PROVİDİNG NUTRİTİONAL SUPPORT İN ADULT PATİENTS: A LOOK AT THE ASPEN GUİDE

Abstract

Introduction: Nutritional support with enteral or parenteral formulas is needed to maintain or improve disrupted nutrition. In individuals at risk for malnutrition, the nutritional status should be assessed by appropriate methods and clearly demonstrated. Malnutrition is a condition that may have negative consequences on mortality and morbidity. Enteral nutrition is the provision of nutritional support by administering nutrients through a catheter, tube or mouth to a part of the gastrointestinal tract away from the oral cavity. Parenteral nutrition is the intravenous administration of nutrients. The use of the gastrointestinal tract instead of parenteral nutrition alone helps to maintain mucosal barrier function and integrity. Aim: This study was conducted to review current, global studies on the provision of nutritional support in adult patients and the latest guidelines of the American Society for Parenteral and Enteral Nutrition. It is aimed to compile and improve the general literature on nutritional support and to contribute to those who want to collect information on this subject. Methods: The guidelines obtained from ASPEN's original website “nutritioncare.org” and the Journal of Parenteral and Enteral Nutrition, the studies of researchers conducted under the name of the ASPEN organization were examined and constituted the source of this review. A literature search was then conducted. The search was conducted using the following electronic databases: Web of Science, PubMed and Google Scholar. The search was performed using the following search terms: ''critically ill patients'', ''nutrition in intensive care'', ''enteral nutrition'', ''parenteral nutrition'', ''nutrition support''. Conclusion: The first choice for nutritional support should always be enteral nutrition. Parenteral nutrition may be mandatory in case of general complications such as diarrhea, aspiration and tube obstructions in enteral nutrition or in case of gastrointestinal failure.

Keywords

• Nutrition support
• Enteral nutrition
• Parenteral nutrition
• ASPEN Guideline

Abstract

Giriş: Sekteye uğramış beslenmenin devam edebilmesi veya beslenmeyi iyileştirmek amacıyla enteral ya da parenteral formüller ile beslenme desteğine ihtiyaç duyulmaktadır. Malnütrisyon açısından riskli bireylerde, beslenme durumu uygun yöntemle değerlendirilerek net olarak ortaya konmalıdır. Malnütrisyon mortalite ve morbidite üzerinde olumsuz sonuçlara neden olabilecek bir durumdur. Enteral nütrisyon; besin öğelerinin bir kateter veya tüp ya da ağız yoluyla ağız boşluğundan uzaklaşarak gastrointestinal kanalın bir yerine verilmesi ile beslenme desteği sağlanmasıdır. Parenteral nütrisyon ise besin öğelerinin intravenöz olarak sağlanmasıdır. Tek başına parenteral nütrisyon yerine gastrointestinal kanalın kullanılması (Enteral Nütrisyon), mukozal bariyer işlevi ve bütünlüğünün korunmasına yardımcı olmaktadır. Amaç: Bu çalışma yetişkin hastalarda nütrisyonel desteğin sağlanması hakkında güncel, küresel çalışmaları ve Amerikan Parenteral ve Enteral Beslenme Derneğinin son kılavuzlarının incelenmesi amacıyla yapılmıştır. Beslenme desteği hakkında genel literatür bilgilerinin derlenmesi, gelişmesi ve bu konuda bilgi toplamak isteyenlere katkı sağlamak amaçlanmıştır. Yöntem: ASPEN’in orjinal web sayfası ‘‘nutritioncare.org’’dan elde edilen kılavuzlar ve Journal of Parenteral and Enteral Nutrition (JPEN) dergisinden, ASPEN kurumu adı altında yürütülen araştırmacıların çalışmaları incelenmiş ve bu derlemenin kaynağını oluşturmuştur. Ardından literatür taraması gerçekleştirilmiştir. Arama şu elektronik veritabanları kullanılarak gerçekleştirilmiştir: Web of Science, PubMed ve Google Akademik. Arama, şu arama terimleri kullanılarak gerçekleştirildi: ‘‘kritik hastalar’’, ‘‘yoğun bakımda beslenme’’,‘‘enteral beslenme’’, ‘‘parenteral beslenme’’, ‘‘beslenme desteği ’’. Sonuç: Hastanın beslenme desteği için her zaman ilk tercih enteral nütrisyon olmalıdır. Enteral nütrisyonda; diyare, aspirasyon ve tüp tıkanıklıkları gibi genel komplikasyonlar yaşanması halinde veya gastrointestinal yetmezlik durumunda parenteral nütrisyon zorunlu olabilmektedir.

