Early total parenteral nutrition in acute pancreatitis: Lack of beneficial effects

Sax, Harry C.; Warner, Brad W.; Talamini, Mark A.; Hamilton, Frederick; Bell, Richard H.; Fischer, Josef E.; Bower, Robert H.

doi:10.1016/0002-9610(87)90211-x

Cited by 220 publications

(98 citation statements)

References 13 publications

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“…In a metaanalysis of 27 studies comparing PN with enteral nutrition and involving >1,800 patients, Braunschweig et al found a >50% higher incidence of infection in participants receiving PN, but no difference in mortality rate [11]. Prospective, randomised trials in other conditions such as acute pancreatitis have shown a higher incidence of infection, and longer hospital stays, when PN is given [12]. Although PN is not routinely administered in the care of patients after coronary artery bypass (see Table 1), nearly two thirds of the patients in the Leuven I trial had undergone cardiac surgery [3].…”

Section: Does Pn Influence Outcomes In the Critically Ill?mentioning

confidence: 99%

No, the glycaemic target in the critically ill should not be ≤6.1 mmol/l

2007

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Section: Does Pn Influence Outcomes In the Critically Ill?mentioning

confidence: 99%

No, the glycaemic target in the critically ill should not be ≤6.1 mmol/l

2007

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“…For this reason, there have been studies based on the nutrition support of these patients because it is an essential part of the management of this disease. Since 1987 Sax et al, published a study that showed that parenteral nutrition (PN) added to traditional treatment with fluid therapy and analgesia did not decrease the number of deaths, infective complications or length of hospitalization [6]. Therefore, it has been put into question the need for nutritional support in severe AP.…”

Section: Review Articlementioning

confidence: 99%

Nutrition in acute pancreatitis: a review

Frutos

Herranz-Antolín

2014

Open Medicine

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AbstractWe perform an update about nutritional measures that have been adopted in patients with acute pancreatitis (AP). The nutritional support is an essential part of treatment in AP. When the AP is mild or moderate, there is no doubt that is not necessary to use an artificial nutritional support, and it is recommended that oral nutritional support should begin as soon as possible. If the AP is severe, the best way to provide nutritional support is through enteral nutritional (EN) because it reduces infection, length of hospitalization and mortality rate. Parenteral nutrition (PN) should be used only when EN is Impossible. However, there is no scientific evidence for recommending the most optimal route necessary to administer this type of nutritional support; we seek to uncover whether this is by gastric or jejunal route and the proper formula to use. There is an international agreement that the nutritional support should begin quickly, within the first 24 and 72 hours of hospitalization. As conclusion, more research needs to be done concerning nutritional support in AP, and many questions are not been answered yet.

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Section: Pancreatic Diseasesmentioning

confidence: 99%

“…123,124 Both trials only included patients with mild disease. No signi®cant differences were seen favouring the PNS group; in fact, in the larger trial, 124 this group had a longer duration of hospitalization. Another trial, in which such patients were randomized into groups receiving PNS or ENS (jejunal feedings), found no difference in outcomes, and advocated the use of ENS because it was cheaper.…”

Section: Pancreatic Diseasesmentioning

confidence: 99%

Nutritional support

Ofman

Koretz

1997

Aliment Pharmacol Ther

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Nutritional support currently accounts for about 1% of the total health care costs in the USA. Interestingly, most of the prospective randomized controlled trials to date have not been able to demonstrate that this therapeutic intervention alters morbidity or mortality. In fact, parenteral nutritional support may predispose the recipients to developing systemic infections. There have been a few areas in which nutritional support may be of benefit. Enteral supplements given to underweight women who suffer hip fractures reduce the hospital stay and, presumably, overall cost. Preoper‐ative parenteral nutritional support may produce a small absolute reduction in post‐operative morbidity, but its cost becomes prohibitive. Preoperative enteral nutritional support, especially if carried out in the home, may be of benefit (using the most optimistic interpretation of a small number of trials); if so, it is an economically defensible intervention. Particular nutrients or diets may have specific effects on certain disease processes. Indirect comparisons have suggested that elemental diets can be used to treat flares of Crohn's disease (perhaps because putative food antigens are removed). However, corticosteroid therapy is more efficacious. Furthermore, it is less expensive to employ 6‐mercaptopurine as the next modality in steroid failures. Branched‐chain amino acid infusions may have some effect on hepatic encephalopathy, but again, lactulose is less expensive. Nutritional support is one area of medicine in which there has been far more enthusiasm than the data justify. Disease‐associated malnutrition probably is a secondary phenomenon, not an important cause of morbidity. The widespread use of this modality cannot be justified in a cost‐constrained health care system.

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Early total parenteral nutrition in acute pancreatitis: Lack of beneficial effects

Cited by 220 publications

References 13 publications

No, the glycaemic target in the critically ill should not be ≤6.1 mmol/l

No, the glycaemic target in the critically ill should not be ≤6.1 mmol/l

Nutrition in acute pancreatitis: a review

Nutritional support

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