Use of Intravenous Lipid Emulsions With Parenteral Nutrition: Practical Handling Aspects

Boullata, Joseph I.; Berlana, David; Piętka, Magdalena; Kłęk, Stanisław; Martindale, Robert G.

doi:10.1002/jpen.1737

Cited by 14 publications

(31 citation statements)

References 70 publications

(191 reference statements)

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“…The final volume of the PN was approximately 1 mL/kcal, unless the patient needed water restriction. The infusion of a 3-in-1 PN included a 1.2 µm filter to limit the infusion of unwanted particles, as recommended by the Federal Drug Administration [ 12 ]. All PN bags were tailor-made in the compounding facilities of the Department of Hospital Pharmacy of our institution and administered for 24 h. Therefore, we did not use ready-to-use standard bags.…”

Section: Methodsmentioning

confidence: 99%

Acute Hypertriglyceridemia in Patients with COVID-19 Receiving Parenteral Nutrition

et al. 2021

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Hypertriglyceridemia is a metabolic complication associated with parenteral nutrition (PN). It is unknown if patients with acute respiratory distress syndrome (ARDS) secondary to COVID-19 are more at risk. Our aim was to describe the incidence, risk factors and clinical impact of hypertriglyceridemia in critically ill patients with ARDS-COVID-19 receiving PN. We designed a cohort study of patients with ARDS-COVID-19 infection that required admission to critical care units and nutritional support with PN. Individual PN prescriptions for macronutrients and insulin were provided. Lipid emulsion contained fish oil (SMOFlipid® or Lipoplus®). Hypertriglyceridemia was defined as plasma levels above 400 mg/dL. Eighty-seven patients, 66.6% men, 60.1 ± 10.8 years old, BMI 29.1 ± 5.6 kg/m2, 71% of whom received lopinavir/ritonavir, 56% received Propofol and 55% received Tocilizumab were included. The incidence of hypertriglyceridemia was 37 × 100 patient-days with PN. This complication was more frequent in obese patients (OR 3.34; 95% CI, 2.35–4.33) and in those treated with lopinavir/ritonavir (OR 4.98; 95% CI, 3.60–6.29) or Propofol (OR 2.45; 95% CI, 1.55–3.35). Total mortality was 33.3%, similar between the type of lipid emulsion (p = 0.478). On average, patients with hypertriglyceridemia had a longer requirement of PN compared to the group without elevated triglycerides (TG), probably because of their longer survival (p = 0.001). TG higher than 400 mg/dL was not a protective factor for mortality (OR 0.31; 95% CI, 0.01–1.30). In conclusion, the incidence of hypertriglyceridemia was 37 × 100 patient-days with PN. The risk of this complication is associated with obesity and the use of lopinavir/ritonavir or Propofol.

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Section: Methodsmentioning

confidence: 99%

Acute Hypertriglyceridemia in Patients with COVID-19 Receiving Parenteral Nutrition

et al. 2021

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“…A 1.2-micron in-line filter is considered appropriate for lipid-containing admixture, but a 0.22-micron filter could be used for non-lipid-containing admixtures [ 32 ]. Although, when the lipid is administered separately, a single container infused over a maximum of 12 h is recommended to reduce the risk of contamination and infection; lipid administered separately is commonly infused over 24 h [ 34 , 35 ]. However, the separate administration of the lipid may lead to multiple manipulations, increasing the risk of catheter-related infection and cost [ 36 ].…”

Section: Vascular Access and Administrationmentioning

confidence: 99%

Parenteral Nutrition Overview

Berlana

2022

Nutrients

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Parenteral nutrition (PN) is a life-saving intervention for patients where oral or enteral nutrition (EN) cannot be achieved or is not acceptable. The essential components of PN are carbohydrates, lipids, amino acids, vitamins, trace elements, electrolytes and water. PN should be provided via a central line because of its hypertonicity. However, peripheral PN (with lower nutrient content and larger volume) can be administered via an appropriate non-central line. There are alternatives for the compounding process also, including hospital pharmacy compounded bags and commercial multichamber bags. PN is a costly therapy and has been associated with complications. Metabolic complications related to macro and micronutrient disturbances, such as hyperglycemia, hypertriglyceridemia, and electrolyte imbalance, may occur at any time during PN therapy, as well as infectious complications, mostly related to venous access. Long-term complications, such as hepatobiliary and bone disease are associated with longer PN therapy and home-PN. To prevent and mitigate potential complications, the optimal monitoring and early management of imbalances is required. PN should be prescribed for malnourished patients or high-risk patients with malnutrition where the feasibility of full EN is in question. Several factors should be considered when providing PN, including timing of initiation, clinical status, and risk of complications.

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“…The safe handling of IV lipid emulsions is an important aspect of PN therapy. The article by Boullata et al 97 in the current supplement reviews the main considerations in the handling of lipid emulsions and offers practical recommendations for the preparation and administration of PN admixtures containing lipid emulsions. Consensus statements related to practical handling aspects are presented in Table 1 (consensus statements [39][40][41][42][43].…”

Section: Practical Handling Aspectsmentioning

confidence: 99%

Summary of Proceedings and Expert Consensus Statements From the International Summit “Lipids in Parenteral Nutrition”

Martindale

Berlana

Boullata

et al. 2020

J Parenter Enteral Nutr

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Background The 2018 Lipids in Parenteral Nutrition summit involved a panel of experts in clinical nutrition, lipid metabolism, and pharmacology, to assess the current state of knowledge and develop expert consensus statements regarding the use of intravenous lipid emulsions in various patient populations and clinical settings. The main purpose of the consensus statements is to assist healthcare professionals by providing practical guidance on common clinical questions related to the provision of lipid emulsions as part of parenteral nutrition (PN). Methods The summit was designed to allow interactive discussion and consensus development. The resulting consensus statements represent the collective opinion of the members of the expert panel, which was informed and supported by scientific evidence and clinical experience. Results The current article summarizes the key discussion topics from the summit and provides a set of consensus statements designed to complement existing evidence‐based guidelines. Lipid emulsions are a major component of PN, serving as a condensed source of energy and essential fatty acids. In addition, lipids modulate a variety of biologic functions, including inflammatory and immune responses, coagulation, and cell signaling. A growing body of evidence suggests that lipid emulsions containing ω‐3 fatty acids from fish oil confer important clinical benefits via suppression of inflammatory mediators and activation of pathways involved in the resolution of inflammation. Conclusions This article provides a set of expert consensus statements to complement formal PN guideline recommendations.

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Use of Intravenous Lipid Emulsions With Parenteral Nutrition: Practical Handling Aspects

Cited by 14 publications

References 70 publications

Acute Hypertriglyceridemia in Patients with COVID-19 Receiving Parenteral Nutrition

Acute Hypertriglyceridemia in Patients with COVID-19 Receiving Parenteral Nutrition

Parenteral Nutrition Overview

Summary of Proceedings and Expert Consensus Statements From the International Summit “Lipids in Parenteral Nutrition”

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