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Observational Study
. 2020 Feb;39(2):585-591.
doi: 10.1016/j.clnu.2019.03.010. Epub 2019 Mar 25.

Home parenteral nutrition provision modalities for chronic intestinal failure in adult patients: An international survey

Loris Pironi  1 , Ezra Steiger  2 , Chrisoffer Brandt  3 , Francisca Joly  4 , Geert Wanten  5 , Cecile Chambrier  6 , Umberto Aimasso  7 , Anna Simona Sasdelli  8 , Sarah Zeraschi  9 , Darlene Kelly  10 , Kinga Szczepanek  11 , Amelia Jukes  12 , Simona Di Caro  13 , Miriam Theilla  14 , Marek Kunecki  15 , Joanne Daniels  16 , Mireille Serlie  17 , Florian Poullenot  18 , Jian Wu  19 , Sheldon C Cooper  20 , Henrik H Rasmussen  21 , Charlene Compher  22 , David Seguy  23 , Adriana Crivelli  24 , Maria C Pagano  25 , Sarah-Jane Hughes  26 , Francesco W Guglielmi  27 , Nada Rotovnik Kozjek  28 , Stéphane M Schneider  29 , Lyn Gillanders  30 , Lars Ellegard  31 , Ronan Thibault  32 , Przemysław Matras  33 , Anna Zmarzly  34 , Konrad Matysiak  35 , Andrè Van Gossum  36 , Alastair Forbes  37 , Nicola Wyer  38 , Marina Taus  39 , Nuria M Virgili  40 , Margie O'Callaghan  41 , Brooke Chapman  42 , Emma Osland  43 , Cristina Cuerda  44 , Peter Sahin  45 , Lynn Jones  46 , Andre Dong Won Lee  47 , Luisa Masconale  48 , Paolo Orlandoni  49 , Ferenc Izbéki  50 , Corrado Spaggiari  51 , Marta Bueno  52 , Maryana Doitchinova-Simeonova  53 , Carmen Garde  54 , Aurora E Serralde-Zúñiga  55 , Gabriel Olveira  56 , Zeljko Krznaric  57 , Laszlo Czako  58 , Gintautas Kekstas  59 , Alejandro Sanz-Paris  60 , Estrella Petrina Jáuregui  61 , Ana Zugasti Murillo  62 , Eszter Schafer  63 , Jann Arends  64 , José P Suárez-Llanos  65 , Simon Lal  66 ; Home Artificial Nutrition and Chronic Intestinal Failure Special Interest Group of ESPEN; European Society for Clinical Nutrition and Metabolism
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Free article
Observational Study

Home parenteral nutrition provision modalities for chronic intestinal failure in adult patients: An international survey

Loris Pironi et al. Clin Nutr. 2020 Feb.
Free article

Abstract

Background & aims: The safety and effectiveness of a home parenteral nutrition (HPN) program depends both on the expertise and the management approach of the HPN center. We aimed to evaluate both the approaches of different international HPN-centers in their provision of HPN and the types of intravenous supplementation (IVS)-admixtures prescribed to patients with chronic intestinal failure (CIF).

Methods: In March 2015, 65 centers from 22 countries enrolled 3239 patients (benign disease 90.1%, malignant disease 9.9%), recording the patient, CIF and HPN characteristics in a structured database. The HPN-provider was categorized as health care system local pharmacy (LP) or independent home care company (HCC). The IVS-admixture was categorized as fluids and electrolytes alone (FE) or parenteral nutrition, either commercially premixed (PA) or customized to the individual patient (CA), alone or plus extra FE (PAFE or CAFE). Doctors of HPN centers were responsible for the IVS prescriptions.

Results: HCC (66%) was the most common HPN provider, with no difference noted between benign-CIF and malignant-CIF. LP was the main modality in 11 countries; HCC prevailed in 4 European countries: Israel, USA, South America and Oceania (p < 0.001). IVS-admixture comprised: FE 10%, PA 17%, PAFE 17%, CA 38%, CAFE 18%. PA and PAFE prevailed in malignant-CIF while CA and CAFE use was greater in benign-CIF (p < 0.001). PA + PAFE prevailed in those countries where LP was the main HPN-provider and CA + CAFE prevailed where the main HPN-provider was HCC (p < 0.001).

Conclusions: This is the first study to demonstrate that HPN provision and the IVS-admixture differ greatly among countries, among HPN centers and between benign-CIF and cancer-CIF. As both HPN provider and IVS-admixture types may play a role in the safety and effectiveness of HPN therapy, criteria to homogenize HPN programs are needed so that patients can have equal access to optimal CIF care.

Keywords: Cancer; Home parenteral nutrition; Intestinal failure; Intravenous supplementation.

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