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Michael P Casaer - One of the best experts on this subject based on the ideXlab platform.
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Early versus Late Parenteral Nutrition in Critically Ill Children.
The New England journal of medicine, 2016Co-Authors: Tom Fivez, Dorian Kerklaan, Dieter Mesotten, Sascha Verbruggen, Pieter J Wouters, Ilse Vanhorebeek, Yves Debaveye, Dirk Vlasselaers, Lars Desmet, Michael P CasaerAbstract:Recent trials have questioned the benefit of early Parenteral Nutrition in adults. The effect of early Parenteral Nutrition on clinical outcomes in critically ill children is unclear. We conducted a multicenter, randomized, controlled trial involving 1440 critically ill children to investigate whether withholding Parenteral Nutrition for 1 week (i.e., providing late Parenteral Nutrition) in the pediatric intensive care unit (ICU) is clinically superior to providing early Parenteral Nutrition. Fluid loading was similar in the two groups. The two primary end points were new infection acquired during the ICU stay and the adjusted duration of ICU dependency, as assessed by the number of days in the ICU and as time to discharge alive from ICU. For the 723 patients receiving early Parenteral Nutrition, Parenteral Nutrition was initiated within 24 hours after ICU admission, whereas for the 717 patients receiving late Parenteral Nutrition, Parenteral Nutrition was not provided until the morning of the 8th day in the ICU. In both groups, enteral Nutrition was attempted early and intravenous micronutrients were provided. Although mortality was similar in the two groups, the percentage of patients with a new infection was 10.7% in the group receiving late Parenteral Nutrition, as compared with 18.5% in the group receiving early Parenteral Nutrition (adjusted odds ratio, 0.48; 95% confidence interval [CI], 0.35 to 0.66). The mean (±SE) duration of ICU stay was 6.5±0.4 days in the group receiving late Parenteral Nutrition, as compared with 9.2±0.8 days in the group receiving early Parenteral Nutrition; there was also a higher likelihood of an earlier live discharge from the ICU at any time in the late-Parenteral-Nutrition group (adjusted hazard ratio, 1.23; 95% CI, 1.11 to 1.37). Late Parenteral Nutrition was associated with a shorter duration of mechanical ventilatory support than was early Parenteral Nutrition (P=0.001), as well as a smaller proportion of patients receiving renal-replacement therapy (P=0.04) and a shorter duration of hospital stay (P=0.001). Late Parenteral Nutrition was also associated with lower plasma levels of γ-glutamyltransferase and alkaline phosphatase than was early Parenteral Nutrition (P=0.001 and P=0.04, respectively), as well as higher levels of bilirubin (P=0.004) and C-reactive protein (P=0.006). In critically ill children, withholding Parenteral Nutrition for 1 week in the ICU was clinically superior to providing early Parenteral Nutrition. (Funded by the Flemish Agency for Innovation through Science and Technology and others; ClinicalTrials.gov number, NCT01536275.).
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early versus late Parenteral Nutrition in critically ill children
The New England Journal of Medicine, 2016Co-Authors: Tom Fivez, Dorian Kerklaan, Dieter Mesotten, Sascha Verbruggen, Pieter J Wouters, Ilse Vanhorebeek, Yves Debaveye, Dirk Vlasselaers, Lars Desmet, Michael P CasaerAbstract:BackgroundRecent trials have questioned the benefit of early Parenteral Nutrition in adults. The effect of early Parenteral Nutrition on clinical outcomes in critically ill children is unclear. MethodsWe conducted a multicenter, randomized, controlled trial involving 1440 critically ill children to investigate whether withholding Parenteral Nutrition for 1 week (i.e., providing late Parenteral Nutrition) in the pediatric intensive care unit (ICU) is clinically superior to providing early Parenteral Nutrition. Fluid loading was similar in the two groups. The two primary end points were new infection acquired during the ICU stay and the adjusted duration of ICU dependency, as assessed by the number of days in the ICU and as time to discharge alive from ICU. For the 723 patients receiving early Parenteral Nutrition, Parenteral Nutrition was initiated within 24 hours after ICU admission, whereas for the 717 patients receiving late Parenteral Nutrition, Parenteral Nutrition was not provided until the morning o...
