Supplemental Parenteral Nutrition

Supplemental Parenteral Nutrition

PEP Topic 
Fatigue
Description 

Supplemental parenteral nutrition is the provision of nutrients intravenously to supplement oral and/or enteral nutritional intake.

Effectiveness Not Established

Research Evidence Summaries

Wu, W., Zhong, M., Zhu, D.M., Song, J.Q., Huang, J.F., Wang, Q., & Tan, L.J. (2016). Effect of early full-calorie nutrition support following esophagectomy: A randomized controlled trial. Journal of Parenteral and Enteral Nutrition. Advance online publication. 

doi: 10.1177/0148607116651509
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Study Purpose:

To evaluate the efficacy and safety of early supplementary parenteral nutrition (PN) following esophagectomy

Intervention Characteristics/Basic Study Process:

Patients who had undergone scheduled esophagectomy (by laparoscopy or open surgery) for esophageal cancer were randomized 1:1 into two groups. The randomization sequence was generated by a computer, and the code was kept in sealed envelopes. Both groups were started on enteral nutrition (EN) within 24 hours after surgery; patients in the EN plus PN group also received supplementary parenteral nutrition (SPN), gradually increased over five days, to meet the full caloric target.

Sample Characteristics:

  • N = 70   
  • AGE = 30–66 years
  • MALES: 68%, FEMALES: 32%
  • CURRENT TREATMENT: Surgery
  • OTHER KEY SAMPLE CHARACTERISTICS: Esophagectomy, nasojejunal tube placement or jejunostomy for postoperative feeding

Setting:

  • SITE: Single site   
  • SETTING TYPE: Inpatient    
  • LOCATION: Department of Thoracic Surgery of Zhongshan Hospital, China

Phase of Care and Clinical Applications:

  • PHASE OF CARE: Active Antitumor Treatment
  • APPLICATIONS: Elder care

Study Design:

Randomized trial

Measurement Instruments/Methods:

The full-calorie target for each patient was based on measured resting energy expenditure, as determined by open-circuit indirect calorimetry (IC) (QUARK RMR). IC measurements were performed daily on each patient in both groups. The Chinese version of the Medical Outcome Study 36-Item Short-Form (MOS SF-36) as a surrogate of health-related quality of life assessment was used, and patients were required to fulfill the scale before surgery. Anthropometric parameters were taken. Standard laboratory blood biochemistry parameters were measured. Perioperatively, tumors were staged using the International Union Against Cancer's sixth edition of the tumor node metastasis (TNM) classification of malignant tumors (www.uicc.org) according to postoperative pathological results. The Clavien-Dindo classification was used to grade and record postoperative complications.

Results:

Patients in the EN plus PN group but not in the EN group preserved body weight (mean = 0.18, SD = 3.38 kg versus mean = −2.15, SD = 3.19 kg; p < 0.05) and FFM (mean = 1.46, SD = 2.97 kg versus mean = −2.08, SD = 4.16 kg) relative to preoperative measurements. Length of hospital stay, postoperative morbidity rates, and standard blood biochemistry profiles were similar. However, scores for physical functioning (mean = 71.5, SD = 24.3 versus mean = 60.4, SD = 27.4; p < 0.05) and energy/fatigue (mean = 62.9, SD = 19.5 versus mean = 54.2, SD = 23.5; p < 0.05) were significantly higher in the EN plus PN group 90 days following surgery.

Conclusions:

Addition of early PN to supplement standard EN did not significantly change the perioperative outcomes of patients undergoing esophagectomy. However, for patients who received SPN, increased calorie and protein intakes were associated with preservation of body weight, FFM, and better health-related quality of life in short-term follow-up. Additional studies with larger sample sizes are needed to confirm these findings.

Limitations:

  • Small sample (< 100)
  • Key sample group differences that could influence results
  • Exclusion criteria study included (a) aged younger than 18 years or older than 75 years, (b) body mass index less than 18 or greater than 30 kg/m2, (c) contraindications for EN or PN, (d) preoperative initiation of EN or PN, (e) ongoing infections, (f) preexisting organ failure (e.g., renal dysfunction–required dialysis, noncompensatory chronic obstructive pulmonary disease), (g) treatment with high doses of steroids, and (h) severe metabolic abnormalities (e.g., diabetes, hyperthyroidism, hypothyroidism).

Nursing Implications:

The literature suggests that optimized nutrition support improves the quality of life of patients with cancer. This paper is a clinical trial and has timely information for patients with esophogeal cancer. Additional studies with larger groups are needed. Collaboration between dieticians and nurses would benefit these patients.

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