Journal of Parenteral and Enteral Nutrition最新文献_第5页

Association between longitudinal changes in phase angle and mortality rate in adults critically ill with COVID-19: A retrospective cohort study COVID-19成人重症患者相角纵向变化与死亡率之间的关系：回顾性队列研究

IF 3.2 3区医学 Q2 NUTRITION & DIETETICS

Journal of Parenteral and Enteral Nutrition

Pub Date : 2024-09-22 DOI: 10.1002/jpen.2685

Alan García-Grimaldo MSc, Ander Samuel Trujillo-Mercado BSc, Nadia Carolina Rodríguez-Moguel MSc, Martin Armando Rios-Ayala MD, Carmen Margarita Hernandez-Cardenas MD, Ivan Armando Osuna-Padilla PhD

Background

Phase angle (PhA) obtained by bioelectrical impedance analysis (BIA) works as a predictor of clinical outcomes. Specific cutoff values for longitudinal changes and their relationship with clinical outcomes are still undetermined for patients with critical illness. Thus, the aim of this study was to analyze the association between longitudinal changes in PhA during intensive care unit (ICU) stay and all-cause 90-day mortality in patients critically ill with COVID-19.

Methods

This was a retrospective cohort study of adults critically ill with COVID-19 undergoing invasive mechanical ventilation with a length of stay >14 days. BIA was performed at ICU admission and at days 7 and 14 of ICU stay; PhA and hydration parameters were collected. Differences between survivors and nonsurvivors were assessed. Longitudinal changes were evaluated using repeated-measures analysis of variance. A receiver operating characteristics curve for PhA declined (%) during the first 14 days, and all-cause 90-day mortality was performed. Survival probability was reported using hazard ratios (HR).

Results

One-hundred nine patients were included. The change in the value of PhA was close to 17.1%. Nonsurvivors had a higher prevalence of individuals with a decrease in PhA >22.2% (area under the curve = 0.65) in the first 14 days in comparison with survivors (70% vs 34.8%, P < 0.01). PhA decrease >22.2% at 14 days was a significant predictor of all-cause 90-day mortality (HR = 2.2, 95% CI 1.71–3.6, P = 0.04).

Conclusion

Changes in PhA are associated with all-cause 90-day mortality. Future studies should be directed to interventions to prevent changes in this nutrition marker.

背景：通过生物电阻抗分析（BIA）获得的相位角（PhA）可以预测临床结果。对于危重症患者来说，纵向变化的具体临界值及其与临床预后的关系仍未确定。因此，本研究旨在分析重症监护室（ICU）住院期间 PhA 纵向变化与 COVID-19 重症患者 90 天内全因死亡率之间的关系：这是一项回顾性队列研究，研究对象为接受有创机械通气且住院时间超过 14 天的 COVID-19 重症成人患者。在重症监护室入院时、住院第 7 天和第 14 天时进行 BIA；收集 PhA 和水合参数。评估了存活者和非存活者之间的差异。采用重复测量方差分析对纵向变化进行评估。对前 14 天的 PhA 下降率（%）和 90 天的全因死亡率进行了接收器操作特征曲线分析。结果：结果：共纳入了 199 名患者。PhA 值的变化接近 17.1%。与存活者相比，未存活者在最初 14 天内 PhA 下降大于 22.2% 的比例更高（曲线下面积 = 0.65）（70% vs 34.8%，P 22.2% 是 90 天内全因死亡率的重要预测因素（HR = 2.2，95% CI 1.71-3.6，P = 0.04）：结论：PhA 的变化与 90 天内全因死亡率相关。结论：PHA 的变化与 90 天内的全因死亡率有关，今后的研究应着眼于采取干预措施，防止这一营养指标发生变化。

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引用次数: 0

Association between SMOF lipid and parenteral nutrition–associated cholestasis compared with Intralipid in extremely low birth weight infants: A retrospective cohort study 与 Intralipid 相比，SMOF 脂质与极低出生体重儿肠外营养相关胆汁淤积症之间存在关联：一项回顾性队列研究。

IF 3.2 3区医学 Q2 NUTRITION & DIETETICS

Journal of Parenteral and Enteral Nutrition

Pub Date : 2024-09-21 DOI: 10.1002/jpen.2689

Pradeep Kumar Velumula MD, Praveen Kumar Boddu MD, Mirjana Lulic-Botica PharmD, Luna Khanal MD, Joe Amoah MD, Monika Bajaj MD

Background

There is limited evidence on benefits of SMOF lipids (mixed fatty acid emulsion of 30% soybean oil, 30% medium chain triglycerides, 25% olive oil, and 15% fish oil) in reducing parenteral nutrition–associated cholestasis in extremely low birth weight infants, compared with soybean oil–based Intralipid.

