Management of acute intestinal failure: A position paper from the European Society for Clinical Nutrition and Metabolism (ESPEN) Special Interest Group

Kłęk, Stanisław; Forbes, Alastair; Gabe, Simon; Holst, Mette; Wanten, Geert; Irtun, Øivind; Damink, Steven W. M. Olde; Panisic-Sekeljic, Marina; Peláez, Rosa Burgos; Pironi, Loris; Blaser, Annika Reintam; Rasmussen, Henrik Højgaard; Schneider, Stéphane; Thibault, Ronan; Visschers, Ruben G.J.; Shaffer, Jonathan

doi:10.1016/j.clnu.2016.04.009

Cited by 135 publications

(94 citation statements)

References 61 publications

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“…Based on the anatomy of the remaining intestine, SBS is divided into three categories, end jejunostomy (type I), jejunocolic anastomosis (type II), and jejunoileal anastomosis (type III) . The greatest difference between type II and III SBS is that the former one does not have ileocecal valve (ICV) and intact colon, which seem to have important impacts on gut microbiota, intestinal adaption, and clinical symptoms …”

Section: Introductionmentioning

confidence: 99%

Fecal microbiota signatures of adult patients with different types of short bowel syndrome

Huang

Guo

et al. 2017

J of Gastro and Hepatol

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Section: Introductionmentioning

confidence: 99%

Fecal microbiota signatures of adult patients with different types of short bowel syndrome

Huang

Guo

et al. 2017

J of Gastro and Hepatol

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“…Strategies such as our remote pathway are clearly beneficial to managing increasing service pressures. Importantly, implementation of the remote discharge pathway did not impact negatively on quality outcomes including low CRBSI rates and unplanned re‐hospitalisations .…”

Section: Discussionmentioning

confidence: 93%

“…Discharge on HPN can be complex clinically and socially and requires intestinal failure expertise , although the increasing use of HPN in the palliative setting can lead to increased pressures on bed occupancy in intestinal failure units (IFU). ESPEN and British Intestinal Failure Alliance (BIFA) guidance advises the use of dedicated IFUs for the management of type II and III intestinal failure (IF) . The increasing utilisation of HPN in the palliative setting is therefore set to increase the demand on such services.…”

Section: Introductionmentioning

confidence: 99%

A novel discharge pathway for patients with advanced cancer requiring home parenteral nutrition

Bond

Teubner

Taylor

et al. 2019

J Human Nutrition Diet

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Background The use of home parenteral nutrition (HPN) for palliative indications is increasing internationally and is the leading indication in some countries. Discharge on HPN can be complex in metabolically unstable patients and requires intestinal failure expertise. Methods Between 2012 and 2018, we performed a retrospective analysis aiming to assess the impact of a novel remote discharge pathway for palliative HPN patients. This was evaluated using a quality improvement approach. Results One hundred and twenty‐five patients with active malignancy [mean (range) age 58 (25–80) years] were referred to the intestinal failure unit (IFU) for remote discharge. Of 82 patients were discharged from the oncology Centre on HPN using the pathway. The remaining 43 patients either declined HPN or the Oncology team felt that the patient became too unwell for HPN or died prior to discharge. There was an increase in patients referred for remote discharge from 13 in 2012 to 43 in 2017. The mean number of days between receipt of referral by the IFU to discharge on HPN from the oncology centre reduced from 29.4 days to 10.1 days. Following remote discharge, the mean number of days on HPN was 215.9 days. Catheter‐related blood stream infection rates in this cohort were very low at 0.169 per 1000 catheter days. Conclusions This is the first study to demonstrate the remote safe, effective and rapid discharge of patients requiring palliative HPN between two hospital sites. This allows patients with a short prognosis more time in their desired location.

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“…Within the HPN population there can be wide variability in terms of fluid and energy needs depending on the etiology of IF. Despite this variability, experts in the field of nutrition and guidelines from major nutrition societies tend to agree that intravenous lipid emulsions (ILEs) are an integral part of PN . Most recent guidelines on chronic IF (CIF) recommend that patients totally dependent on HPN should receive a minimum of 1 g/kg/wk of ILE containing essential fatty acids (EFAs) in order to prevent EFA deficiency (EFAD) .…”

Section: Essential Fatty‐acid Deficiencymentioning

confidence: 99%

Use of Lipids in Adult Patients Requiring Parenteral Nutrition in the Home Setting

Mundi

Kłęk²,

Martindale

2020

J Parenter Enteral Nutr

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It is estimated that over 25,000 Americans receive home parenteral nutrition (HPN), mostly because of intestinal failure (IF). Although there is significant variability in the fluid and energy needs of patients receiving HPN, intravenous lipid emulsions (ILEs) are an essential part of the macronutrient composition, serving as an excellent source of non‐protein energy, as well as supplying essential fatty acids. However, the long‐term use of ILEs in particular may be associated with some detrimental health effects, such as intestinal failure associated liver disease (IFALD). Although there is lack of unifying diagnosis, IFALD can present as cholestasis, steatosis, or fibrosis, with a prevalence that ranges between 5% and 43%. The development of IFALD tends to be multifactorial. Risk factors of IFALD can include those related to IF, inflammation/infection, and long‐term parenteral nutrition. Some studies have shown a link between development of IFALD and ILE dose, especially if the dose is >1 g/kg/d, with high ω‐6:ω‐3 polyunsaturated fatty acid (PUFA) ratio and phytosterol content being theorized as some contributing factors. Thus, efforts have been made to use alternative oils (olive oil, medium‐chain triglycerides, and fish oil) to reduce the soybean‐oil content of ILE, which tends to be high in ω‐6 PUFA and phytosterols. Although additional long‐term clinical data are emerging, this strategy, as reviewed in the current manuscript, has shown to provide some benefit in both prevention and treatment of IFALD and other sequelae of HPN.

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Management of acute intestinal failure: A position paper from the European Society for Clinical Nutrition and Metabolism (ESPEN) Special Interest Group

Cited by 135 publications

References 61 publications

Fecal microbiota signatures of adult patients with different types of short bowel syndrome

Fecal microbiota signatures of adult patients with different types of short bowel syndrome

A novel discharge pathway for patients with advanced cancer requiring home parenteral nutrition

Use of Lipids in Adult Patients Requiring Parenteral Nutrition in the Home Setting

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