The University of Manchester, United Kingdom.
The University of Manchester, United Kingdom.
Clin Nutr ESPEN. 2024 Dec;64:324-331. doi: 10.1016/j.clnesp.2024.10.007. Epub 2024 Oct 22.
BACKGROUND & AIMS: Home Parenteral Nutrition (HPN) prescriptions should be tailored to a patient's nutritional requirements and comprise of individually compounded regimens (IC-HPN) or standard licensed multi-chamber bags (MCB). There is a paucity of research exploring factors associated with admixture type. This study aimed to evaluate the nutrient composition of adult IC-HPN prescriptions and variance in nutrient dosing, make comparisons with the range of MCB available and dosing recommendations stated in international guidelines.
This cross-sectional observational study analysed anonymised prescription data for adults under the care of a single home care company in England, commencing IC-HPN after January 2021.
There were 155 patient prescriptions (245 HPN bags) included, with body weight available in 82 (52.9 %) cases. Data were reported for each HPN bag, and summarised as an average daily amount, considering the number of different HPN bags and their daily frequency per patient prescription. A vast range of nutrients were prescribed, with variance in dosing highest for lipid, phosphate, and calcium; with coefficient of variance of 106 %, 74 % and 67 %, respectively. One-hundred-thirty-four (54.7 %) bags contained lipid, resulting in variable ratios of lipid to aqueous bags provided weekly. Negligible amounts of at least one electrolyte were prescribed in 93 (38.0 %) bags, of which 52 (21.2 %) contained ≤2 mmol calcium. Compared with MCB (65 bags), IC-HPN bags contained higher amounts of all nutrients, apart from nitrogen and phosphate. Mean sodium intake differed substantially between types of bags (IC-HPN 187.5, SD 100.1 mmol versus MCB 49.1, SD 31.7 mmol, p < 0.001). A substantial number of patients received HPN dosages beyond guideline recommendations, with higher amounts of sodium and fluid provided in 41 (50.0 %) cases; conversely, lower than recommended dosages were seen in 55 (67.1 %) for potassium and 61 (74.4 %) for calcium.
This study has demonstrated vast variance in IC-HPN parenteral nutrient dosing, with minimal or an omission of at least one nutrient seen. Further research is needed to explore factors that influence usage of IC-HPN, clinical reasons related to lipid dosing and around the variation in doses prescribed outside of guideline recommendations.
家庭肠外营养（HPN）处方应根据患者的营养需求进行调整，并包括个体化配制的方案（IC-HPN）或标准许可的多腔袋（MCB）。目前关于与混合类型相关的因素的研究较少。本研究旨在评估成人 IC-HPN 处方的营养素组成，并比较可用的 MCB 范围以及国际指南中规定的剂量建议。
本横断面观察性研究分析了英格兰一家家庭护理公司护理的成人患者的匿名处方数据，这些患者于 2021 年 1 月后开始接受 IC-HPN。
共纳入 155 例患者处方（245 袋 HPN），其中 82 例（52.9%）提供了体重数据。报告了每袋 HPN 的数据，并根据患者处方中不同 HPN 袋的数量及其每日频率，以平均每日量进行总结。处方的营养素种类繁多，脂质、磷酸盐和钙的剂量差异最大；变异系数分别为 106%、74%和 67%。134 袋（54.7%）含有脂质，导致每周提供的脂质和水袋比例不同。93 袋（38.0%）中至少有一种电解质的剂量可忽略不计，其中 52 袋（21.2%）中钙含量≤2mmol。与 MCB（65 袋）相比，IC-HPN 袋中的所有营养素含量均较高，除氮和磷酸盐外。不同类型袋之间的钠摄入量差异很大（IC-HPN 187.5，SD 100.1mmol 与 MCB 49.1，SD 31.7mmol，p<0.001）。相当数量的患者接受的 HPN 剂量超过了指南建议，41 例（50.0%）患者接受的钠和液体量较高；相反，55 例（67.1%）患者的钾和 61 例（74.4%）患者的钙低于推荐剂量。
本研究表明，IC-HPN 肠外营养剂的剂量存在很大差异，最小剂量或至少一种营养素缺失。需要进一步研究以探讨影响 IC-HPN 使用的因素、与脂质剂量相关的临床原因以及超出指南建议的剂量差异。