Aim

To compare incidence of parenteral nutrition–associated cholestasis in preterm infants who received Intralipid vs SMOF lipid.

Methods

We conducted a retrospective study on infants with birth weight <1000 g, admitted between January 2013 to December 2022, who received parenteral nutrition for >14 days and divided them into two groups based on lipid emulsion received (Intralipid, n = 187, SMOF, n = 127). Primary outcome was incidence of parenteral nutrition–associated cholestasis, defined as direct bilirubin ≥2 mg/dl.

Results

Baseline characteristics did not differ between the two groups. No significant difference was noted in parenteral nutrition–associated cholestasis between the two groups on logistic regression, (adjusted odds ratio: 0.71, 95% confidence interval 0.35–1.42, P value 0.33) after adjusting for gestational age, parenteral nutrition days, lipid days, and late-onset sepsis.

Conclusion

There was no difference in the rates of parenteral nutrition–associated cholestasis between preterm infants administered SMOF lipids and those given Intralipid.

背景：SMOF脂质（由30%豆油、30%中链甘油三酯、25%橄榄油和15%鱼油组成的混合脂肪酸乳液）与以豆油为基础的Intralipid相比，在减少极低出生体重儿肠外营养相关胆汁淤积方面的益处证据有限：我们对出生体重 14 天的婴儿进行了一项回顾性研究，并根据接受的脂质乳剂将其分为两组（Intralipid，187 人；SMOF，127 人）。主要结果是肠外营养相关胆汁淤积症的发生率，定义为直接胆红素≥2 mg/dl：两组患者的基线特征无差异。在对胎龄、肠外营养天数、血脂天数和晚期脓毒症进行调整后，两组间肠外营养相关胆汁淤积的Logistic回归结果无明显差异（调整后的几率比：0.71，95%置信区间为0.35-1.42，P值为0.33）：结论：给予SMOF脂质和给予Intralipid的早产儿发生肠外营养相关胆汁淤积症的比率没有差异。

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引用次数: 0

Effects of parenteral nutrition supplemented with beta-hydroxy-beta-methylbutyrate on gut-associated lymphoid tissue and morphology in mice 补充β-羟基-β-甲基丁酸的肠外营养对小鼠肠道相关淋巴组织和形态的影响

IF 3.2 3区医学 Q2 NUTRITION & DIETETICS

Journal of Parenteral and Enteral Nutrition

Pub Date : 2024-09-20 DOI: 10.1002/jpen.2686

Haruka Takayama RD, PhD, Kazuhiko Fukatsu MD, PhD, Midori Noguchi BA, Kazuya Takahashi MD, PhD, Ayako Watkins RD, PhD, Nana Matsumoto RD, MS, Tomonori Narita MD, Satoshi Murakoshi MD, PhD

Background

Parenteral nutrition (PN) without enteral nutrition (EN) leads to marked atrophy of gut-associated lymphoid tissue (GALT), causing mucosal defense failure in both the gut and the extraintestinal mucosal system. We evaluated the effects of beta-hydroxy-beta-methylbutyrate (HMB) on GALT and gut morphology in PN-fed mice.

Methods

Experiment 1: male Institute of Cancer Research mice were assigned to the Chow (n = 12), Control (standard PN: n = 10), or H600 and H2000 (PN containing 600 mg/kg or H2000 mg/kg body weight of Ca-HMB: n = 12 and 10, respectively) groups. After 5 days of dietary manipulation, all mice were killed and the whole small intestine was harvested. GALT lymphocyte cell numbers and phenotypes of Peyer patch (PP), intraepithelial space, and lamina propria lymphocytes were evaluated. Experiment 2: 47 mice (Chow: n = 12; Control: n = 14; H600: n = 11; and H2000: n = 10) were fed for 5 days as in experiment 1. Proliferation and apoptosis of gut immune cells and mucosa, and protein expressions (mammalian target of rapamycin [mTOR], caspase-3, and Bcl2) were evaluated in the small intestine.

