Laszlo / Kekstas, Gintautas / Sanz-Paris, Alejandro / Jáuregui, Estrella Petrina / Murillo, Ana Zugasti / Schafer, Eszter / Arends, Jann / Suárez-Llanos, José P / Lal, Simon

Clinical nutrition. 2019 Mar. 09,

2019

Abstract: The safety and effectiveness of a home parenteral nutrition (HPN) program depends both on the expertise and the management approach of the HPN center. We aimed to evaluate both the approaches of different international HPN-centers in their provision of ... ...

Institution	The Home Artificial Nutrition and Chronic Intestinal Failure Special Interest Group of ESPEN The European Society for Clinical Nutrition and Metabolism
Abstract	The safety and effectiveness of a home parenteral nutrition (HPN) program depends both on the expertise and the management approach of the HPN center. We aimed to evaluate both the approaches of different international HPN-centers in their provision of HPN and the types of intravenous supplementation (IVS)-admixtures prescribed to patients with chronic intestinal failure (CIF).In March 2015, 65 centers from 22 countries enrolled 3239 patients (benign disease 90.1%, malignant disease 9.9%), recording the patient, CIF and HPN characteristics in a structured database. The HPN-provider was categorized as health care system local pharmacy (LP) or independent home care company (HCC). The IVS-admixture was categorized as fluids and electrolytes alone (FE) or parenteral nutrition, either commercially premixed (PA) or customized to the individual patient (CA), alone or plus extra FE (PAFE or CAFE). Doctors of HPN centers were responsible for the IVS prescriptions.HCC (66%) was the most common HPN provider, with no difference noted between benign-CIF and malignant-CIF. LP was the main modality in 11 countries; HCC prevailed in 4 European countries: Israel, USA, South America and Oceania (p < 0.001). IVS-admixture comprised: FE 10%, PA 17%, PAFE 17%, CA 38%, CAFE 18%. PA and PAFE prevailed in malignant-CIF while CA and CAFE use was greater in benign-CIF (p < 0.001). PA + PAFE prevailed in those countries where LP was the main HPN-provider and CA + CAFE prevailed where the main HPN-provider was HCC (p < 0.001).This is the first study to demonstrate that HPN provision and the IVS-admixture differ greatly among countries, among HPN centers and between benign-CIF and cancer-CIF. As both HPN provider and IVS-admixture types may play a role in the safety and effectiveness of HPN therapy, criteria to homogenize HPN programs are needed so that patients can have equal access to optimal CIF care.
Keywords	adults ; databases ; digestive system diseases ; electrolytes ; health services ; intravenous injection ; parenteral feeding ; patients ; physicians ; surveys ; Europe ; Israel ; Pacific Ocean Islands ; South America ; United States
Language	English
Dates of publication	2019-0309
Publishing place	Elsevier Ltd
Document type	Article
Note	Pre-press version
ZDB-ID	604812-2
ISSN	1532-1983 ; 0261-5614
ISSN (online)	1532-1983
ISSN	0261-5614
DOI	10.1016/j.clnu.2019.03.010
Database	NAL-Catalogue (AGRICOLA)

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Article ; Online: Orthotopic liver transplantation: the first experience and results of the Vilnius University Hospital Santariskiu Klinikos.

Annals of transplantation

2010 Volume 15, Issue 1, Page(s) 14–24

Abstract: Background: Liver transplantation has become the treatment of choice for chronic and acute end-stage liver failure as well as for selected cases of malignancies and metabolic disorders. We report our first experience of the orthotopic liver ... ...

