Comparison between Total Parenteral Nutrition Vs. Partial Parenteral Nutrition on Serum Lipids Among Chronic Ventilator Dependent Patients; A Multi Center Study

Abstract

Background:

malnutrition is identical coarse among chronically hospitalized patients, specially those in the intensive care unit of measurement ( ICU ). Identifying the patients at risk and providing desirable nutritional corroborate can prevent and/or get the better of malnutrition in them. total parenteral nutrition ( TPN ) and partial parenteral nutriment ( PPN ) are two coarse routes to deliver nutriment to hospitalized patients. We conducted a multicenter, prospective double blind randomized controlled test to evaluate the benefits and compare their adverse effects of each method acting .

Materials and Methods:

97 patients were enrolled and divided into two groups based on the inclusion criteria. Serum protein, serum albumin, serum transferrin, and sum lymphocyte count were measured on days 7 and 14 .

Results:

We did not find any statistically significant differences in clinical status or lab values between the two groups but there were significant improvements in quantify lab values between days 7 and 14 ( p < 0.005 ) indicating improved nutritional condition in each groups.

Conclusion:

This learn shows that both TPN and PPN can be used safely in chronic ICU patients to provide nutritional documentation and prevent catabolic state among chronic critically ill patients. We need to develop accurate survival criteria in order to choose the patients who would benefit the most from TPN and PPN. In accession, appropriate testing ground markers are needed to monitor the metabolic requirements of the patients and assess their advance. Keywords:

Total parenteral nutrition, peripheral parenteral nutrition, critical illness, chronic critical illness, intensive care unit (ICU)

INTRODUCTION

malnutrition is very coarse among chronically hospitalized patients and it may be more severe in chronic critically ill patients in the ICU, in whom oral consumption may be reduced or even impossible. Based on holocene studies arsenic much as 40 % of all critically ill adult patients are seriously malnourished upon entree, and up to two thirds of the patients experience deterioration of their nutritional status during their ICU persist ( 1 ). Acute illness foster increases metabolic rate and mar utilization of nutritional substrates ( 2 ). Patients with chronic pneumonic diseases, particularly breathing device dependent patients, are at increased risk of developing malnutrition due to underestimate of their nutritional needs and stay initiation of appropriate nutritional support by their physicians ( 3 ). several other factors such as liverwort and respiratory insufficiency, increased metabolic rate, minus nitrogen counterweight, weight loss, brawn atrophy, and impaired gastrointestinal function may occur during their hospital stay and may be due to stress reaction and/or hormonal changes ( 4 ). Appropriate checkup treatments, vitamin a good as adequate nutrition are required to overcome the patients ’ implicit in illness. Based on the patients ’ ability and their general conditions there are three different ethods to provide nutrition, including intestinal nutrition, TPN, and PPN. Enteral feeding may not be possible in some patients due to technical foul problems ( i.e. access ) and/or the severity of their illness. On the other pass TPN and PPN have electric potential benefits and disadvantages ( 5, 6 ). TPN is an accept and approved method for balancing thermal and nutritional needs in chronically hospitalize patients. however, the combination of intravenous nutrition and enteric run may be beneficial and have fewer side effects ( 7, 8 ). There are several clinical and testing ground markers for evaluating nutritional status. clinical markers include body weight unit and arm circumference, and lab markers consist of serum albumin, transferrin, total protein, and entire lymphocyte count. These markers should not be interpreted independently and should always be considered together in ordain to accurately assess the patients ’ nutritional status ( 7 ). The study aimed to evaluate the benefits and compare their adverse effects of each method acting in ICU patients with chronic respiratory diseases.