Results

Compared with the Controls, the Chow and HMB groups showed significantly higher PP cell numbers, prevented gut mucosal atrophy, inhibited apoptosis of gut cells, and increased their proliferation in association with increased mTOR activity and Bcl2 expression.

Conclusion

HMB-supplemented PN is a potentially novel method of preserving GALT mass and gut morphology in the absence of EN.

背景：没有肠内营养（EN）的肠外营养（PN）会导致肠道相关淋巴组织（GALT）明显萎缩，导致肠道和肠道外粘膜系统的粘膜防御功能失效。我们评估了β-羟基-β-甲基丁酸（HMB）对PN喂养小鼠肠道相关淋巴组织（GALT）和肠道形态的影响：实验 1：雄性癌症研究所小鼠被分配到 Chow 组（n = 12）、对照组（标准 PN：n = 10）或 H600 和 H2000 组（PN 含 600 毫克/千克或 H2000 毫克/千克体重的 Ca-HMB：分别为 n = 12 和 10）。经过 5 天的饮食处理后，杀死所有小鼠并采集整个小肠。评估 GALT 淋巴细胞数量以及佩耶斑块（PP）、上皮内间隙和固有层淋巴细胞的表型。实验 2：47 只小鼠（Chow：n = 12；Control：n = 14；H600：n = 11；H2000：n = 10）按实验 1 的方法喂养 5 天。评估小肠中肠道免疫细胞和粘膜的增殖、凋亡以及蛋白质表达（雷帕霉素哺乳动物靶标[mTOR]、Caspase-3 和 Bcl2）：结果：与对照组相比，Chow组和HMB组的PP细胞数量明显增加，防止了肠道粘膜萎缩，抑制了肠道细胞的凋亡，增加了肠道细胞的增殖，同时增加了mTOR活性和Bcl2的表达：补充 HMB 的 PN 是在无 EN 的情况下保留 GALT 质量和肠道形态的一种潜在的新方法。

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引用次数: 0

Intravenous tigecycline with selected multichamber bag parenteral nutrition: A compatibility study 静脉注射替加环素与精选多室袋肠外营养：兼容性研究

IF 3.2 3区医学 Q2 NUTRITION & DIETETICS

Journal of Parenteral and Enteral Nutrition

Pub Date : 2024-09-10 DOI: 10.1002/jpen.2683

Katarzyna Dettlaff PhD, Julia Guzińska MSc, Pharm, Marta Klimaszewska MSc, Pharm, Katarzyna Dominiak MSc, Pharm, Anna Jelińska PhD

Background

Tigecycline is widely used to treat infections in intensive care units. Drugs often need to be delivered to critically ill patients feeding by parenteral nutrition (PN). Before two preparations are administered in the same infusion line, the safety of this combination should be established. The objective of this study was to determine the compatibility of tigecycline with selected multichamber bag PN (MCB-PN).

Methods

Tigecycline was diluted in 0.9% sodium chloride solution and 5% glucose solution to obtain two 0.5 mg/ml solutions. Then the solutions were combined with selected MCB-PN in appropriate proportions. The samples were visually assessed, and pH, osmolality, turbidity, particle size, and zeta potential were measured. These measurements were made immediately after combining the solutions and after 4 h of storage at 23°C ± 1°C.

Results

It was determined that the pH values of the mixtures after combining with tigecycline changed by ≤0.1 unit. An increase in zeta potential was recorded, excluding one combination of tigecycline with the mixture. For all samples tested, the particle size distribution was within the acceptable range immediately after combination and after 4 h of storage. The difference in osmolality did not exceed ±3%, whereas the zeta potential decreased for only one combination. The turbidity of none of the samples exceeded a critical value.

Conclusion

The physical compatibility of the tigecycline with five MCB-PN was proved. They can therefore be administered to patients in one infusion line using the Y-site.

背景替加环素被广泛用于治疗重症监护病房的感染。重症患者通常需要通过肠外营养（PN）给药。在同一输液管道中使用两种制剂之前，应确定这种组合的安全性。本研究的目的是确定替加环素与选定的多室袋 PN（MCB-PN）的兼容性。方法将替加环素稀释在 0.9% 氯化钠溶液和 5% 葡萄糖溶液中，得到两种 0.5 mg/ml 的溶液。然后将这两种溶液按适当比例与选定的 MCB-PN 混合。目测样品，测量 pH 值、渗透压、浊度、粒度和 zeta 电位。结果表明，与替加环素混合后，混合物的 pH 值变化≤0.1 个单位。除了一种与替加环素混合的混合物外，ZETA电位均有所上升。所有测试样品在混合后和储存 4 小时后的粒度分布都在可接受的范围内。渗透压的差异不超过 ±3%，而只有一种组合的 zeta 电位有所下降。结论已证明替加环素与五种 MCB-PN 具有物理兼容性。因此，它们可以通过 Y 型输液管输注给患者。

