경정맥 영양요법 환자의 지방 투여량에 따른 영양학적 개선효과 및 유해반응 분석
Assessment of Effectiveness and Safety for Total Parenteral Nutrition based on Lipid dosage
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Total parenteral nutrition (TPN), essentially fat emulsions, is commonly administered to prevent the deficiency of essential fatty acids and to provide a calorically dense source without protein-derived calories. A guideline of American Society for Parenteral and Enteral Nutrition (ASPEN) recommends an amount of 1g/kg/d of lipid for typical patients. However, since total nutrients admixtures (TNA) contains varying amounts of fat (viz, up to 80g per one bag), patients may receive lipids exceeding the recommended amounts without effectiveness/safety assessment. The purpose of this study, therefore, is to assess the effectiveness and safety of total parenteral nutritions containing high dose lipid with those of the formulation containing the recommended lipid dose. Using electronic medical records, a retrospective study was carried out for inpatients (≥18 years) receiving TPN for more than 7 days in Seoul National University Bundang Hospital between January 1, 2009 to June 30. The patients were classified into two groups; group A of 1g/kg/d of lipid or less, and group B of more than 1g/kg/d. Various parameters (e.g., the status of nutritional support, the duration of hospitalization, the duration of TPN, the change in body weight, the variation in nutritional index and the incidence of abnormalities in the level of hematologic factors) were consolidated and compared between the two groups. Total number of patients of this study was 184 (i.e., 91 patients for group A and 93 patients for group B). Average amounts of lipid dosage were 0.65±0.23g/kg/d for group A and 1.32±0.25g/kg/d for group B. Body weight, albumin, hemoglobin and hematocrit were slightly elevated in group A. Total amounts of protein were significantly increased in group B (i.e., 0.32±0.83g/dL vs. 0.52±1.17g/dL p<0.001). The incidence of reduction in TLC were elevated in group B (i.e., 34.15% vs. 55.36% p=0.039) and the frequency of LFT abnormality increased in group A (i.e., 30.14% vs. 26.47%). These observations indicate that, although there was no significant nutritional improvement, there is an elevated risk of compromised immune functions in patients parenterally receiving high dose lipid. Therefore, it is recommended that the lipid dosage may be set within the recommended amount by ASPEN (i.e., 1g/kg/d).
Abstract
Total parenteral nutrition (TPN), essentially fat emulsions, is commonly administered to prevent the deficiency of essential fatty acids and to provide a calorically dense source without protein-derived calories. A guideline of American Society for Parenteral and Enteral Nutrition (ASPEN) recommends an amount of 1g/kg/d of lipid for typical patients. However, since total nutrients admixtures (TNA) contains varying amounts of fat (viz, up to 80g per one bag), patients may receive lipids exceeding the recommended amounts without effectiveness/safety assessment. The purpose of this study, therefore, is to assess the effectiveness and safety of total parenteral nutritions containing high dose lipid with those of the formulation containing the recommended lipid dose. Using electronic medical records, a retrospective study was carried out for inpatients (≥18 years) receiving TPN for more than 7 days in Seoul National University Bundang Hospital between January 1, 2009 to June 30. The patients were classified into two groups; group A of 1g/kg/d of lipid or less, and group B of more than 1g/kg/d. Various parameters (e.g., the status of nutritional support, the duration of hospitalization, the duration of TPN, the change in body weight, the variation in nutritional index and the incidence of abnormalities in the level of hematologic factors) were consolidated and compared between the two groups. Total number of patients of this study was 184 (i.e., 91 patients for group A and 93 patients for group B). Average amounts of lipid dosage were 0.65±0.23g/kg/d for group A and 1.32±0.25g/kg/d for group B. Body weight, albumin, hemoglobin and hematocrit were slightly elevated in group A. Total amounts of protein were significantly increased in group B (i.e., 0.32±0.83g/dL vs. 0.52±1.17g/dL p<0.001). The incidence of reduction in TLC were elevated in group B (i.e., 34.15% vs. 55.36% p=0.039) and the frequency of LFT abnormality increased in group A (i.e., 30.14% vs. 26.47%). These observations indicate that, although there was no significant nutritional improvement, there is an elevated risk of compromised immune functions in patients parenterally receiving high dose lipid. Therefore, it is recommended that the lipid dosage may be set within the recommended amount by ASPEN (i.e., 1g/kg/d).
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