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Impact of Early Parenteral Nutrition on Metabolism and Kidney Injury
Journal of The American Society of Nephrology, 2013Co-Authors: Jan Gunst, Pieter J Wouters, Ilse Vanhorebeek, Michael P Casaer, Greet Hermans, Jasperina Dubois, Kathleen Claes, Miet Schetz, Greet Van Den BergheAbstract:A poor Nutritional state and a caloric deficit associate with increased morbidity and mortality, but a recent multicenter, randomized controlled trial found that early Parenteral Nutrition to supplement insufficient enteral Nutrition increases morbidity in the intensive care unit, including prolonging the duration of renal replacement therapy, compared with withholding Parenteral Nutrition for 1 week. Whether early versus late Parenteral Nutrition impacts the incidence and recovery of AKI is unknown. Here, we report a prespecified analysis from this trial, the Early Parenteral Nutrition Completing Enteral Nutrition in Adult Critically Ill Patients (EPaNIC) study. The timing of Parenteral Nutrition did not affect the incidence of AKI, but early initiation seemed to slow renal recovery in patients with stage 2 AKI. Early Parenteral Nutrition did not affect the time course of creatinine and creatinine clearance but did increase plasma urea, urea/creatinine ratio, and nitrogen excretion beginning on the first day of amino acid infusion. In the group that received late Parenteral Nutrition, infusing amino acids after the first week also increased ureagenesis. During the first 2 weeks, ureagenesis resulted in net waste of 63% of the extra nitrogen intake from early Parenteral Nutrition. In conclusion, early Parenteral Nutrition does not seem to impact AKI incidence, although it may delay recovery in patients with stage 2 AKI. Substantial catabolism of the extra amino acids, which leads to higher levels of plasma urea, might explain the prolonged duration of renal replacement therapy observed with early Parenteral Nutrition.
Tom Fivez - One of the best experts on this subject based on the ideXlab platform.
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Early versus Late Parenteral Nutrition in Critically Ill Children.
The New England journal of medicine, 2016Co-Authors: Tom Fivez, Dorian Kerklaan, Dieter Mesotten, Sascha Verbruggen, Pieter J Wouters, Ilse Vanhorebeek, Yves Debaveye, Dirk Vlasselaers, Lars Desmet, Michael P CasaerAbstract:Recent trials have questioned the benefit of early Parenteral Nutrition in adults. The effect of early Parenteral Nutrition on clinical outcomes in critically ill children is unclear. We conducted a multicenter, randomized, controlled trial involving 1440 critically ill children to investigate whether withholding Parenteral Nutrition for 1 week (i.e., providing late Parenteral Nutrition) in the pediatric intensive care unit (ICU) is clinically superior to providing early Parenteral Nutrition. Fluid loading was similar in the two groups. The two primary end points were new infection acquired during the ICU stay and the adjusted duration of ICU dependency, as assessed by the number of days in the ICU and as time to discharge alive from ICU. For the 723 patients receiving early Parenteral Nutrition, Parenteral Nutrition was initiated within 24 hours after ICU admission, whereas for the 717 patients receiving late Parenteral Nutrition, Parenteral Nutrition was not provided until the morning of the 8th day in the ICU. In both groups, enteral Nutrition was attempted early and intravenous micronutrients were provided. Although mortality was similar in the two groups, the percentage of patients with a new infection was 10.7% in the group receiving late Parenteral Nutrition, as compared with 18.5% in the group receiving early Parenteral Nutrition (adjusted odds ratio, 0.48; 95% confidence interval [CI], 0.35 to 0.66). The mean (±SE) duration of ICU stay was 6.5±0.4 days in the group receiving late Parenteral Nutrition, as compared with 9.2±0.8 days in the group receiving early Parenteral Nutrition; there was also a higher likelihood of an earlier live discharge from the ICU at any time in the late-Parenteral-Nutrition group (adjusted hazard ratio, 1.23; 95% CI, 1.11 to 1.37). Late Parenteral Nutrition was associated with a shorter duration of mechanical ventilatory support than was early Parenteral Nutrition (P=0.001), as well as a smaller proportion of patients receiving renal-replacement therapy (P=0.04) and a shorter duration of hospital stay (P=0.001). Late Parenteral Nutrition was also associated with lower plasma levels of γ-glutamyltransferase and alkaline phosphatase than was early Parenteral Nutrition (P=0.001 and P=0.04, respectively), as well as higher levels of bilirubin (P=0.004) and C-reactive protein (P=0.006). In critically ill children, withholding Parenteral Nutrition for 1 week in the ICU was clinically superior to providing early Parenteral Nutrition. (Funded by the Flemish Agency for Innovation through Science and Technology and others; ClinicalTrials.gov number, NCT01536275.).
