The Role of a Nutrition Support Team in the Management of Intestinal Failure Patients.

Sjoerd C J Nagelkerke,Cora F Jonkers-Schuitema,Merit M Tabbers,Lotte E Vlug,Edmond H H M Rings

doi:10.3390/nu12010172

Abstract

Parenteral nutrition (PN) is a complex and specialized form of nutrition support that has revolutionized the care for both pediatric and adult patients with acute and chronic intestinal failure (IF). This has led to the development of multidisciplinary teams focused on the management of patients receiving PN: nutrition support teams (NSTs). In this review we aim to discuss the historical aspects of IF management and NST development, and the practice, composition, and effectiveness of multidisciplinary care by NSTs in patients with IF. We also discuss the experience of two IF centers as an example of contemporary NSTs at work. An NST usually consists of at least a physician, nurse, dietitian, and pharmacist. Multidisciplinary care by an NST leads to fewer complications including infection and electrolyte disturbances, and better survival for patients receiving short- and long-term PN. Furthermore, it leads to a decrease in inappropriate prescriptions of short-term PN leading to significant cost reduction. Complex care for patients receiving PN necessitates close collaboration between team members and NSTs from other centers to optimize safety and effectiveness of PN use.

Highlights

Intestinal failure (IF), first defined in 1981 as “a reduction in the functioning gut mass below the minimal amount necessary for adequate digestion and absorption of food” [1], is characterized by dependence on parenteral nutrition (PN)
Several retrospective studies report that in hospitalized adult patients receiving short-term Parenteral nutrition (PN) an nutrition support teams (NSTs) results in fewer electrolyte disturbances, complications not otherwise defined, central line-associated blood stream infections (CLABSIs) and mortality. These findings demonstrate that PN administration is not risk free and potentially lethal and should be monitored by an NST
Oliveira et al reported on reduced disease-related mortality after installation of a multidisciplinary intestinal rehabilitation program for children diagnosed with intestinal failure (IF) between 0–365 days with 0.6 deaths per 3 months

Summary

Introduction

Intestinal failure (IF), first defined in 1981 as “a reduction in the functioning gut mass below the minimal amount necessary for adequate digestion and absorption of food” [1], is characterized by dependence on parenteral nutrition (PN). Chronic IF has different etiologies (see Table 1), but the most common cause in both adults and children is short bowel syndrome (SBS). As a consequence of extensive small bowel resection, followed by intestinal motility disorders and congenital enteropathies [4,5]. The administration of macronutrients, micronutrients, fluids, and electrolytes can be given enterally via oral and tube feeding, and parenterally via a central venous catheter (CVC) or shunt. The enteral route is the optimal and most physiologic route of feeding and should always be extensively considered before PN is initiated. Feeding via the enteral route stimulates bowel adaptation and decreases the risk of IF-associated liver disease.

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