A descriptive analysis of individually compounded home parenteral nutrition prescriptions provided to adults with chronic intestinal failure

IF 2.9 Q3 NUTRITION & DIETETICS

Clinical nutrition ESPEN Pub Date : 2024-10-22 DOI:10.1016/j.clnesp.2024.10.007

Melanie Baker , Mark Hann , Simon Lal , Sorrel Burden

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引用次数: 0

Abstract

Background & aims

Home Parenteral Nutrition (HPN) prescriptions should be tailored to a patient's nutritional requirements and comprise of individually compounded regimens (IC-HPN) or standard licensed multi-chamber bags (MCB). There is a paucity of research exploring factors associated with admixture type. This study aimed to evaluate the nutrient composition of adult IC-HPN prescriptions and variance in nutrient dosing, make comparisons with the range of MCB available and dosing recommendations stated in international guidelines.

Methods

This cross-sectional observational study analysed anonymised prescription data for adults under the care of a single home care company in England, commencing IC-HPN after January 2021.

Results

There were 155 patient prescriptions (245 HPN bags) included, with body weight available in 82 (52.9 %) cases. Data were reported for each HPN bag, and summarised as an average daily amount, considering the number of different HPN bags and their daily frequency per patient prescription.

A vast range of nutrients were prescribed, with variance in dosing highest for lipid, phosphate, and calcium; with coefficient of variance of 106 %, 74 % and 67 %, respectively. One-hundred-thirty-four (54.7 %) bags contained lipid, resulting in variable ratios of lipid to aqueous bags provided weekly.

Negligible amounts of at least one electrolyte were prescribed in 93 (38.0 %) bags, of which 52 (21.2 %) contained ≤2 mmol calcium. Compared with MCB (65 bags), IC-HPN bags contained higher amounts of all nutrients, apart from nitrogen and phosphate. Mean sodium intake differed substantially between types of bags (IC-HPN 187.5, SD 100.1 mmol versus MCB 49.1, SD 31.7 mmol, p < 0.001). A substantial number of patients received HPN dosages beyond guideline recommendations, with higher amounts of sodium and fluid provided in 41 (50.0 %) cases; conversely, lower than recommended dosages were seen in 55 (67.1 %) for potassium and 61 (74.4 %) for calcium.

Conclusions

This study has demonstrated vast variance in IC-HPN parenteral nutrient dosing, with minimal or an omission of at least one nutrient seen. Further research is needed to explore factors that influence usage of IC-HPN, clinical reasons related to lipid dosing and around the variation in doses prescribed outside of guideline recommendations.

查看原文本刊更多论文

对提供给慢性肠功能衰竭成人的个体化家庭肠外营养处方的描述性分析。

背景与目的：家庭肠外营养（HPN）处方应根据患者的营养需求量身定制，包括单独复方制剂（IC-HPN）或标准许可多室袋（MCB）。目前还很少有研究探讨与混合剂类型相关的因素。本研究旨在评估成人 IC-HPN 处方的营养成分和营养剂量差异，并与现有的 MCB 范围和国际指南中的剂量建议进行比较：这项横断面观察性研究分析了英格兰一家家庭护理公司护理的成人匿名处方数据，这些成人在 2021 年 1 月后开始接受 IC-HPN 治疗：共有 155 份患者处方（245 个 HPN 袋），其中 82 例（52.9%）有体重数据。考虑到每个患者处方中不同 HPN 袋的数量及其每日使用频率，报告了每个 HPN 袋的数据，并汇总为每日平均用量。处方中的营养素种类繁多，其中血脂、磷酸盐和钙的剂量差异最大；差异系数分别为 106%、74% 和 67%。134袋（54.7%）营养袋含有脂质，导致每周提供的脂质营养袋与水质营养袋的比例各不相同。有 93 袋（38.0%）至少含有一种电解质，其中 52 袋（21.2%）的钙含量小于 2 毫摩尔。与 MCB（65 袋）相比，IC-HPN 袋中除氮和磷酸盐外，所有营养素的含量都较高。不同类型包装袋的平均钠摄入量差别很大（IC-HPN 187.5，SD 100.1 mmol；MCB 49.1，SD 31.7 mmol，p 结论：这项研究表明，IC-HPN 肠外营养素剂量存在巨大差异，至少有一种营养素的剂量极低或遗漏。需要进一步开展研究，探索影响 IC-HPN 使用的因素、与脂质剂量相关的临床原因以及指南建议之外的处方剂量差异。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Clinical nutrition ESPEN NUTRITION & DIETETICS-

CiteScore

4.90

自引率

3.30%

发文量

512

期刊介绍： Clinical Nutrition ESPEN is an electronic-only journal and is an official publication of the European Society for Clinical Nutrition and Metabolism (ESPEN). Nutrition and nutritional care have gained wide clinical and scientific interest during the past decades. The increasing knowledge of metabolic disturbances and nutritional assessment in chronic and acute diseases has stimulated rapid advances in design, development and clinical application of nutritional support. The aims of ESPEN are to encourage the rapid diffusion of knowledge and its application in the field of clinical nutrition and metabolism. Published bimonthly, Clinical Nutrition ESPEN focuses on publishing articles on the relationship between nutrition and disease in the setting of basic science and clinical practice. Clinical Nutrition ESPEN is available to all members of ESPEN and to all subscribers of Clinical Nutrition.