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引用次数: 0

JPEN Journal Club 87. The subgroup paradox JPEN 期刊俱乐部 87。子群悖论

IF 3.2 3区医学 Q2 NUTRITION & DIETETICS

Journal of Parenteral and Enteral Nutrition

Pub Date : 2024-09-07 DOI: 10.1002/jpen.2684

Ronald L. Koretz MD

引用次数: 0

Serial transverse enteroplasty in adults with parenteral nutrition dependence: A case series 对依赖肠外营养的成人进行连续横向肠成形术：病例系列。

IF 3.2 3区医学 Q2 NUTRITION & DIETETICS

Journal of Parenteral and Enteral Nutrition

Pub Date : 2024-09-02 DOI: 10.1002/jpen.2682

Eli Mlaver MD, MSc, Savannah R. Smith MD, Abraham J. Matar MD, Vivian M. Zhao PharmD, Rachel Leong PharmD, Jyotirmay Sharma MD, Jahnavi K. Srinivasan MD, John R. Galloway MD

Background

Serial transverse enteroplasty is used to treat patients with chronic intestinal failure owing to short bowel syndrome. Current literature lacks discussion of its role for other etiologies of intestinal failure and its impact on adult patients' nutrition support needs and quality of life.

Methods

We performed a case series on adults with parenteral nutrition (PN) dependence who underwent serial transverse enteroplasty at Emory University Hospital, a quaternary referral center between 2011 and 2022. Data collected included demographics, operative technique, and preoperative and postoperative PN requirements. A phone survey was administered to evaluate the impact of PN and the operation on quality of life.

Results

Ten patients underwent the procedure of interest during the study period. Indications included short bowel syndrome following multiple abdominal operations or intra-abdominal catastrophe and chronic partial bowel obstruction with dysmotility. Bowel length increased by a median of 83%. All patients were discharged home after a median hospital stay of 21 days. At 1-year follow-up, survival was 100%, two (20%) patients fully weaned from PN, three others (30%) reduced PN frequency, and six (60%) decreased their daily parenteral energy requirement. Two additional patients fully weaned from PN by 18 months postoperatively.

Conclusion

This represents one of the largest case series of serial transverse enteroplasty in adults. Small intestinal length nearly doubled, and PN dependence was reduced in most patients. Given the low morbidity and good quality of life observed in this series, this procedure should be more widely investigated for patients with chronic intestinal failure.

背景：连续横向肠成形术用于治疗因短肠综合征导致的慢性肠功能衰竭患者。目前的文献缺乏对其在其他病因引起的肠功能衰竭中的作用及其对成年患者营养支持需求和生活质量的影响的讨论：我们对 2011 年至 2022 年期间在埃默里大学医院（一家四级转诊中心）接受连续横结肠肠成形术的肠外营养（PN）依赖成人患者进行了病例系列研究。收集的数据包括人口统计学、手术技术、术前和术后肠外营养需求。还进行了电话调查，以评估PN和手术对生活质量的影响：十名患者在研究期间接受了相关手术。适应症包括多次腹部手术或腹内灾难后的短肠综合征，以及伴有运动障碍的慢性部分肠梗阻。肠道长度增加的中位数为 83%。所有患者的中位住院时间均为 21 天，之后均已出院回家。随访 1 年时，患者存活率为 100%，2 名患者（20%）完全断绝了肠外营养，另外 3 名患者（30%）减少了肠外营养次数，6 名患者（60%）减少了每日肠外能量需求。另有两名患者在术后 18 个月完全脱离了 PN：结论：这是最大的成人连续横向肠成形术病例系列之一。大多数患者的小肠长度增加了近一倍，对 PN 的依赖性降低。鉴于该系列病例中观察到的低发病率和良好的生活质量，应该对慢性肠功能衰竭患者进行更广泛的研究。

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引用次数: 0

Propyl acetate protects intestinal barrier during parenteral nutrition in mice and Caco-2 cells 醋酸丙酯在小鼠和 Caco-2 细胞肠外营养过程中保护肠道屏障。

