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

Abstract

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...

Parenteral nutrition in the intensive care unit

“…In 1968, Dudrick and Rhodes spearheaded the use of high‐energy parenteral nutrition called hyperalimentation 3 . Subsequently, PN became the major route of nutritional support on both sides of the Atlantic 4–6 . Over the next two decades, a number of studies consisting of small controlled trials suggested that PN was harmful and promoted increased sepsis.…”

“…3 Subsequently, PN became the major route of nutritional support on both sides of the Atlantic. [4][5][6] Over the next two decades, a number of studies consisting of small controlled trials suggested that PN was harmful and promoted increased sepsis. Consequently, EN is now recommended as the preferred route of nutritional support in critically ill patients.…”