Abstract
Purpose
The optimal therapy for intestinal failure (IF) is unknown. The results of a systematic,
protocol-driven management strategy by a multidisciplinary team are described.
Methods
Intestinal failure was defined as bowel length of less than 40 cm or parenteral nutrition (PN) for more
than 42 days. A multidisciplinary team and protocol to prevent PN-associated liver
disease (PNALD) were instituted in 2006. Data were gathered prospectively with consent
and ethics board approval.
Results
From 1998 to 2006, 33 patients were treated (historical cohort) with an overall survival
of 72%. Rotating prophylactic antibiotics for bacterial overgrowth were given to 27%
of patients; 6% had lipid-sparing PN, and none received fish oil–based lipids. Median
time to intestinal rehabilitation was 7 ± 3.1 months, and 27% of patients who developed
PNALD died. From 2006 to 2009, 31 patients were treated. Seventy-seven percent received
PAB; 60%, lipid-sparing PN; and 47%, parenteral fish oil emulsion. Eighty-seven percent
weaned from PN at 3.9 ± 3.8 months, and no patients developed PNALD with 100% survival.
Novel lipid therapies were associated with changes in essential fatty acid profile
and one case of clinical essential fatty acid deficiency.
Conclusion
The institution of a multidisciplinary team and a protocol-driven strategy to prevent
PNALD improves survival in IF. Further studies are recommended.
Key words
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Article info
Publication history
Accepted:
September 30,
2010
Received:
September 22,
2010
Identification
Copyright
© 2011 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