IF 3.2 3区医学 Q2 NUTRITION & DIETETICS

Journal of Parenteral and Enteral Nutrition

Pub Date : 2024-08-26 DOI: 10.1002/jpen.2681

Jiwei Wang PhD, Jing Du MS, Xiaomei Gou MS, Yong Huang MS, Jixin He MS, Xiaoyun Lu MS, Ming Xie MD

Background

Gut microbiota dysbiosis induces intestinal barrier damage during parenteral nutrition (PN). However, the underlying mechanisms remain unclear. This study aimed to investigate gut microbiota dysbiosis, luminal short-chain fatty acids, and autophagy in a mouse model and how these short-chain fatty acids regulate autophagy.

Methods

Eight-week-old male specific-pathogen–free mice were randomly divided into a Chow group (standard diet and intravenous normal saline infusion) and a PN group (continuous infusion of PN nutrient solution) for 7 days. Caco-2 cells were also treated with intestinal rinse solutions from Chow and PN mouse models.

Results

Compared with the Chow group, the PN group exhibited increased Proteobacteria and decreased Firmicutes, correlating with decreased propyl acetate. In the PN group, intestinal tissue exhibited elevated adenosine monophosphate–activated protein kinase (AMPK) phosphorylation, LC3II protein levels, and Atg3 and Atg7 messenger RNA levels. P62 protein levels were decreased, indicating an increase of autophagy flux in the PN group. In the Caco-2 cell model, cells treated with PN solution plus propyl acetate exhibited increased Claudin-1 and occluding along with decreased interleukin-6 and tumor necrosis factor α compared with those treated with PN solution alone. Propyl acetate addition inhibited the AMPK–mammalian target of rapamycin (mTOR) pathway, mitigating the excessive autophagy induced by the PN intestinal rinse solution in Caco-2 cells.

Conclusion

PN led to a significant reduction in propyl acetate levels in the intestine, excessive activation of autophagy, and barrier dysfunction. Propyl acetate inhibited excessive autophagy via the AMPK/mTOR signaling pathway and protected the intestinal barrier during PN.

背景：肠道微生物群失调会在肠外营养（PN）过程中诱发肠道屏障损伤。然而，其潜在机制仍不清楚。本研究旨在研究小鼠模型中的肠道微生物群失调、管腔短链脂肪酸和自噬，以及这些短链脂肪酸如何调控自噬：方法：将八周大的雄性无特异性病原体小鼠随机分为 Chow 组（标准饮食和静脉注射生理盐水）和 PN 组（持续注射 PN 营养液），每组 7 天。Caco-2细胞也用Chow组和PN组小鼠的肠道冲洗液处理：结果：与 Chow 组相比，PN 组的变形菌增加，而真菌减少，这与乙酸丙酯的减少有关。在 PN 组中，肠组织显示单磷酸腺苷激活蛋白激酶（AMPK）磷酸化、LC3II 蛋白水平以及 Atg3 和 Atg7 信使 RNA 水平升高。P62 蛋白水平降低，表明 PN 组的自噬通量增加。在 Caco-2 细胞模型中，与单用 PN 溶液处理的细胞相比，用 PN 溶液加醋酸丙酯处理的细胞表现出 Claudin-1 和闭塞增加，白细胞介素-6 和肿瘤坏死因子 α 减少。添加醋酸丙酯抑制了 AMPK-哺乳动物雷帕霉素靶标（mTOR）通路，减轻了 PN 冲洗肠道溶液在 Caco-2 细胞中诱导的过度自噬：结论：PN 会导致肠道中乙酸丙酯水平显著下降、自噬过度激活和屏障功能障碍。醋酸丙酯可通过 AMPK/mTOR 信号通路抑制过度自噬，并在 PN 期间保护肠道屏障。

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引用次数: 0

Caregiver burden and eating-related guilt during dysphagia rehabilitation: A descriptive cross-sectional time series study 吞咽困难康复期间照顾者的负担和与进食有关的内疚感：一项描述性横断面时间序列研究。

IF 3.2 3区医学 Q2 NUTRITION & DIETETICS

Journal of Parenteral and Enteral Nutrition

Pub Date : 2024-08-22 DOI: 10.1002/jpen.2679

Hiroko Mori MPH, PhD, Ayako Nakane DDS, Yuri Yokota PhD, Haruka Tohara DDS, PhD, Takeo Nakayama MPH, PhD

Background

Caregivers of patients with chronic dysphasia experience stress and guilt regarding their eating behaviors. Dysphagia rehabilitation, including minimal oral intake with tube feeding, may be vital for caregivers. This study investigated the effects of dysphagia rehabilitation on caregiver well-being and attitudes toward eating assistance.

