Expediting Transition to Home Parenteral Nutrition With Fast-Track Cycling

Area of Science:

• Clinical Nutrition
• Gastroenterology
• Internal Medicine

Background:

• Home parenteral nutrition (PN) delivery is typically 12-hour cycles.
• Discharge on PN is often delayed due to concerns about adverse events (AEs) during cycling.
• Investigating faster cycling protocols for PN is crucial for efficient patient management.

Purpose of the Study:

• To evaluate the safety of a 1-day fast-track PN cycling protocol (24 to 12 hours) compared to a standard 2-day protocol.
• To determine if immediate 12-hour cycling increases the risk of PN-related adverse events.
• To assess the feasibility of expediting PN cycling for long-term home use.

Main Methods:

• Eligible patients receiving PN at goal calories over 24 hours were randomized.
• Two protocols were compared: a 1-step "fast-track" and a 2-step "standard" protocol.
• Adverse events (AEs) included hyperglycemia, dyspnea, tachycardia, edema, and pulmonary edema, graded as minor or major.

Main Results:

• Hyperglycemia was the most common AE (24.2% fast-track vs. 30.0% standard).
• No significant difference in minor AEs between groups (33.3% vs. 53.3%, P = .5).
• No major AEs in the fast-track group; one major AE (pulmonary edema) in the standard group.

Conclusions:

• Fast-track PN cycling is safe for patients without diabetes or major organ dysfunction.
• This protocol can potentially expedite hospital discharge for home PN patients.
• Faster cycling may lead to reduced healthcare costs and improved patient satisfaction.