Influence of Parenteral Nutrition Delivery System on the Development of Bloodstream Infections in Critically Ill Patients

Pontes-Arruda, Alessandro; Santos, Maria Cecília Freitas Cesarino dos; Martins, Laércia Ferreira; González, Eddy René Rodriguez; Kliger, Rubén Gustavo; Maia, Marcelo de Oliveira; Magnan, Gisele Brocco

doi:10.1177/0148607111427040

Cited by 56 publications

(70 citation statements)

References 59 publications

(56 reference statements)

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“…Of these, we excluded 40 trials due to the following reasons: 22 trials [14,15,16,17,18,19,20,21,22,23,24,25,26,27, 28,29,30,31,32,33,34,35] trials did not include ICU patients (mostly elective surgery and cancer patients), 12 trials [36,37,38,39,40,41,42,43,44,45,46,47] did not evaluate clinically important outcomes; 2 trials [48,49] did not include SO-based LE in the control group; 1 trial [50] compared LCT vs. another LCT emulsion without reduction in SO; 1 trial [51] was conducted in a pediatric population; 1 trial[52] had a short duration of intervention (12 hour of lipid emulsion infusion during the first day); 1 trial included patients with poisoning and not representative of ICU patients[53]. In the end, 12 RCTs [54,55,56,57,58,59,60,61,62,63,64,65] enrolling a total of 806 patients met the inclusion criteria and were included in this systematic review (see Table 1 and 2). The authors reached 100% agreement for inclusion of relevant trials in this review.…”

Section: Resultsmentioning

confidence: 99%

“…When the results of 12 RCTs [54–65] that evaluated mortality were statistically aggregated, ω-6-sparing strategies were associated with a reduction in mortality that was not statistically significant (risk ratio [RR]= 0.83, 95 % confidence intervals [CI] 0.62, 1.11, P= 0.20, heterogeneity I 2 =0% see Figure 1). …”

Section: Resultsmentioning

confidence: 99%

“…There was a trend towards a reduction in ICU LOS associated with the use of ω-6-sparing strategies when compared to LCT [54,56,58,59,60,61,62,64] (WMD −2.31, 95% CI −5.28, 0.66, P=0.13, I 2= 68%, P< 0.003) (Figure 3). When the data from 5 RCTs [58,60,62,63,65] that reported ICU-acquired infections were aggregated, ω-6-sparing strategy had no effect (RR= 1.13, 95% CI 0.87, 1.46, P=0.35, heterogeneity I 2 =0%).…”

Section: Resultsmentioning

confidence: 99%

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Alternative lipid emulsions in the critically ill: a systematic review of the evidence

et al. 2013

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Introduction Parenteral lipid emulsions (LEs) are commonly rich in long-chain triglycerides (LCT) derived from soybean oil (SO). SO containing emulsions may promote systemic inflammation and therefore may adversely affect clinical outcomes. We hypothesized that alternative oil-based LEs (SO-sparing strategies) may improve clinical outcomes in critically ill adult patients compared to SO emulsion only products. The purpose of this systematic review was to evaluate the effect of parenteral SO-sparing strategies on clinical outcomes in intensive care unit (ICU) patients. Methods We searched computerized databases from 1980 to 2013. We included randomized controlled trials (RCTs) conducted in critically ill adult patients that evaluated SO-sparing strategies versus SO-based LEs in the context of parenteral nutrition (PN). Results A total of 12 RCTs met inclusion criteria. When the results of these RCTs that were statistically aggregated, SO-sparing strategies were associated with clinically important reductions in mortality (risk ratio RR= 0.83, 95% confidence intervals CI 0.62, 1.11, P = 0.20), in duration of ventilation (weighted mean difference, WMD −2.57, 95% CI −5.51, 0.37, P= 0.09), and in ICU length of stay (WMD −2.31, 95% CI −5.28, 0.66, P= 0.13) but none of these differences were statistically significant. SO-sparing strategies had no effect on infectious complications (RR=1.13, 95% CI 0.87, 1.46, P=0.35). Conclusion Alternative oil-based LEs may be associated with clinically important reductions in mortality, duration of ventilation, and ICU LOS but lack of statistical precision precludes any clinical recommendations at this time. Further research is warranted to confirm these potential positive treatment effects.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Alternative lipid emulsions in the critically ill: a systematic review of the evidence

et al. 2013

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“…Most of the controlled clinical trials do not directly compare the use of "premixed" standard with compounded customized PN systems for patient outcomes, efficacy, or safety. [50][51][52][53][54][55][56] Rather, the available literature focuses on sequential evaluations of institutions after converting from one delivery approach to another system (ie, customized to standardized PN formulations). A majority of the literature is derived from European experiences, including some within the neonatal population.…”