Methods

This cross-sectional questionnaire study was conducted at two dental university hospitals on caregivers of homebound patients with dysphagia undergoing rehabilitation. Caregivers' experiences, with an emphasis on guilt and psychological status, were assessed using the Apathy Scale and Patient Health Questionnaire-5 Depression Scale. Patients were evaluated at the time of the survey and rehabilitation commencement using the Barthel Index and Functional Oral Intake Scale (FOIS). Changes in FOIS scores and caregiver guilt were assessed using the Wilcoxon signed rank test and McNemar test, respectively. The impact of oral intake changes on caregiving motivation was assessed using the Fisher exact test.

Results

Between August 2019 and January 2021, 55 of 100 targeted caregivers responded (median age=64.5 years). A significant difference in FOIS scores was found (median rehabilitation duration=9.7 months). Despite 25 pneumonia cases, 65% of the caregivers continued to encourage oral intake. Guilt decreased from 48% during peak dysphagia to 22% at survey time (odds ratio=0.2, 95% CI=0.04–0.70; P < 0.01). No association was found between caregiving motivation and improved oral intake.

Conclusion

Severe dysphagia impacted caregiver well-being, indicating preferences for patients' oral intake. To support caregivers, healthcare professionals should explore and integrate new multidisciplinary approaches into dysphagia rehabilitation strategies.

背景：慢性吞咽困难患者的照顾者会因患者的进食行为而感到压力和内疚。吞咽困难康复治疗，包括用管式喂养进行最低限度的口腔摄入，可能对照顾者至关重要。本研究调查了吞咽困难康复对照顾者的幸福感和对饮食协助的态度的影响：这项横断面问卷调查研究在两所牙科大学医院进行，对象是居家接受康复治疗的吞咽困难患者的护理人员。使用冷漠量表和患者健康问卷-5 抑郁量表对护理人员的经历进行评估，重点是内疚感和心理状态。在调查和康复开始时，使用巴特尔指数和功能性口腔摄入量表（FOIS）对患者进行评估。采用 Wilcoxon 符号秩检验和 McNemar 检验分别评估 FOIS 分数和护理人员内疚感的变化。口腔摄入量变化对护理动机的影响采用费雪精确检验进行评估：在 2019 年 8 月至 2021 年 1 月期间，100 名目标护理人员中有 55 人做出了回应（中位年龄=64.5 岁）。发现 FOIS 评分有明显差异（中位数康复时间=9.7 个月）。尽管出现了 25 例肺炎病例，但仍有 65% 的护理人员继续鼓励患者口服药物。内疚感从吞咽困难高峰期的 48% 降至调查时的 22%（几率比=0.2，95% CI=0.04-0.70；P 结论：严重吞咽困难影响了患者的生活质量：严重吞咽困难影响了护理人员的幸福感，表明他们更倾向于患者的口服摄入。为了支持护理人员，医护人员应探索新的多学科方法，并将其融入吞咽困难康复策略中。

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引用次数: 0

Association between new insertion of a long-term enteral feeding tube and mortality in adults admitted to the hospital with aspiration: A retrospective cohort study 新插入长期肠内喂食管与因吸入而入院的成人死亡率之间的关系：一项回顾性队列研究。

IF 3.2 3区医学 Q2 NUTRITION & DIETETICS

Journal of Parenteral and Enteral Nutrition

Pub Date : 2024-08-20 DOI: 10.1002/jpen.2680

Anthony D. Bai MD, MSc, Siddhartha Srivastava MD, MSc, Marie Leung MD, Heather Johnson MD, Amol A. Verma MD, MPhil, Fahad Razak MD, MSc

Background

We aimed to describe the association between insertion of a new long-term enteral feeding tube during admission for aspiration and in-hospital mortality.

Methods

This retrospective cohort study across 28 Canadian hospitals from 2015 to 2022 included consecutive patients who were admitted for aspiration. Patients were categorized based on new long-term enteral feeding tube insertion during hospital stay or not. The primary outcome was the time to death in hospital. Secondary outcomes included time to discharge alive and hospital readmission for aspiration within 90 days. We used propensity score weighting to balance covariates, and a competing risk model to describe in-hospital death and discharge.

