The Future of Parenteral Nutrition
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This article has been cited by 1 Parenteral nutrition: Few more facts Roy, P. Indian Journal of Anaesthesia. Parenteral nutrition: Revisited. Indian J Anaesth ; Energy Requirements and Recommendations. Fluid Requirement. Protein Requirements. Carbohydrate Requirements. FAT Requirements.
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- Nutrition Support Services | Option Care.
- Parenteral nutrition?
- Box 1 Summary of Recommendations.
Micronutrient Requirements. Initiation , Maintenance and Monitoring of Parenteral Nutrition. Home Parenteral Nutrition. Complications of TPN. Malnutrition in critically ill children: From admission to 6 months after discharge.
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Parenteral nutrition: a risky treatment with positive results
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A prospective, randomized study comparing transparent and dry gauze dressings for central venous catheters. J Infect Dis ; Biometric Studies of Basal Metabolism in Man.
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Publication No. Metabolic response to injury and illness: Estimation of energy and protein needs from indirect calorimetry and nitrogen balance. Relationships between resting and total energy expenditure in injured and septic patients. Crit Care Med ; Effect of routine intensive care interactions on metabolic rate. Chest ; Measured and predicted caloric expenditure in the acutely ill. Oxygen consumption and resting metabolic rate in sepsis, sepsis syndrome, and septic shock. Resting energy expenditure in the critically ill: estimations versus measurement.
New study designs have been developed to overcome limitations of traditional approaches. Preclinical, cell culture, omics, and translational approaches have advanced our understanding of mechanistic relationships at an incredible pace and have become more available as research tools.
New study techniques like gene editing via CRISPR clustered, regularly interspaced, short palindromic repeat and nanotechnology have been developed to overcome limitations of traditional approaches at a breathtaking pace. Artificial intelligence AI and cloud computing are developing rapidly and contributing to greater automation in nutrition care delivery. Health services research has entered the clinical practice arena, with promise as an evidence base for practice decisions.
Consensus approaches for the identification of malnutrition in adult 2 and pediatric 3 , 4 clinical settings have been developed, together with conversations with global nutrition support leaders aiming to align our identification of malnutrition in clinical settings, not excluding the home or alternative site setting, with greater consistency. Hospitals have developed electronic health records EHRs that are data repositories that could be mined using complex analytical techniques to answer clinical research questions that might result in improved patient care.
Expansion of local databases into larger registries has provided a more robust source of clinical research data. This ASPEN research agenda reflects a multiprofessional effort to highlight gaps in knowledge and present broad priorities for research needed to guide optimal nutrition strategies in a variety of settings summary in Box 1.
Although this document provides an overview of research approaches and pathways, the authors recognize that it is not exhaustive.
Instead, the agenda focuses on areas for prioritization to optimize nutrition care, maximize patient safety, and improve healthcare outcomes. Apply modern study designs and research technologies to clinically important nutrition support questions. Use translational research models to examine mechanisms of disease in basic science experiments and compare key outcomes in clinical applications relating to nutrition support. Develop a standardized but rich set of phenotypic variables for description of patient nutrition status. Exploit the potential of health services research to identify the most effective approaches to provision of nutrition support.
Leverage health informatics to make comparisons across practice systems. Validate the consensus criteria for identification of malnutrition in adult and pediatric patients in diverse clinical situations. Foster the development of clinically available methods of measurement of body composition and relevant biomarkers. Novel research methodologies and technological developments are available for application to nutrition questions.
Specific study designs that could complement and advance ASPEN's dynamic research agenda and nutrition support initiatives are listed with examples of research questions in Table 1. Critically ill patients randomized to 1 of 2 doses of protein or energy in common use with data collection using an existing clinical registry framework. Comparison of the impact of provision of oral nutrition supplements vs standard care before admission for major abdominal surgery on outcomes of hospital length of stay, surgical wound infections, or discharge disposition. Assessment of the impact of timing of EN or PN provision on nutrient requirements, assimilation, and metabolism.
Cohort observation of child growth and days of ventilation when receiving an innovative nutrition support therapy as opposed to usual care. Although randomized controlled trials RCTs are a strong source of evidence for clinical guidelines and practice recommendations, the tight inclusion criteria in RCTs make them less generalizable than the diverse patients cared for in clinical settings. This limitation in generalizability might be reduced by adding a randomization framework into existing clinical practice registries that collect meaningful outcomes data as part of clinical practice.
These mechanistic insights can then inform future RCTs or pragmatic trials that will enable further precision of approach and eventual strength of clinical practice guideline recommendations. Omics approaches that include the microbiome, metabolome, epigenome, and chronobiome can potentially portray health and disease states with greater accuracy and specificity, both in human subjects and in preclinical research models. The gut microbiome plays an important role in health and disease, including conditions where EN or PN is used. In the context of an individual's genetic profile, immune and inflammatory pathways triggered by gut bacteria may play a role in disease initiation or progression.
Preclinical studies translated into human trials have yielded important insights into microbial roles in obesity, diabetes, inflammatory bowel disease, and allergic disorders, but the impact of provision of nutrition support in these contexts is largely unexplored.
Metabolomic signatures resulting from nutrition and medication delivery to individual subjects and its modulation by microbial communities may shed light on individualized responses. Chronobiome refers to variations in physiological function, disease expression, and drug responses throughout the day. Could more precise or rapid diagnosis of disease, empowered by AI decisions based on a full complement of nutrition biomarkers, clinical, and omics data, lead to more efficacious nutrition responses?
Standard operating procedures for collection of biological samples in nutrition support patients would enhance our ability to combine and compare study results.