No abstract

Background The 2018 Lipids in Parenteral Nutrition summit involved a panel of experts in clinical nutrition, lipid metabolism, and pharmacology, to assess the current state of knowledge and develop expert consensus statements regarding the use of intravenous lipid emulsions in various patient populations and clinical settings. The main purpose of the consensus statements is to assist healthcare professionals by providing practical guidance on common clinical questions related to the provision of lipid emulsions as part of parenteral nutrition (PN). Methods The summit was designed to allow interactive discussion and consensus development. The resulting consensus statements represent the collective opinion of the members of the expert panel, which was informed and supported by scientific evidence and clinical experience. Results The current article summarizes the key discussion topics from the summit and provides a set of consensus statements designed to complement existing evidence‐based guidelines. Lipid emulsions are a major component of PN, serving as a condensed source of energy and essential fatty acids. In addition, lipids modulate a variety of biologic functions, including inflammatory and immune responses, coagulation, and cell signaling. A growing body of evidence suggests that lipid emulsions containing ω‐3 fatty acids from fish oil confer important clinical benefits via suppression of inflammatory mediators and activation of pathways involved in the resolution of inflammation. Conclusions This article provides a set of expert consensus statements to complement formal PN guideline recommendations.

Background Parenteral nutrition (PN) is a costly technology used widely to provide nutrition to patients who have an inaccessible or non-functioning intestine. Two all-in-one systems currently being used are customised formulations, prepared by hospital pharmacies, and three-compartment bags. Purpose To provide a systematic cost comparison of the two all-inone PN systems: individualised (made from nutrient solutions) versus manufactured (made from three-compartment bag), both prepared in hospital pharmacies. Materials and MethodsWe conducted a prospective study to analyse the total cost of PN bags, accounting for all of the processes involved in preparing and delivering them (the cost of manpower, nutrition solutions, medical supplies and quality controls) in three different healthcare settings. To compare therapeutic alternatives of equivalent nutritional value, the study was performed for the most frequently-employed formulation, which was similar to commercial preparations. A univariate sensitivity analysis was performed to evaluate the impact of different rates of use of three-compartment PN bags. Results 157 routine acts of PN bag preparation (65 hospital compounded and 92 three-compartment) were observed and timed over 9 days. Total costs of the 157 PN bags were included in the study. Mean costs of hospital-compounded bags were higher than threecompartment bags, 51.16 ± 5.63€ versus 39.69 ± 3.00€ respectively (p < 0.01). Manpower costs were responsible for the majority of the differences found (70%). In scenarios using a three-compartment system for 30%, 70% and 90% of PN provision, a cost savings of 4.3%, 10.1% and 12.9% respectively could be achieved. Greatest rates of changing from hospital compounded bags (70% and 90%), in a hospital with 1,800 PN bags/year, might reduce the annual budget by 9306€ and 11,964.8€, respectively. Meanwhile, in a large facility the savings for 8,000 TPN days would be 64,248€ and 82,605€, respectively. Conclusions Since we need to reduce the costs of effective treatments, three-compartment bags could be used for standard adult PN to save money.

The systematic literature review identified evidence of potential clinical, ergonomic, and economic benefits for MCBs compared with COBs and MBSs; however, methodological factors limited evidence quality. More prospective studies are required to corroborate existing evidence.