The Development of Intravenous Hyperalimentation

Rhoads, Jonathan E.; Vars, Harry M.; Dudrick, Stanley J.

doi:10.1016/s0039-6109(16)42429-1

Cited by 22 publications

(10 citation statements)

References 20 publications

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“…In the 1960s, a technique was developed whereby nutrient solutions could be infused intravenously ('parenteral nutrition') and the modern era of nutrition support was born [3]. In a subsequent narrative review of parenteral nutrition, Dudrick and Ruberg claimed that this treatment would significantly improve the morbidity and mortality of a wide variety of disease processes, including patients undergoing surgery for various reasons or receiving radiation or chemotherapy (henceforth referred to as medical oncotherapy) for cancer [4].…”

Section: Introductory Commentsmentioning

confidence: 99%

Should patients with cancer be offered nutritional support: does the benefit outweigh the burden?

Koretz¹

2007

European Journal of Gastroenterology & Hepatology

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Nutrition support has been widely advocated as adjunctive therapy for a variety of underlying illnesses, including surgery and medical oncotherapy (radiation or chemotherapy for cancer). Both parenteral and enteral nutrition have been mistakenly viewed as feeding, when, in fact, they are medical interventions with associated risks and costs. The argument that nutrition support has to be provided to patients to prevent 'starving to death' confuses the difference between dying in a malnourished state and dying as a direct consequence of nutrient deprivation; cancer patients fit into the former category. As is true for any other medical intervention, efficacy is best established by randomized controlled clinical trials. When these forms of nutrition support have been so assessed, they have not usually been found to be any more efficacious than food on a tray or intravenous 5% dextrose solutions. In fact, parenteral nutrition actually caused harm in patients receiving medical oncotherapy (more total and infectious complications and fewer tumor responses). With regard to cancer patients, the only benefit that was demonstrated was the use of preoperative parenteral nutrition in patients undergoing attempted curative surgery for cancer of the upper gastrointestinal tract (esophagus, stomach, or pancreas). As nutrition support has associated complications (infections, mechanical problems with the tubes, and metabolic problems from the infusates) as well as costs, it cannot be recommended for cancer patients with the exception of the preoperative care of those with upper gastrointestinal malignancies and the occasional patient with gastrointestinal tract inadequacy owing to a slow-growing lesion.

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Section: Introductory Commentsmentioning

confidence: 99%

Should patients with cancer be offered nutritional support: does the benefit outweigh the burden?

Koretz¹

2007

European Journal of Gastroenterology & Hepatology

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“…This paper became one of the major reasons why surgeons spent decades afterward trying to develop ways to provide malnourished patients with some type of nutrient intake, parenteral nutrition in particular . Inherent in any effort to create methods of nutrition support is the assumption that the excess mortality was due to the weight loss.…”

Section: The Assessment Of Evidencementioning

confidence: 99%

Assessing the Evidence in Evidence‐Based Medicine

Koretz

2018

Nut in Clin Prac

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Evidence‐based medicine (EBM) has become a fixture in today's medical practice. Evidence consists of memorialized observations and should be contrasted with dogmatic pronouncements and/or hypotheses. Evidence has varying degrees of reliability. The randomized clinical trial (RCT) or a systematic review of RCTs is accorded the highest level of credibility and expert opinion the lowest. This ranking reflects the internal validity (degree to which factors in the study interfere with the gathering or interpretation of the observations) of the study design; more valid designs are more credible. The provision of healthcare requires an almost constant assessment of evidence. In so doing, there are a number of principles of EBM that need to be kept in mind: Association can never prove causation. Various methodologic biases can influence conclusions made in both RCTs and observational studies. The strength of RCTs is in the elimination of confounding bias. Surrogate outcomes must be validated in RCTs assessing how they are changed compared with the clinical outcomes. Subgroup analyses cannot prove hypotheses although they can generate them. P < 0.05 is not the same as truth. Type I errors are more likely to occur when multiple analyses are performed, when trials are prematurely stopped for perceived benefit when there was no a priori plan to do so, or in small papers with dramatic results that are selectively published. The failure to find a difference does not mean that no difference exists (type II error).

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“…9 Hypoproteinemic dogs displayed greater susceptibility to hemorrhagic shock. 10 Healing of bone fractures during hypoproteinemia in the dog was retarded. 11 This important series of observations, both clinical and experimental, was key in determining the potential benefit to be gleaned from TPN.…”

Section: Early Links Between Malnutrition and Outcomesmentioning

confidence: 99%

Total parenteral nutrition, an ally in the management of patients with intestinal failure and malnutrition: a long‐term view

Spencer¹,

Compher²

2003

J Parenter Enteral Nutr

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Jonathan Rhoads, MD, devoted his career to efforts designed to improve supportive patient care. He was a pioneer in the development of parenteral nutrition, continuing with determination despite daunting clinical challenges. The research efforts of Dr. Rhoads and his colleagues in addressing and remedying nutritional obstacles in surgical patients, including hypoproteinemia and infused-volume constraints, helped pave the way toward the collaborative development of total parenteral nutrition and elevated surgical practice of modern-day medicine.The following abstracted articles are 2 representative examples of Rhoads' body of research and demonstrate how much of his early work dealt with the substantial challenges he faced in the development of a viable parenteral nutrition formula. These research efforts were instrumental in pushing the development of parenteral nutrition forward.The full text of this article is available on the A.S.P.E.N. website at www.nutritioncare.org/ publications/journals/jpenabs.html.ABSTRACT. The Influence of Hypoproteinemia on the Formation of Callus in Experimental Fracture. Jonathan E. Rhoads, William Kasinskas. Surgery 11:38 -44, 1942 Background: This abstract relates the importance of adequate serum protein levels for proper bone healing. The process in which the dog's ulna was sawed, whereby the radius acted as a natural splint, was clever and compassionate. This study and its findings help support the idea that adequate serum protein levels and nutritional status impact sound surgical practices and outcomes. Hypoproteinemia has been shown to delay healing in soft tissue wounds in dogs and is frequently present in patients with wound disruption. These observations suggest that hypoproteinemia may also play a role in the delay of fracture healing, and their purpose was to determine the effect of hypoproteinemia on the formation of bony callus after fractures in dogs. Methods: Normal appearing, medium-sized mongrel dogs were used. Hypoproteinemia was induced by a low-protein diet and repeated plasmapheresis. The diet was adequate for all of the dog's requirements except protein, which was approximately 1%. Plasmapheresis consisted of aspirating blood from the femoral artery, whereby the plasma was removed and the remaining diluted cells were returned to the animal from which they were taken. This procedure was completed about 3 times per week until the serum protein level declined to below 4 g/dL and then as needed to maintain that level for a period of 6 weeks after fracture. During the control periods, the diet consisted of table scraps. The 3 stock dogs subsisting on this diet maintained plasma protein levels of 6 to 7 g/dL. The type of fracture induced for the study was Gigli saw section of the ulna, which permits self-splinting by the radius and allows readily accessible x-ray examination. In the spring of 1938, 3 dogs were rendered hypoproteinemic, with plasma protein levels near 4 g/dL, and the left ulna of each animal was sectioned about 5 cm above the distal end. The hypopr...

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The Development of Intravenous Hyperalimentation

Cited by 22 publications

References 20 publications

Should patients with cancer be offered nutritional support: does the benefit outweigh the burden?

Should patients with cancer be offered nutritional support: does the benefit outweigh the burden?

Assessing the Evidence in Evidence‐Based Medicine

Total parenteral nutrition, an ally in the management of patients with intestinal failure and malnutrition: a long‐term view

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