Results

Of 12,850 patients admitted for aspiration, 852 (6.6%) patients received a long-term enteral feeding tube. In the hospital, 184 (21.6%) and 2489 (20.8%) patients in the enteral feeding tube group and no enteral feeding tube group died, respectively. Within 90 days of discharge, 127 (14.9%) and 1148 (9.6%) patients in the enteral feeding tube and no enteral feeding tube group were readmitted for aspiration, respectively. After balancing covariates, an enteral feeding tube was associated with a similar in-hospital mortality risk (subdistribution hazard ratio [sHR] = 1.05, 95% CI = 0.89–1.23; P = 0.5800), longer time to discharge alive (sHR = 0.58, 95% CI = 0.54–0.63; P < 0.0001), and a higher risk of readmission (risk difference = 5.0%, 95% CI = 2.4%–7.6%; P = 0.0001).

Conclusion

Initiation of long-term enteral tube feeding was not uncommon after admission for aspiration and was not associated with an improvement in the probability of being discharged alive from the hospital or readmitted for aspiration.

背景我们旨在描述因吸痰入院期间插入新的长期肠内喂养管与院内死亡率之间的关系：这项回顾性队列研究从 2015 年至 2022 年在加拿大 28 家医院进行，纳入了因吸入而入院的连续患者。根据住院期间是否新插入长期肠内喂养管对患者进行分类。主要结果为住院期间死亡时间。次要结果包括出院时存活时间和 90 天内因吸入而再次入院的时间。我们使用倾向评分加权法平衡协变量，并使用竞争风险模型描述院内死亡和出院情况：在因吸入而入院的12850名患者中，852名（6.6%）患者接受了长期肠内喂养管。在住院期间，肠内喂食管组和无肠内喂食管组分别有 184 名（21.6%）和 2489 名（20.8%）患者死亡。出院后 90 天内，肠内喂养管组和无肠内喂养管组分别有 127 名（14.9%）和 1148 名（9.6%）患者因误吸再次入院。在平衡协变量后，肠内喂养管与相似的院内死亡风险（亚分布危险比 [sHR] = 1.05，95% CI = 0.89-1.23；P = 0.5800）、更长的出院存活时间（sHR = 0.58，95% CI = 0.54-0.63；P 结论：肠内喂养管对患者的死亡风险和出院存活时间具有相关性：因吸痰入院后开始长期肠管喂养的情况并不少见，但这与提高出院后存活的概率或因吸痰再次入院的概率无关。

{"title":"Association between new insertion of a long-term enteral feeding tube and mortality in adults admitted to the hospital with aspiration: A retrospective cohort study","authors":"Anthony D. Bai MD, MSc, Siddhartha Srivastava MD, MSc, Marie Leung MD, Heather Johnson MD, Amol A. Verma MD, MPhil, Fahad Razak MD, MSc","doi":"10.1002/jpen.2680","DOIUrl":"10.1002/jpen.2680","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>We aimed to describe the association between insertion of a new long-term enteral feeding tube during admission for aspiration and in-hospital mortality.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This retrospective cohort study across 28 Canadian hospitals from 2015 to 2022 included consecutive patients who were admitted for aspiration. Patients were categorized based on new long-term enteral feeding tube insertion during hospital stay or not. The primary outcome was the time to death in hospital. Secondary outcomes included time to discharge alive and hospital readmission for aspiration within 90 days. We used propensity score weighting to balance covariates, and a competing risk model to describe in-hospital death and discharge.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of 12,850 patients admitted for aspiration, 852 (6.6%) patients received a long-term enteral feeding tube. In the hospital, 184 (21.6%) and 2489 (20.8%) patients in the enteral feeding tube group and no enteral feeding tube group died, respectively. Within 90 days of discharge, 127 (14.9%) and 1148 (9.6%) patients in the enteral feeding tube and no enteral feeding tube group were readmitted for aspiration, respectively. After balancing covariates, an enteral feeding tube was associated with a similar in-hospital mortality risk (subdistribution hazard ratio [sHR] = 1.05, 95% CI = 0.89–1.23; <i>P</i> = 0.5800), longer time to discharge alive (sHR = 0.58, 95% CI = 0.54–0.63; <i>P</i> < 0.0001), and a higher risk of readmission (risk difference = 5.0%, 95% CI = 2.4%–7.6%; <i>P</i> = 0.0001).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Initiation of long-term enteral tube feeding was not uncommon after admission for aspiration and was not associated with an improvement in the probability of being discharged alive from the hospital or readmitted for aspiration.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16668,"journal":{"name":"Journal of Parenteral and Enteral Nutrition","volume":"48 7","pages":"841-849"},"PeriodicalIF":3.2,"publicationDate":"2024-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jpen.2680","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142008954","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Effect of parenteral lipids on essential fatty acid deficiency in pediatric intestinal failure: A retrospective cohort study 肠外脂质对小儿肠功能衰竭患者必需脂肪酸缺乏症的影响：回顾性队列研究