Section: Strongmentioning

confidence: 99%

A.S.P.E.N. Clinical Guidelines

Boullata

Gilbert

Sacks

et al. 2014

J Parenter Enteral Nutr

253

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Background: Parenteral nutrition (PN) is a high-alert medication available for patient care within a complex clinical process. Beyond application of best practice recommendations to guide safe use and optimize clinical outcome, several issues are better addressed through evidence-based policies, procedures, and practices. This document provides evidence-based guidance for clinical practices involving PN prescribing, order review, and preparation. Method: A systematic review of the best available evidence was used by an expert work group to answer a series of questions about PN prescribing, order review, compounding, labeling, and dispensing. Concepts from the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) format were applied as appropriate. The specific clinical guideline recommendations were developed using consensus prior to review and approval by the American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.) Board of Directors. The following questions were addressed: (1) Does education of prescribers improve PN ordering? (2) What is the maximum safe osmolarity of PN admixtures intended for peripheral vein administration? (3) What are the appropriate calcium intake and calciumphosphate ratios in PN for optimal neonatal bone mineralization? (4) What are the clinical advantages or disadvantages of commercially available premade ("premixed") multichambered PN formulations compared with traditional/customized PN formulations? (5) What are the clinical (infection, catheter occlusion) advantages or disadvantages of 2-in-1 compared with 3-in-1 PN admixtures? (6) What macronutrient dosing limits are expected to provide for the most stable 3-in-1 admixtures? (7) What are the most appropriate recommendations for optimizing calcium (gluconate) and (Na-or K-) phosphate compatibility in PN admixtures? (8) What micronutrient contamination is present in parenteral stock solutions currently used to compound PN admixtures? (9) Is it safe to use the PN admixture as a vehicle for non-nutrient medication delivery? (10) Should heparin be included in the PN admixture to reduce the risk of central vein thrombosis? (11) What methods of repackaging intravenous fat emulsion (IVFE) into smaller patient-specific volumes are safe? (12) What beyond-use date should be used for (a) IVFE dispensed for separate infusion in the original container and (b) repackaged IVFE? (JPEN J Parenter Enteral Nutr. 2014;38:334-377)

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“…Older age and patients with a wide range of comorbid medical illnesses not limited to immune suppression, diabetes, congestive heart failure, chronic liver disease, peripheral vascular diseases, renal diseases, coronary heart diseases, and cancer have all been shown to increase risk in the community and hospital settings [9,11 & 45,46]. Red blood cell transfusion has been associated with an increased risk for BSI [47], and the use of total parenteral nutrition increases risk, particularly, due to yeasts [48]. A number of host-specific immune determinants have also been identified as risk factors.…”

Section: Risk Factorsmentioning

confidence: 99%

Update on bloodstream infections in ICUs

Timsit

Laupland²

2012

Current Opinion in Critical Care

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The incidence of healthcare-associated BSIs increases and is associated with bacteria resistant to antimicrobials used in community-acquired infections. The recent years have witnessed the emergence of extensively resistant bacteria in many regions worldwide, and this is associated with major implications for failure of antimicrobial therapies. Enhanced preventive efforts and optimization of therapy are needed in order to reduce the major burden of BSIs in critically ill patients and to minimize the further emergence of resistance.

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Influence of Parenteral Nutrition Delivery System on the Development of Bloodstream Infections in Critically Ill Patients

Abstract: NCT00798681.

Cited by 56 publications

References 59 publications

Alternative lipid emulsions in the critically ill: a systematic review of the evidence

Alternative lipid emulsions in the critically ill: a systematic review of the evidence

A.S.P.E.N. Clinical Guidelines

Update on bloodstream infections in ICUs

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