Abstract	Background: Liver transplantation has become the treatment of choice for chronic and acute end-stage liver failure as well as for selected cases of malignancies and metabolic disorders. We report our first experience of the orthotopic liver transplantation. Material/methods: Between 2005 and 2008 16 cadaveric orthotopic liver transplantations in 16 adults (12 males, 4 females, mean age 44 years) were performed. Main indications for orthotopic liver transplantation were cholestatic liver disease (31%), viral-induced cirrhosis (25%), alcoholic liver disease (19%), hepatocellular carcinoma associated with hepatitis virus infection (13%), autoimmune cirrhosis (6%), cryptogenic acute liver failure (6%). Mean follow-up was 15 month (range: 4 days - 43 month). Results: Intraabdominal haemorrhage was observed in 6 patients (37.5%). Vascular complications were observed in 3 patients (18.75%). Biliary complication were observed in 3 patients (18.75%). Overall 1 year patient survival was 87,5%. Four (25%) patients died during follow-up. All patients died because of sepsis and multiorgan system failure. Conclusions: Our first results showed that secret of successful liver transplantation is perfect interdisciplinary team approach, including selection of the recipient and timing of transplantation, the operative procedure itself, prevention and treatment of complications, the perioperative anaesthesiological and intensive-care management, and careful follow up after transplantation.
MeSH term(s)	Adult ; Carcinoma, Hepatocellular/complications ; Carcinoma, Hepatocellular/surgery ; Female ; Hospitals, University ; Humans ; Liver Cirrhosis/complications ; Liver Cirrhosis/surgery ; Liver Diseases, Alcoholic/complications ; Liver Diseases, Alcoholic/surgery ; Liver Failure/complications ; Liver Failure/surgery ; Liver Neoplasms/complications ; Liver Neoplasms/surgery ; Liver Transplantation/mortality ; Male
Language	English
Publishing date	2010-01
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	1484710-3
ISSN	2329-0358 ; 1425-9524
ISSN (online)	2329-0358
ISSN	1425-9524
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: Home parenteral nutrition provision modalities for chronic intestinal failure in adult patients: An international survey.

Clinical nutrition (Edinburgh, Scotland)

2019 Volume 39, Issue 2, Page(s) 585–591

Abstract: Background & aims: The safety and effectiveness of a home parenteral nutrition (HPN) program depends both on the expertise and the management approach of the HPN center. We aimed to evaluate both the approaches of different international HPN-centers in ... ...

Abstract	Background & aims: The safety and effectiveness of a home parenteral nutrition (HPN) program depends both on the expertise and the management approach of the HPN center. We aimed to evaluate both the approaches of different international HPN-centers in their provision of HPN and the types of intravenous supplementation (IVS)-admixtures prescribed to patients with chronic intestinal failure (CIF). Methods: In March 2015, 65 centers from 22 countries enrolled 3239 patients (benign disease 90.1%, malignant disease 9.9%), recording the patient, CIF and HPN characteristics in a structured database. The HPN-provider was categorized as health care system local pharmacy (LP) or independent home care company (HCC). The IVS-admixture was categorized as fluids and electrolytes alone (FE) or parenteral nutrition, either commercially premixed (PA) or customized to the individual patient (CA), alone or plus extra FE (PAFE or CAFE). Doctors of HPN centers were responsible for the IVS prescriptions. Results: HCC (66%) was the most common HPN provider, with no difference noted between benign-CIF and malignant-CIF. LP was the main modality in 11 countries; HCC prevailed in 4 European countries: Israel, USA, South America and Oceania (p < 0.001). IVS-admixture comprised: FE 10%, PA 17%, PAFE 17%, CA 38%, CAFE 18%. PA and PAFE prevailed in malignant-CIF while CA and CAFE use was greater in benign-CIF (p < 0.001). PA + PAFE prevailed in those countries where LP was the main HPN-provider and CA + CAFE prevailed where the main HPN-provider was HCC (p < 0.001). Conclusions: This is the first study to demonstrate that HPN provision and the IVS-admixture differ greatly among countries, among HPN centers and between benign-CIF and cancer-CIF. As both HPN provider and IVS-admixture types may play a role in the safety and effectiveness of HPN therapy, criteria to homogenize HPN programs are needed so that patients can have equal access to optimal CIF care.
MeSH term(s)	Chronic Disease ; Cross-Sectional Studies ; Female ; Health Surveys/methods ; Health Surveys/statistics & numerical data ; Humans ; Internationality ; Intestinal Diseases/diet therapy ; Intestinal Diseases/epidemiology ; Male ; Middle Aged ; Parenteral Nutrition, Home/methods ; Parenteral Nutrition, Home/statistics & numerical data ; Treatment Outcome
Language	English
Publishing date	2019-03-25
Publishing country	England
Document type	Journal Article ; Multicenter Study ; Observational Study ; Research Support, Non-U.S. Gov't
ZDB-ID	604812-2
ISSN	1532-1983 ; 0261-5614
ISSN (online)	1532-1983
ISSN	0261-5614
DOI	10.1016/j.clnu.2019.03.010
Database	MEDical Literature Analysis and Retrieval System OnLINE

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