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MATERIALS AND METHODS

We conducted a prospective double blinded randomized controlled trial to evaluate the superiority of TPN and PPN and compare their adverse effects in ICU patients with chronic respiratory diseases. From 2012 to 2014, 97 patients ( 49 males, 48 females ) with chronic breathing device dependence in three university ICUs were randomly were randomly divided into two groups. Chronic ventilator addiction was defined as requiring breathing device support for more than ten days and bankruptcy to wean during the adjacent seven days. Informed consent was obtained from the patients or their adjacent of keen and was approved by each hospital ’ randomness ethics committee and the discipline was registered in the iranian register of clinical trials : hypertext transfer protocol : //www.irct.ir. Every patient received a central venous catheter via internal jugular vein vein, a Foley catheter, and a naso-, or orogastric tube. Patients did not receive albumin supplements. Individual data such as senesce, sex, nutritional method, and GCS were recorded. Harris-Benedict convention was used in order to estimate the radical energy requirements ( this method is used to estimate an individual ’ randomness basal metabolic rate ( BMR ) and casual kilocalorie requirement ) and Clifton formula was used to calculate thermal requirements ( 9, 10 ). In group A patients TPN was started after achieving hemodynamic stability. The TPN solution consisted of amino acids, 10 % dextrose, intralipid, vitamins, and minerals and included 40 % fat, 42 % carbohydrates, and 18 % proteins. entire caloric and nutritional needs were calculated for each affected role by our dietician. In group B patients PPN was started if gastric secretions were less than 100 milliliter during 2 straight hours and bowel sounds were present. Total energy requirements for each patient were calculated and total caloric inhalation was divided equally between enteric and parenteral nutriment. parenteral solutions were prepared in a similar fashion to those in group A and the enteric nutrition rule was prepared such that it contained one Kcal per milliliter. Each 2000 milliliter of the intestinal nutrition convention contained 100 grams of tomatoes, 100 grams of yogurt, 60 gram of beef, 70 grams of soy, 20 grams of carbohydrate, 40 grams of anoint, and 60 grams of rice gunpowder. The osmolarity of the solution was 440 mosm/kg. enteric nutrition was delivered every 4 hours by an know nurse, starting with a 100 milliliter bolus and increasing by 100 milliliter until reaching the day by day goal of ? If gastric residual volume was higher than 100 milliliter before the following bolus, we did not increase the amount of the following bolus. The choice and quantity of parenteral solutions were alike in both groups. In both groups nutriment was provided at least for 2 weeks and during this period blood samples were drawn casual at 7 and 9 AM. Serum total protein ( STP ), serum albumin ( SA ), serum transferrin ( ST ) and total lymphocyte count ( TLC ) were measured for each affected role on days 7 and 14 of their ICU stay. SP, SA and ST were calculated by technician RA-1000 device and TLC was measured by a cell counter. Height ( in centimeter ) was measured on the day of admission and all patients were weighed on the 1st, 7th, and the 14th day of their ICU stay. We used two sample distribution T-test and Mann-Whitney U-test. P < 0.01 was set as statistically significant .

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DISCUSSION

Patients with chronic illness, specially those in the ICU may develop a catabolic state, which increases the hazard of malnutrition, multiple organ dysfunction, and worsens outcomes. There are some clinical and lab parameters that are used to assess the nutritional condition of patients. STP, SA, ST, and TLC are normally used for this aim ( 11 ). TPN and PPN have been previously shown to improve the nutritional status of critically ill patients. however, they both have electric potential side effects. therefore, our finish was to find the nutritional method with less side effects in these patients. Schloerb et aluminum. have previously reported the patterns and problems of TPN use in pornographic critically ill patients in the US ( 12 ). Our results confirm improved caloric and protein inhalation, based on testing ground values, in both groups. In 2003, Datta et aluminum. reported a regular level of serum protein in PPN ( 13 ). besides Lapp et aluminum. reported that TPN inhibited the transferrin decrease in patients undergo spinal anesthesia fusion ( 14 ). Griffiths found that PPN would have fewer complications in these serum elements and was better preserved ( 15 ). Borzotta et aluminum. found that serum albumin was identical in both intestinal and partial parenteral nutrition groups ( 16 ). These studies show the importance of testing ground evaluation in assessing nutritional needs arsenic well as preventing catabolic department of state. In our analyze we show benefits of these measurement both in comparing PPN and TPN, adenine well as reaching a good nutritional state of matter in both groups. Mokhalalaty et alabama. found that non-standard solutions are associated with greater risk of infections ( 17 ). consequently standard formula for both TPN and PPN are powerfully advised. In our sketch we use standard rule in both groups. sum lymphocyte count is routinely used to assess immunological condition. however, it has been used in some studies to assess nutritional condition, severe physiological try, corticosteroid therapy and hematologic disorders ( 18, 19 ).

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While there are no statistically meaning differences between the two groups, we observed increases in all the measured parameters on day 14 relative to day 7, which shows a significant build up in nutritional condition in both groups. Therefore we found both TPN and PPN effective for providing nutritional support in chronically ailment patients in the ICU. As each method has likely side effects, future studies are required to better determine the best nutritional road in chronically critically ill patients who require ventilator support. additionally, it is clear that standard formulas should be used in ordain to provide adequate nutrition documentation to patients. Serum full protein can be used to asses nutritional status of the patients and detect the presence of catabolic state. In 1996, Miles et. aluminum, noticed that proteins should be included for calorie measuring stick and precise metabolic evaluation. ( 20 )

CONCLUSION

This study shows that both PPN and TPN can be used safely to provide nutriment for chronically ventilator pendent patients in the ICU and preventing catabolic state among them. Following precise studies in the future can clear the measure of each method acting equally well as probable side effects .

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