IF 3.2 3区医学 Q2 NUTRITION & DIETETICS

Journal of Parenteral and Enteral Nutrition

Pub Date : 2024-08-08 DOI: 10.1002/jpen.2678

Parker Johnson PharmD, Victoria L. Phillips PharmD, Nathan Lamb PharmD, Kexin Guo MS, Lihui Zhao PhD, Katherine M. Brennan MSN, Joshua D. Prozialeck MD, Valeria C. Cohran MD

Background

Pediatric patients with intestinal failure require long-term parenteral nutrition owing to impaired enteral nutrition absorption. A potential complication is essential fatty acid deficiency (EFAD), resulting from decreased linoleic and α-linolenic acid concentrations and defined by an increased triene:tetraene ratio (TTR; Mead acid:arachidonic acid). Historically, soybean oil lipid emulsion (SOLE) was the only commercially available parenteral lipid in the United States. Recently, a composite lipid emulsion (CLE) and fish oil lipid emulsion (FOLE) received US Food and Drug Administration approval. This study investigated whether lipid emulsion regimen impacts EFAD incidence in pediatric patients with intestinal failure.

Methods

This study was a 10-year retrospective cohort study of pediatric patients with intestinal failure who received parenteral SOLE, CLE, or FOLE. The primary outcome was EFAD incidence, defined as a TTR ≥ 0.2. Secondary outcomes included TTR ≥ 0.05, cholestasis incidence, lipid dose effect on EFAD incidence, and fatty acid parameter differences.

Results

A total of 144 fatty acid profiles from 47 patients were reviewed. EFAD did not occur in any lipid emulsion group. There were no differences in the incidence of TTR ≥ 0.05 or cholestasis. The effect of dose could not be evaluated because of no EFAD incidence. Lastly, although each group had varied fatty acid parameters, none saw decreased essential fatty acid levels.

Conclusion

This study found that, with close monitoring, the lipid emulsion regimen did not impact EFAD incidence. This suggests that FOLE and CLE do not increase EFAD risk compared with SOLE in pediatric patients with intestinal failure.

背景：肠功能衰竭的小儿患者因肠内营养吸收障碍而需要长期肠外营养。一种潜在的并发症是必需脂肪酸缺乏症（EFAD），其原因是亚油酸和α-亚麻酸浓度降低，三烯：四烯比率（TTR；米德酸：花生四烯酸）升高。一直以来，大豆油脂乳剂（SOLE）是美国唯一的商用肠外脂质。最近，一种复合脂质乳剂（CLE）和鱼油脂质乳剂（FOLE）获得了美国食品药品管理局的批准。本研究调查了脂质乳剂疗法是否会影响肠功能衰竭儿科患者的 EFAD 发生率：该研究是一项为期 10 年的回顾性队列研究，研究对象是接受肠外 SOLE、CLE 或 FOLE 治疗的肠功能衰竭儿科患者。主要结果是 EFAD 发生率，定义为 TTR ≥ 0.2。次要结果包括 TTR ≥ 0.05、胆汁淤积发生率、脂质剂量对 EFAD 发生率的影响以及脂肪酸参数差异：结果：共审查了 47 名患者的 144 份脂肪酸图谱。所有脂质乳剂组均未发生 EFAD。TTR≥0.05或胆汁淤积的发生率没有差异。由于没有发生 EFAD，因此无法评估剂量的影响。最后，虽然每组的脂肪酸参数不同，但都没有发现必需脂肪酸水平下降：本研究发现，在密切监测的情况下，脂质乳剂疗法不会影响 EFAD 的发生率。这表明，在肠功能衰竭的儿科患者中，FOLE 和 CLE 与 SOLE 相比不会增加 EFAD 风险。

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引用次数: 0