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early versus late Parenteral Nutrition in critically ill children
The New England Journal of Medicine, 2016Co-Authors: Tom Fivez, Dorian Kerklaan, Dieter Mesotten, Sascha Verbruggen, Pieter J Wouters, Ilse Vanhorebeek, Yves Debaveye, Dirk Vlasselaers, Lars Desmet, Michael P CasaerAbstract:BackgroundRecent trials have questioned the benefit of early Parenteral Nutrition in adults. The effect of early Parenteral Nutrition on clinical outcomes in critically ill children is unclear. MethodsWe conducted a multicenter, randomized, controlled trial involving 1440 critically ill children to investigate whether withholding Parenteral Nutrition for 1 week (i.e., providing late Parenteral Nutrition) in the pediatric intensive care unit (ICU) is clinically superior to providing early Parenteral Nutrition. Fluid loading was similar in the two groups. The two primary end points were new infection acquired during the ICU stay and the adjusted duration of ICU dependency, as assessed by the number of days in the ICU and as time to discharge alive from ICU. For the 723 patients receiving early Parenteral Nutrition, Parenteral Nutrition was initiated within 24 hours after ICU admission, whereas for the 717 patients receiving late Parenteral Nutrition, Parenteral Nutrition was not provided until the morning o...
Ilse Vanhorebeek - One of the best experts on this subject based on the ideXlab platform.
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Early versus Late Parenteral Nutrition in Critically Ill Children.
The New England journal of medicine, 2016Co-Authors: Tom Fivez, Dorian Kerklaan, Dieter Mesotten, Sascha Verbruggen, Pieter J Wouters, Ilse Vanhorebeek, Yves Debaveye, Dirk Vlasselaers, Lars Desmet, Michael P CasaerAbstract:Recent trials have questioned the benefit of early Parenteral Nutrition in adults. The effect of early Parenteral Nutrition on clinical outcomes in critically ill children is unclear. We conducted a multicenter, randomized, controlled trial involving 1440 critically ill children to investigate whether withholding Parenteral Nutrition for 1 week (i.e., providing late Parenteral Nutrition) in the pediatric intensive care unit (ICU) is clinically superior to providing early Parenteral Nutrition. Fluid loading was similar in the two groups. The two primary end points were new infection acquired during the ICU stay and the adjusted duration of ICU dependency, as assessed by the number of days in the ICU and as time to discharge alive from ICU. For the 723 patients receiving early Parenteral Nutrition, Parenteral Nutrition was initiated within 24 hours after ICU admission, whereas for the 717 patients receiving late Parenteral Nutrition, Parenteral Nutrition was not provided until the morning of the 8th day in the ICU. In both groups, enteral Nutrition was attempted early and intravenous micronutrients were provided. Although mortality was similar in the two groups, the percentage of patients with a new infection was 10.7% in the group receiving late Parenteral Nutrition, as compared with 18.5% in the group receiving early Parenteral Nutrition (adjusted odds ratio, 0.48; 95% confidence interval [CI], 0.35 to 0.66). The mean (±SE) duration of ICU stay was 6.5±0.4 days in the group receiving late Parenteral Nutrition, as compared with 9.2±0.8 days in the group receiving early Parenteral Nutrition; there was also a higher likelihood of an earlier live discharge from the ICU at any time in the late-Parenteral-Nutrition group (adjusted hazard ratio, 1.23; 95% CI, 1.11 to 1.37). Late Parenteral Nutrition was associated with a shorter duration of mechanical ventilatory support than was early Parenteral Nutrition (P=0.001), as well as a smaller proportion of patients receiving renal-replacement therapy (P=0.04) and a shorter duration of hospital stay (P=0.001). Late Parenteral Nutrition was also associated with lower plasma levels of γ-glutamyltransferase and alkaline phosphatase than was early Parenteral Nutrition (P=0.001 and P=0.04, respectively), as well as higher levels of bilirubin (P=0.004) and C-reactive protein (P=0.006). In critically ill children, withholding Parenteral Nutrition for 1 week in the ICU was clinically superior to providing early Parenteral Nutrition. (Funded by the Flemish Agency for Innovation through Science and Technology and others; ClinicalTrials.gov number, NCT01536275.).