Keywords

• Beslenme desteği
• Enteral beslenme
• Parenteral beslenme
• ASPEN kılavuzu

References

1. Ayers P, Adams S, Boullata J, et al. (2014). ASPEN parenteral nutrition safety consensus recommendations. J Parenter Enter Nutr., 38(3), 296-333.
2. Bankhead R, Boullata J, Brantley S et al. (2009). Enteral nutrition practice recommendations. J Parenteral and Enteral Nutr., 33(2), 122-167. Boullata JI, Gilbert K, Sacks G, et al. (2014). ASPEN clinical guidelines: parenteral nutrition ordering, order review, compounding, labeling, and dispensing. Clinical Guidelines. J Parenter Enter Nutr., 38(3), 334-377.
3. Burlew CC, Moore EE, Cuschieri J et al.,& WTA Study Group. (2012). Who should we feed? A Western Trauma Association multi-institutional study of enteral nutrition in the open abdomen after injury. J Trauma and Acute Care Surgery, 73(6), 1380-1388.
4. Compher C, Bingham AL, McCall M et al. (2022). Guidelines for the provision of nutrition support therapy in the adult critically ill patient: The American Society for Parenteral and Enteral Nutrition. J Parenteral and Enteral Nutr., 46(1), 12-41.
5. Critical Care Medicine (SCCM) and American Society for Parenteral and Enteral Nutrition (ASPEN) Iesujhs I 56 (2016). J Parenter Enteral Nutr., 40(2), 159-211.
6. Gura KM. (2009). Is there still a role for peripheral parenteral nutrition? Nutr Clin Pract., 24, 709-717. Drover JW, Dhaliwal R, Weitzel L, et al. (2011). Perioperative use of arginine-supplemented diets: a systematic review of the evidence. J the American College of Surgeons, 212(3), 385-399e1.
7. Frankenfield, D. C., Rowe, W. A., Smith, J. S., & Cooney, R. N. (2003). Validation of several established equations for resting metabolic rate in obese and nonobese people. J The American Dietetic Association, 103(9), 1152-1159.
8. Hall T.C., Bilku D.K., Al-Leswas D., et al. (2015). A randomized controlled trial investigating the effects of parenteral fish oil on survival outcomes in critically ill patients with sepsis: a pilot study. J Parenter Enter Nutr., 39(3), 301-312.

9. Harris J.A., Benedict F.G., (1919). A biometric study of basal metabolism in man, Washington DC, Carnegie Institue of Washington: 279.
10. Jensen G, Cederholm T, Carreia I., et al. (2018). GLİM criteria for the diagnosis of malnutrition: a consessus report from the global clinical nutrition community. J Parenteral ve Enteral Nutr. 43(1), 32- 40.
11. Leuck M., Levandovski R., Harb A., et al. (2014). Circadian rhythm of energy expenditure and oxygen consumption. J Parenteral and Enteral Nutr., 38(2), 263-268.
12. Mahan L.K., Raymond J.L., (2019). Besin ve Beslenme Bakım Süreci. İçinde: Enerji Alımı, Besin ve Besin Öğelerinin Sağlanması: Nütrisyon Desteği, Yoğun Bakımda Tıbbi Beslenme. Ed: Akbulut G., 14. Baskı, Nobel Tıp Kitabevleri, Ankara, s:25, 209-225, 775-789.
13. Manzanares W., Dhaliwal R., Jurewitsch B., et al. (2014). Parenteral fish oil lipid emulsion in the critically ill: systematic review and meta-analysis, J Parenter Enteral Nutr., 38, 20-28.
14. Marik P.E. and Zaloga G.P. (2010). Immunonutrition in high‐risk surgical patients: a systematic review and analysis of the literature. J Parenteral and Enteral Nutr., 34(4), 378-386.
15. Martindale R., McClave S., Varek V., et al. (2009). Guidelines for the provision and assessment of nutrition support therapy in the adult critically ill patient: SCCM and ASPEN. Crit Care Med., 37(5).
16. McClave S.A., Martindale R.G., Vanek V.W. et al., & American College of Critical Care Medicine. (2009). Guidelines for the provision and assessment of nutrition support therapy in the adult critically ill patient: Society of Critical Care Medicine (SCCM) and American Society for Parenteral and Enteral Nutrition (ASPEN). J Parenteral and Enteral Nutr., 33(3): 277-316.
17. Mifflin M.D., St Jeor S.T., Hill L.A. et al. (1990). A new predictive equation for resting energy expenditure in healthy individuals. The American journal of clinical nutrition, 51(2), 241-247. Mirtallo J., Todd C., Johnson D., et al. (2004). ASPEN Safe practice for parenteral nutrition. J Parenteral and Enteral Nutr., 28, 39-70.
18. Pontes-Arruda A., Dos Santos M.C. et al. (2012). Influence of parenteral nutrition delivery system on the development of bloodstream infections in critically ill patients: an international, multicenter, prospective, open-label, controlled study--EPICOS study. J Parenter Enter Nutr., 36(5), 574-586.
19. Pradelli L., Mayer K., Muscaritoli M., (2020). Ω-3 fatty acid enriched parenteral nutrition in hospitalized patients: systematic review with meta-analysis an trial sequential analysis. J Parenter Enter Nutr., 44:44- 57.
20. Rodriguez N.A., Jeschke M.G., Williams F.N., et al. (2011). Nutrition in burns: galveston contributions. J Parenter Enter Nutr., 35(6), 704-714.
21. Sacks G.S., Mayhew S., Johnson D., (2005). Parenteral nutrition implementation and management. In: The ASPEN Nutrition Support Practice Manual. Merritt R (ed), 2nd ed:108-117. Teitelbaum D., Guenter P., Howell W.H., et al. (2005). Definition of terms, style, and conventions used in ASPEN guidelines and standards. Nutr Clin Pract., 20(2), 281-285.
22. Wu MH, Wang MY, Yang CY et al. (2014). Randomized clinical trial of new intravenous lipid (SMOFlipid 20%) versus medium-chain triglycerides/long-chain triglycerides in adult patients undergoing gastrointestinal surgery. J Parenter Enter Nutr., 38(7):800-808.