Question 1
Most of these studies suggest there were no significant differences seen with regard to mortality or morbidity and some found no significant differences in other areas, such as duration of hospitalization, costs, and complication rates. In these cases, would you recommend parenteral nutrition over protein-sparing therapy if there is no significant difference between the two treatments? Why or why not?
posted by Vanessa @ 12:38 PM
12 comments
12 Comments:
I think there are other things to take into consideration when considering a patient’s wellbeing than just infection rate, hospitalization time and costs. Obviously, those are pretty good indicators of overall health and rate of healing for the patient, but there other things to take into consideration such as costs of treatment, specific disease states, and length of time on therapy. I would look into more research regarding the feeding practices that pertained to the specific disease state I was treating. There could be significant differences depending on your patient’s specific problems. I would also consider choosing the treatment that would be most “cost-effective” for how good the outcomes actually are. There are several things to consider regarding nutrition support before you make a decision about specific feeding regimens.
I agree with Karlie in the respect that each patient will have different needs. Since research is concluding that there are no significant differences between the two when considering cost, hospitalization length and infection rate, I would think that determining the correct form of nutrition would be dependent solely on the patient's specific condition and how they respond to the treatments. I also think that they should further research this topic and consider other factors besides cost, hospitalization length and infection rate.
I believe I would still recommend Parenteral Nutrition due to the simple fact that the meta-analysis looked at many "lower quality" studies as well as the fact that conflicting results were found in some of the categories. More conclusive results should be determined before Parenteral Nutrition should be terminated. In the end, the Patient's well-being should be the main consideration and should be taken into account when deciding whether Parenteral Nutrition is necessary or not.
I agree with all the above in that each patient presents a different situation, thus the RD must ultimately make a decision. Since there was no significant difference, the disease state and status of the patient would aid in the decision. There are disease states in which protein-sparing therapy would make sense (any disease in which protein is not being handled properly in the body), however on the flip side there would be disease states in which protein-sparing therapy would not make sense (patients with infections or trauma/wounds that need to heal). Thus it all comes down to the individual patient and what would be best for them (whether or not one is more beneficial than the other for that patient).
I agree with the others that have said that each patient's condition would have to be considered on an individual basis even though that is an easy answer. I do think however that the lack of strong evidential support of Parenteral nutrition as well as the negative outcomes that can also be associated with overfeeding, I would want to be careful to monitor the patients that I did recommend it for very closely. If their conditions did not show improvements with the TPN then I would likely recommend d/c.
Annie- I agree with you that even though it sounds like a simple answer, just making decisions on an individual basis and monitoring the patient during the intervention is the most efficient way to determine the appropriate route of care for each patient. Keeping that mentality also keeps professionals from getting into the habit of giving similar patients the exact same care; sometimes little changes can make a big difference and while care should be standardized, you also have to work with the individual characteristics of each patient.
Since most of the studies show no significant differences between the two treatments, I would probably use which ever treatment the patient tolerated better. In some of the disease states, parenteral nutrition was shown to work somewhat better than protein sparing, but in other disease states, protein sparing worked better. I would probably initially pick parenteral nutrition support because I am more familiar with how to calculate nutrient needs, but if there was no improvements in pt status over the course of a few days, I would not be hesitant to try protein sparing to see if this method worked better for this pt's state.
Overall, I would recommend protein sparing therapy. Perhaps this treatment would be less stressful and decrease GI complications with pt later in treatment or recovery. I understand (theoretically) each person will have a treatment plan that will be tailored to disease and what the pt can tolerate. In the hospital it is trial and error, what works best for one pt will be awful for another.
I agree with Annie in the respect that the patient should be monitored very closley to determine what works for them as far as treatment. Joanna also makes a good point in being more familiar with parenteral nutrition.
I think that Steph brings up a great point with the fact that there may be disease states out that would require less protein. For these patients, if their body is not utilizing protein, or if too much protein is harming them, of course you would turn to using the protein sparing theory. That is the reasoning why so many of us brought up the fact that it depends on pt status. Your care plan should reflect the best possible approach to correct as much of the disease state as possible. If you disregard important issues related to pt care, you could just be putting the pt in a worsened condition.
I agree with Karlie and Shanell that each patient will have different conditions which will require many considerations when determining treatment. I do however think we have to keep in mind that each hospital we work for may have different policies that dictate what we do and we may have to be recommending a treatment based on what the hospital can offer or what is the standard treatment of the facility.
Heather,
You are right in that treatment is somewhat like trial and error. We don't always know what will work best, so you try things until you find what works. I also agree that a protein sparing diet may be less stressful for some patients, it would just make it easier if we knew exactly which disease states a protein sparing diet was best for.
Post a Comment
<< Home