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early versus late Parenteral Nutrition in critically ill children
The New England Journal of Medicine, 2016Co-Authors: Tom Fivez, Dorian Kerklaan, Dieter Mesotten, Sascha Verbruggen, Pieter J Wouters, Ilse Vanhorebeek, Yves Debaveye, Dirk Vlasselaers, Lars Desmet, Michael P CasaerAbstract:BackgroundRecent trials have questioned the benefit of early Parenteral Nutrition in adults. The effect of early Parenteral Nutrition on clinical outcomes in critically ill children is unclear. MethodsWe conducted a multicenter, randomized, controlled trial involving 1440 critically ill children to investigate whether withholding Parenteral Nutrition for 1 week (i.e., providing late Parenteral Nutrition) in the pediatric intensive care unit (ICU) is clinically superior to providing early Parenteral Nutrition. Fluid loading was similar in the two groups. The two primary end points were new infection acquired during the ICU stay and the adjusted duration of ICU dependency, as assessed by the number of days in the ICU and as time to discharge alive from ICU. For the 723 patients receiving early Parenteral Nutrition, Parenteral Nutrition was initiated within 24 hours after ICU admission, whereas for the 717 patients receiving late Parenteral Nutrition, Parenteral Nutrition was not provided until the morning o...
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Impact of Early Parenteral Nutrition on Metabolism and Kidney Injury
Journal of The American Society of Nephrology, 2013Co-Authors: Jan Gunst, Pieter J Wouters, Ilse Vanhorebeek, Michael P Casaer, Greet Hermans, Jasperina Dubois, Kathleen Claes, Miet Schetz, Greet Van Den BergheAbstract:A poor Nutritional state and a caloric deficit associate with increased morbidity and mortality, but a recent multicenter, randomized controlled trial found that early Parenteral Nutrition to supplement insufficient enteral Nutrition increases morbidity in the intensive care unit, including prolonging the duration of renal replacement therapy, compared with withholding Parenteral Nutrition for 1 week. Whether early versus late Parenteral Nutrition impacts the incidence and recovery of AKI is unknown. Here, we report a prespecified analysis from this trial, the Early Parenteral Nutrition Completing Enteral Nutrition in Adult Critically Ill Patients (EPaNIC) study. The timing of Parenteral Nutrition did not affect the incidence of AKI, but early initiation seemed to slow renal recovery in patients with stage 2 AKI. Early Parenteral Nutrition did not affect the time course of creatinine and creatinine clearance but did increase plasma urea, urea/creatinine ratio, and nitrogen excretion beginning on the first day of amino acid infusion. In the group that received late Parenteral Nutrition, infusing amino acids after the first week also increased ureagenesis. During the first 2 weeks, ureagenesis resulted in net waste of 63% of the extra nitrogen intake from early Parenteral Nutrition. In conclusion, early Parenteral Nutrition does not seem to impact AKI incidence, although it may delay recovery in patients with stage 2 AKI. Substantial catabolism of the extra amino acids, which leads to higher levels of plasma urea, might explain the prolonged duration of renal replacement therapy observed with early Parenteral Nutrition.
Pieter J Wouters - One of the best experts on this subject based on the ideXlab platform.
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Early versus Late Parenteral Nutrition in Critically Ill Children.
