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Delivery of parenteral nutrition by `all in one bag' (AIO) versus single bottle system (SBS) in critically ill patients: a prospective randomized trial

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Rationale

AIO has become an easy and practical way to deliver total parenteral nutrition (TPN) in patients on a regular ward. However no data are available yet concerning the use of AIO in critical ill patients. Here the SBS is still the gold standard.

Method

A prospective randomized trial was conducted in surgical patients who were expected to need TPN for more than five days after major surgery or trauma. Patients were randomized to receive for at least five days an isocaloric and isonitrogenic TPN delivered as AIO or as SBS. The TPN met the caloric requirements, which were determined by indirect calorimetry. Substrates delivered, numerous laboratory parameters, metabolic disturbances as a result of the nutrition, as well as expenses for equipment and manpower were documented daily. Forty patients are required by the protocol to complete the study.

Results

37 patients have entered the study since 2/98. 3/37 refused to continue after the first day (drop out). 16 patients received AIO (86 days recorded) and 18 pat received SBS (101 days recorded). There was no difference in age, sex, diagnosis, risk factors between the treatment groups. Three patients died during the hospital course (18, 14 and 123 days after completing the study), all in the SBS group. Cause of death was in no case related to the TPN. The nutrition could be delivered without problems in both groups. Reduction of the TPN for hyperglycaemia was necessary only in one patient in each treatment group. Reduction of the TPN for hypertriglyceridaemia was necessary in one patient in each group. The SBS required more equipment e.g. infusion pumps and disposable infusion systems as well as more manpower e.g. to fix technical alarms.

Conclusion

AIB seems to be an useful alternative to SBS in critically ill and metabolically stable surgical patients.

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Ebener, C., Harms, J., Thümmer, B. et al. Delivery of parenteral nutrition by `all in one bag' (AIO) versus single bottle system (SBS) in critically ill patients: a prospective randomized trial. Crit Care 4, P167 (2000). https://doi.org/10.1186/cc887

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Keywords

  • Treatment Group
  • Randomized Trial
  • Surgical Patient
  • Full Text
  • Laboratory Parameter