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Effects of a Nutrition Support Team on Clinical Outcomes, Metabolic Complications and Electrolyte Abnormalities in Patients Receiving Parenteral Nutrition

營養支持小組對接受腸道外營養病人之臨床預後、代謝併發症及電解質異常的影響

摘要


The effectiveness of the Nutrition Support Team (NST) at Hospital Sungai Buloh, a large public hospital in Kuala Lumpur, Malaysia, in optimising parenteral nutrition (PN) has not been evaluated. To evaluate the effects of this NST in optimising patient outcomes, treatment outcomes, and adherence to biochemical monitoring guidelines, two groups of patients, those given PN before (n=106) NST intervention and those given PN after (n=106) NST intervention, were retrospectively compared. Intervention by the NST significantly reduced metabolic abnormalities, reducing sodium abnormalities from 67% to 44% (p<0.01); potassium abnormalities from 42% to 15% (p<0.01); magnesium abnormalities from 13% to 3% (p<0.05) and phosphate abnormalities from 21% to 9% (p=0.01). Intervention by the NST also significantly reduced the incidence of hypertriglyceridemia from 68% to 45% (p=0.002) and significantly improved adherence to biochemical monitoring guidelines from 46% to 72% (p<0.01). However, the length of hospital stay, patient mortality, and duration of PN were similar in both groups. This study failed to demonstrate that the establishment of a NST gave better outcomes in terms of the common measures of effectiveness. In conclusion, although management by an NST significantly reduced metabolic abnormalities and improved adherence to biochemical monitoring guidelines, the NST did not improve patient mortality rates and length of hospital stay.

關鍵字

腸道外 營養 支持 團隊 跨領域

並列摘要


The effectiveness of the Nutrition Support Team (NST) at Hospital Sungai Buloh, a large public hospital in Kuala Lumpur, Malaysia, in optimising parenteral nutrition (PN) has not been evaluated. To evaluate the effects of this NST in optimising patient outcomes, treatment outcomes, and adherence to biochemical monitoring guidelines, two groups of patients, those given PN before (n=106) NST intervention and those given PN after (n=106) NST intervention, were retrospectively compared. Intervention by the NST significantly reduced metabolic abnormalities, reducing sodium abnormalities from 67% to 44% (p<0.01); potassium abnormalities from 42% to 15% (p<0.01); magnesium abnormalities from 13% to 3% (p<0.05) and phosphate abnormalities from 21% to 9% (p=0.01). Intervention by the NST also significantly reduced the incidence of hypertriglyceridemia from 68% to 45% (p=0.002) and significantly improved adherence to biochemical monitoring guidelines from 46% to 72% (p<0.01). However, the length of hospital stay, patient mortality, and duration of PN were similar in both groups. This study failed to demonstrate that the establishment of a NST gave better outcomes in terms of the common measures of effectiveness. In conclusion, although management by an NST significantly reduced metabolic abnormalities and improved adherence to biochemical monitoring guidelines, the NST did not improve patient mortality rates and length of hospital stay.

並列關鍵字

parenteral nutrition support team multidisciplinary

參考文獻


Shang E, Hasenberg T, Sclegel B, Sterchi AB, Schindler K, Druml W, Koletzko B, Meier R. An European survey of structure and organisation of nutrition support teams in Germany, Austria and Switzerland. Clin Nutr. 2005;24: 1005-13. doi: 10.1016/j.clnu.2005.07.005
Trujillo EB, Young LS, Chertow GM, Randall S, Clemons T, Jacobs DO, Robinson MK. Metabolic and monetary costs of avoidable parenteral nutrition use. JPEN J Parenter Enteral Nutr. 1999;23:109-13. doi: 10.1177/0148607199023002109
Kennedy JF, Nightingale JMD. Cost savings of an adult hospital nutrition support team. Nutrition. 2005;21:1127-33. doi: 10.1016/j.nut.2005.08.002
Dalton MJ, Schepers G, Gee JP, Alberts CC, Eckhauser FE, Kirking DM. Consultative total parenteral nutrition teams: the effect of the incidences of total parenteral nutritionrelated complications. JPEN J Parenter Enteral Nutr. 1984;8: 146-52. doi: 10.1177/0148607184008002146
Nehme AE. Nutritional support of the hospitalised patientthe team concept. JAMA. 1980;243:1906-8. doi: 10.1001/ jama.243.19.1906

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