Department of Human Nutrition and Hospitality Management, The University of Alabama, Tuscaloosa, Alabama, USA.
Hazard Appalachian Regional Healthcare Medical Center, Hazard, Kentucky, USA.
JPEN J Parenter Enteral Nutr. 2020 Nov;44(8):1447-1460. doi: 10.1002/jpen.1864. Epub 2020 Jun 24.
Inappropriate parenteral nutrition (PN) administration often occurs in hospitalized patients, increasing the risk of complications. Nutrition support teams (NSTs) regulate and approve PN use in some hospitals. This systematic review examined whether appropriateness of PN use in hospitalized adult patients increased under NST oversight. Ten databases were searched systematically to select studies from 2004 to 2020 that analyzed appropriateness of PN use in adult hospitalized patients under NST oversight. Studies were included if appropriateness of PN was examined and NSTs were involved in PN orders or recommendations. Studies were evaluated using the Quality Criteria Checklist from the Academy of Nutrition and Dietetics Evidence Analysis Library. Nine studies were included in the final analysis. One received a positive rating on the quality checklist, whereas 8 received a neutral rating. Inappropriate PN use varied from 4.3% to 18%. Two studies compared PN use between multiple hospitals, both with and without NSTs. Two compared appropriateness before and after NST implementation, whereas another 2 studies compared it before and after NST restructuring. Three studies examined appropriateness of PN with NST oversight at a single facility with no control group. Overall, NSTs were associated with decreased incidence of inappropriate PN use. No studies were randomized, and several did not describe demographics between groups. Although NSTs appear to decrease inappropriate PN use, the results are limited because of study design or reporting. Future studies should monitor and evaluate clinical outcomes, such as mortality, and utilize more rigorous methodologies.
不适当的肠外营养（PN）管理在住院患者中经常发生，增加了并发症的风险。营养支持小组（NST）在一些医院中规范和批准 PN 的使用。本系统评价研究了在 NST 监督下，住院成年患者 PN 使用的适当性是否增加。系统地搜索了 10 个数据库，以选择 2004 年至 2020 年期间分析 NST 监督下住院成年患者 PN 使用适当性的研究。如果研究检查了 PN 的适当性并且 NST 参与了 PN 医嘱或建议，则纳入研究。使用来自营养与饮食学会证据分析库的质量标准检查表评估研究。最终分析包括 9 项研究。一项研究在质量检查表上获得了正面评价，而 8 项研究获得了中性评价。不适当的 PN 使用的比例从 4.3%到 18%不等。两项研究比较了有和没有 NST 的多家医院的 PN 使用情况。两项研究比较了 NST 实施前后的适当性，而另外两项研究则比较了 NST 重组前后的适当性。三项研究在没有对照组的单一机构中检查了 NST 监督下 PN 的适当性。总体而言，NST 与降低不适当的 PN 使用发生率有关。没有研究是随机的，并且有几项研究没有描述组间的人口统计学特征。尽管 NST 似乎可以减少不适当的 PN 使用，但由于研究设计或报告的原因，结果有限。未来的研究应监测和评估临床结果，如死亡率，并利用更严格的方法。
