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Home parenteral nutrition provision modalities for chronic intestinal failure in adult patients: An international survey

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Authors

  • Loris Pironi (Lead Author)
  • Denise Konrad
  • Chrisoffer Brandt
  • Francisca Joly
  • Geert Wanten
  • Cecile Chambrier
  • Umberto Aimasso
  • Anna Simona Sasdelli
  • Sarah Zeraschi
  • Darlene Kelly
  • Kinga Szczepanek
  • Amelia Jukes
  • Simona Di Caro
  • Miriam Theilla
  • Marek Kunecki
  • Joanne Daniels
  • Mireille Serlie
  • Florian Poullenot
  • Jian Wu
  • Sheldon Cooper
  • Henrik Højgaard Rasmussen
  • Charlene Compher
  • David Seguy
  • Adriana Crivelli
  • Maria C. Pagano
  • Sarah-Jane Hughes
  • Francesco Guglielmi
  • Nada Rotovnik Kozjek
  • Stéphane M. Schneider
  • Lyn Gillanders
  • Lars Ellegard
  • Ronan Thibault
  • Przemysław Matras
  • Anna Zmarzly

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Abstract

Background & aims: The safety and effectiveness of a home parenteral nutrition (HPN) program depends both on the expertise and the management approach of the HPN center. We aimed to evaluate both the approaches of different international HPN-centers in their provision of HPN and the types of intravenous supplementation (IVS)-admixtures prescribed to patients with chronic intestinal failure (CIF). Methods: In March 2015, 65 centers from 22 countries enrolled 3239 patients (benign disease 90.1%, malignant disease 9.9%), recording the patient, CIF and HPN characteristics in a structured database. The HPN-provider was categorized as health care system local pharmacy (LP) or independent home care company (HCC). The IVS-admixture was categorized as fluids and electrolytes alone (FE) or parenteral nutrition, either commercially premixed (PA) or customized to the individual patient (CA), alone or plus extra FE (PAFE or CAFE). Doctors of HPN centers were responsible for the IVS prescriptions. Results: HCC (66%) was the most common HPN provider, with no difference noted between benign-CIF and malignant-CIF. LP was the main modality in 11 countries; HCC prevailed in 4 European countries: Israel, USA, South America and Oceania (p < 0.001). IVS-admixture comprised: FE 10%, PA 17%, PAFE 17%, CA 38%, CAFE 18%. PA and PAFE prevailed in malignant-CIF while CA and CAFE use was greater in benign-CIF (p < 0.001). PA + PAFE prevailed in those countries where LP was the main HPN-provider and CA + CAFE prevailed where the main HPN-provider was HCC (p < 0.001). Conclusions: This is the first study to demonstrate that HPN provision and the IVS-admixture differ greatly among countries, among HPN centers and between benign-CIF and cancer-CIF. As both HPN provider and IVS-admixture types may play a role in the safety and effectiveness of HPN therapy, criteria to homogenize HPN programs are needed so that patients can have equal access to optimal CIF care.

Details

Original languageEnglish
Pages (from-to)585-591
Number of pages7
JournalClinical Nutrition
Volume39
Issue number2
Early online date25 Mar 2019
DOIs
Publication statusPublished - Feb 2020
Peer-reviewedYes

Keywords

    Research areas

  • Cancer, Home parenteral nutrition, Intestinal failure, Intravenous supplementation, ESPEN GUIDELINES, CLASSIFICATION

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