The New England journal of medicine, 2016Co-Authors: Tom Fivez, Dorian Kerklaan, Dieter Mesotten, Sascha Verbruggen, Pieter J Wouters, Ilse Vanhorebeek, Yves Debaveye, Dirk Vlasselaers, Lars Desmet, Michael P CasaerAbstract:Recent trials have questioned the benefit of early Parenteral Nutrition in adults. The effect of early Parenteral Nutrition on clinical outcomes in critically ill children is unclear. We conducted a multicenter, randomized, controlled trial involving 1440 critically ill children to investigate whether withholding Parenteral Nutrition for 1 week (i.e., providing late Parenteral Nutrition) in the pediatric intensive care unit (ICU) is clinically superior to providing early Parenteral Nutrition. Fluid loading was similar in the two groups. The two primary end points were new infection acquired during the ICU stay and the adjusted duration of ICU dependency, as assessed by the number of days in the ICU and as time to discharge alive from ICU. For the 723 patients receiving early Parenteral Nutrition, Parenteral Nutrition was initiated within 24 hours after ICU admission, whereas for the 717 patients receiving late Parenteral Nutrition, Parenteral Nutrition was not provided until the morning of the 8th day in the ICU. In both groups, enteral Nutrition was attempted early and intravenous micronutrients were provided. Although mortality was similar in the two groups, the percentage of patients with a new infection was 10.7% in the group receiving late Parenteral Nutrition, as compared with 18.5% in the group receiving early Parenteral Nutrition (adjusted odds ratio, 0.48; 95% confidence interval [CI], 0.35 to 0.66). The mean (±SE) duration of ICU stay was 6.5±0.4 days in the group receiving late Parenteral Nutrition, as compared with 9.2±0.8 days in the group receiving early Parenteral Nutrition; there was also a higher likelihood of an earlier live discharge from the ICU at any time in the late-Parenteral-Nutrition group (adjusted hazard ratio, 1.23; 95% CI, 1.11 to 1.37). Late Parenteral Nutrition was associated with a shorter duration of mechanical ventilatory support than was early Parenteral Nutrition (P=0.001), as well as a smaller proportion of patients receiving renal-replacement therapy (P=0.04) and a shorter duration of hospital stay (P=0.001). Late Parenteral Nutrition was also associated with lower plasma levels of γ-glutamyltransferase and alkaline phosphatase than was early Parenteral Nutrition (P=0.001 and P=0.04, respectively), as well as higher levels of bilirubin (P=0.004) and C-reactive protein (P=0.006). In critically ill children, withholding Parenteral Nutrition for 1 week in the ICU was clinically superior to providing early Parenteral Nutrition. (Funded by the Flemish Agency for Innovation through Science and Technology and others; ClinicalTrials.gov number, NCT01536275.).
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early versus late Parenteral Nutrition in critically ill children
The New England Journal of Medicine, 2016Co-Authors: Tom Fivez, Dorian Kerklaan, Dieter Mesotten, Sascha Verbruggen, Pieter J Wouters, Ilse Vanhorebeek, Yves Debaveye, Dirk Vlasselaers, Lars Desmet, Michael P CasaerAbstract:BackgroundRecent trials have questioned the benefit of early Parenteral Nutrition in adults. The effect of early Parenteral Nutrition on clinical outcomes in critically ill children is unclear. MethodsWe conducted a multicenter, randomized, controlled trial involving 1440 critically ill children to investigate whether withholding Parenteral Nutrition for 1 week (i.e., providing late Parenteral Nutrition) in the pediatric intensive care unit (ICU) is clinically superior to providing early Parenteral Nutrition. Fluid loading was similar in the two groups. The two primary end points were new infection acquired during the ICU stay and the adjusted duration of ICU dependency, as assessed by the number of days in the ICU and as time to discharge alive from ICU. For the 723 patients receiving early Parenteral Nutrition, Parenteral Nutrition was initiated within 24 hours after ICU admission, whereas for the 717 patients receiving late Parenteral Nutrition, Parenteral Nutrition was not provided until the morning o...
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Impact of Early Parenteral Nutrition on Metabolism and Kidney Injury
Journal of The American Society of Nephrology, 2013Co-Authors: Jan Gunst, Pieter J Wouters, Ilse Vanhorebeek, Michael P Casaer, Greet Hermans, Jasperina Dubois, Kathleen Claes, Miet Schetz, Greet Van Den BergheAbstract:A poor Nutritional state and a caloric deficit associate with increased morbidity and mortality, but a recent multicenter, randomized controlled trial found that early Parenteral Nutrition to supplement insufficient enteral Nutrition increases morbidity in the intensive care unit, including prolonging the duration of renal replacement therapy, compared with withholding Parenteral Nutrition for 1 week. Whether early versus late Parenteral Nutrition impacts the incidence and recovery of AKI is unknown. Here, we report a prespecified analysis from this trial, the Early Parenteral Nutrition Completing Enteral Nutrition in Adult Critically Ill Patients (EPaNIC) study. The timing of Parenteral Nutrition did not affect the incidence of AKI, but early initiation seemed to slow renal recovery in patients with stage 2 AKI. Early Parenteral Nutrition did not affect the time course of creatinine and creatinine clearance but did increase plasma urea, urea/creatinine ratio, and nitrogen excretion beginning on the first day of amino acid infusion. In the group that received late Parenteral Nutrition, infusing amino acids after the first week also increased ureagenesis. During the first 2 weeks, ureagenesis resulted in net waste of 63% of the extra nitrogen intake from early Parenteral Nutrition. In conclusion, early Parenteral Nutrition does not seem to impact AKI incidence, although it may delay recovery in patients with stage 2 AKI. Substantial catabolism of the extra amino acids, which leads to higher levels of plasma urea, might explain the prolonged duration of renal replacement therapy observed with early Parenteral Nutrition.
