The ESPEN clinical practice guidelines on Parenteral Nutrition: Present status and perspectives for future research

Department of Surgery, Hospital of Prato, Piazza dell'Ospedale 5, 59100 Prato, Italy.
Clinical nutrition (Edinburgh, Scotland) (Impact Factor: 4.48). 07/2009; 28(4):359-64. DOI: 10.1016/j.clnu.2009.05.010
Source: PubMed

ABSTRACT The ESPEN Guidelines on Parenteral Nutrition (PN) reflect current scientific knowledge in the field of clinical nutrition in adults. They summarize the indications for PN and its anticipated outcomes in respect of the underlying disease, nutritional status and quality of life. They are companion documents to the ESPEN Guidelines on Enteral Nutrition and follow the same general format. They address the influence of the underlying disease on the patient's nutritional status, and that of malnutrition on the outcome of the disease. Contraindications to and complications of PN are considered, together with comparative analyses of the roles of the parenteral and enteral routes in different illness states. The quality and strength of the supporting literature has been graded according to the criteria of the Scottish Intercollegiate Guidelines Network (SIGN) and the Agency for Health Care Policy and Research. Hence, meta-analysis of randomised clinical trials (level of evidence Ia) or at least one randomised clinical trial (level of evidence Ib) translate to a Grade A recommendation. Levels of evidence IIa, IIb and III are attributed respectively to: at least one well-designed controlled trial without randomisation; at least one other type of well-designed, quasi-experimental study; or well-designed non-experimental descriptive studies such as comparative studies, correlation studies, case-control studies; each of these sustains a Grade B recommendation. Grade C recommendations reflect expert opinion and/or the clinical experience of respected authorities (level of evidence IV). Each of the 11 sets of PN Guidelines was devised by an international working group, the total faculty comprising no fewer than 87 experts from 16 European/Mediterranean countries, each group's contributions being co-ordinated by a designated chairman. Once each guideline had been approved by all the members of the relevant working group, this version was reviewed by at least two independent external reviewers (one selected from ESPEN's Education and Clinical Practice Committee, and at least one from outside the ESPEN committee structure). Following this review each guideline was hosted in draft form on the public pages of the ESPEN website for at least one month to permit the receipt of comments or suggestions from any interested party. At this point the Guidelines were reviewed and revised again by the original working group chairman and submitted to the Clinical Nutrition editorial process. At least 3 further reviewers were selected by the Journal's editorial office for each guideline, in line with the normal selection process. Final revisions were performed by the Chairmen of the working groups, and by ourselves as commissioning editors of the whole project. More than 300 evidence-based recommendations are now presented. Fewer than one sixth of the recommendations are Grade A, and disappointingly, but unsurprisingly, more than 50% are Grade C. The need for more and better controlled trials in the field remains apparent.

Download full-text


Available from: Alastair Forbes, Sep 25, 2015
385 Reads
  • [Show abstract] [Hide abstract]
    ABSTRACT: The problem of implementing self-adaptive equalization algorithms in real-time is addressed. Self-adaptive equalization determines the transmitted sequence without using a training sequence. We focus our attention on the special case of a discrete-time finite-state Markov process in which a sequence of equally likely symbols s<sub>k</sub> drawn from an a discrete and finite alphabet A is input to a channel which introduces intersymbol interference in addition to white Gaussian noise. Simulation results for the self-adaptive tree search procedures based on Fano (1963), stack and M-algorithm are presented
    Information Theory, 1995. Proceedings., 1995 IEEE International Symposium on; 10/1995
  • [Show abstract] [Hide abstract]
    ABSTRACT: The Group on Nutrition of the Spanish Society of Hospital Pharmacy (SEFH) recently published the practice standards for the pharmacist regarding specialized nutritional support. One of these standards includes the parameters that should be monitored for a correct follow-up of the adult patient on parenteral nutrition (PN.) to assess the level of monitoring of PN patients according to the practices recommended by SEFH. a prospective observational study was designed. Data were gathered from all adult patients with PN admitted to the Xeral-Calde Hospital Complex (Lugo) for a 3-month period. The standards were applied and their implementation was assessed by means of a numerical scale with values ranging 1 to 5. Of the 171 episodes of PN, the monitoring level is higher among critically ill patients (3.5) than among stable patients (2.7-2.8). The use of standards is a useful tool to objectively assess the items to be improved in order to provide a quality, safe, and efficient nutritional support. Although the monitoring level is higher in critically ill patients than in stable ones, according to the standards, in both cases it may be improved.
    Nutricion hospitalaria: organo oficial de la Sociedad Espanola de Nutricion Parenteral y Enteral 01/2010; 25(3):443-8. DOI:10.3305/nh.2010.25.3.4414 · 1.04 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Objetivo: proponer una guía de manejo para la nutrición en los pacientes con pancreatitis aguda grave basada en la mejor evidencia disponible. Diseño: revisión sistemática y guía de práctica clínica. Población: pacientes críticos con pancreatitis aguda grave hospitalizados en la unidad de cuidados intensivos. Intervenciones y controles: nutrición entérica Vs. parenteral; dieta hipocalórica Vs. normocalórica; glutamina Vs. sin glutamina; arginina Vs. sin arginina; ácidos grasos omega 3/omega 6 Vs. omega 6 solamente; prebióticos o probióticos Vs. dieta estándar. Desenlaces: mortalidad, estancia hospitalaria y en la unidad de cuidados intensivos y, infecciones y sepsis, disfuncion de organos. Materiales y métodos: búsqueda en bases de datos médicas en línea. Resultados: las 765 referencias iniciales fueron filtradas con las palabras clave y quedaron 69 artículos. Cinco artículos más de autores latinoamericanos o de habla hispana fueron también revisados por considerarlos pertinentes. Conclusiones: los pacientes con pancreatitis aguda grave se benefician del soporte nutricional y la vía entérica es de elección con dietas normocalóricas de inicio temprano, preferencialmente en los primeros tres días. La intervención nutricional pudiera ser un determinante al disminuir la morbilidad y la mortalidad elevada en esta patología pero aún faltan estudios bien diseñados que permitan determinar con claridad el efecto de cada uno de sus componentes
    06/2010; 25(2):104-120.
Show more