Does a multidisciplinary total parenteral nutrition team improve patient outcomes? A systematic review

• Published in: JPEN. Journal of parenteral and enteral nutrition Vol. 28; no. 4; pp. 251 - 258
• Main Authors: Naylor, CJ, Griffiths, RD, Fernandez, RS
• Format: Journal Article
• Language: English
• Published: London, England SAGE Publications 01.07.2004; ASPEN; American Society for Parenteral and Enteral Nutrition
• Subjects: Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Clinical death. Palliative care. Organ gift and preservation; Cost-Benefit Analysis; Emergency and intensive cardiocirculatory care. Cardiogenic shock. Coronary intensive care; Emergency and intensive care: metabolism and nutrition disorders. Enteral and parenteral nutrition; Humans; Intensive care medicine; Medical sciences; Parenteral Nutrition, Total - adverse effects; Parenteral Nutrition, Total - economics; Patient Care Team; Sepsis - epidemiology; Sepsis - etiology; Treatment Outcome; Water-Electrolyte Balance; Human; Prognosis; Nutrition; Enteral administration; Parenteral administration; Feeding
• ISSN: 0148-6071; 1941-2444
• DOI: 10.1177/0148607104028004251

BACKGROUND: Total parenteral nutrition (TPN) is a specialized form of nutrition support. The complexity associated with the management of patients receiving TPN therapy has led to the development of multidisciplinary TPN teams. The purpose of this review was to critically analyze the literature and present the best available evidence that investigated the effectiveness of multidisciplinary TPN teams in the provision of TPN to adult hospitalized patients. METHODS: A systematic review of studies identified from the Cochrane Library (2001, Issue 4), CINAHL, Complete MEDLINE, Complete Biomedical Collection, Complete Nursing Collection, and EMBASE, published in any language. RESULTS: Eleven studies, 4 with concurrent controls and 7 with historical controls, were eligible for inclusion in the review. Results of the studies indicate that the incidence of total mechanical complications is reduced in patients managed by the TPN team. However, the benefit of the TPN team in the reduction of catheter-related sepsis remains inconclusive. Four of the 5 studies reported fewer total metabolic and electrolyte abnormalities in patients cared for by the team, and these patients were more likely to receive their optimal caloric intake. However it was unclear if the management of the patients by the TPN team prevented the inappropriate use of TPN therapy. Although only 2 studies (n = 356) investigated total costs associated with management of patients by the TPN teams, there was evidence that a team approach is a cost-effective strategy. CONCLUSIONS: Overall, the general effectiveness of the TPN team has not been conclusively demonstrated. There is evidence that patients managed by TPN teams have a reduced incidence of total mechanical complications; however, it is unclear if there is a reduction in catheter-related sepsis and metabolic and electrolyte complications. The available evidence, although limited, suggests financial benefits from the introduction of multidisciplinary TPN teams in the hospital setting.