Federico Bozzetti - One of the best experts on this subject based on the ideXlab platform.
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espen guidelines on Parenteral Nutrition surgery
Clinical Nutrition, 2009Co-Authors: Marco Braga, Olle Ljungqvist, Peter B Soeters, Kenneth C H Fearon, Arved Weimann, Federico BozzettiAbstract:In modern surgical practice it is advisable to manage patients within an enhanced recovery protocol and thereby have them eating normal food within 1-3 days. Consequently, there is little room for routine perioperative artificial Nutrition. Only a minority of patients may benefit from such therapy. These are predominantly patients who are at risk of developing complications after surgery. The main goals of perioperative Nutritional support are to minimize negative protein balance by avoiding starvation, with the purpose of maintaining muscle, immune, and cognitive function and to enhance postoperative recovery. Several studies have demonstrated that 7-10 days of preoperative Parenteral Nutrition improves postoperative outcome in patients with severe underNutrition who cannot be adequately orally or enterally fed. Conversely, its use in well-nourished or mildly undernourished patients is associated with either no benefit or with increased morbidity. Postoperative Parenteral Nutrition is recommended in patients who cannot meet their caloric requirements within 7-10 days orally or enterally. In patients who require postoperative artificial Nutrition, enteral feeding or a combination of enteral and supplementary Parenteral feeding is the first choice. The main consideration when administering fat and carbohydrates in Parenteral Nutrition is not to overfeed the patient. The commonly used formula of 25 kcal/kg ideal body weight furnishes an approximate estimate of daily energy expenditure and requirements. Under conditions of severe stress requirements may approach 30 kcal/kg ideal body weights. In those patients who are unable to be fed via the enteral route after surgery, and in whom total or near total Parenteral Nutrition is required, a full range of vitamins and trace elements should be supplemented on a daily basis.
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Total Parenteral Nutrition in cancer patients.
Current Opinion in Supportive and Palliative Care, 2007Co-Authors: Federico BozzettiAbstract:PURPOSE OF REVIEW: To report on how the Parenteral Nutrition of patients with advanced cancer has evolved and on the current status of research and clinical practice in this field. RECENT FINDINGS: Clinical research has shown that Parenteral Nutrition may play a role in incurable cancer if patients are expected to die earlier from starvation than from tumour progression. A benefit was recently observed in hypophagic patients requiring supplemental on-demand home Parenteral Nutrition. There is some doubt that Parenteral Nutrition plays a palliative role, and data on quality of life are limited. The regimen of Parenteral Nutrition should be tailored to the needs of the patient, and recent data indicate a reduction in total energy expenditure and water requirements. There is interest in new lipid emulsions enriched with N-3 polyunsaturated fatty acids, which are well utilized by tumour-bearing individuals and may reduce the catabolic drive of cachectic patients. SUMMARY: Future research is addressed at identifying parameters to help in the selection of aphagic/obstructed patients who may benefit from home Parenteral Nutrition, the early use of supplemental Parenteral Nutrition in hypophagic patients and developing a better Nutritional formulation of lipid emulsions more appropriate for use in advanced cancer patients.
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Home Parenteral Nutrition
Revue medicale de Bruxelles, 2006Co-Authors: Federico Bozzetti, Michael Staun, André Van GossumAbstract:Containing contributions for leading international experts this book explores the life-saving treatment of home Parenteral Nutrition. It covers the complete scenario of home Parenteral Nutrition, from its prevalence in different continents to clinical indications and the practical aspects of its management. Topics covered inlcude the growing use of HPN, scientific and practical issues associated with HPN in adults and the pediatric population, indications and outcomes in various diseases, complications, nutrient requirements, preparation and administration of the admixtures, monitoring of patients, medical and surgical alternatives, ethics and legislation, and quality of life. Home Parenteral Nutrition (HPN) is the intravenous administration of nutrients carried out in the patient's home. This book analyses current practices in HPN, with a view to inform best practice, covering epidemiology of HPN in regions including the UK and Europe, USA and Australia, its role in the treatment of clinical conditions including gastrointestinal disorders and cancer, ethical and legal aspects and patient quality of life. © CAB International 2006. All rights reserved.
