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Journal of Parenteral and Enteral Nutrition
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Identifying ICU Patients Who Would Not Benefit from Total Parenteral Nutrition

Rene W.S. Chang, B.Sc., M.S., F.R.C.S.

Nutrition Support Service, Department of Surgery, and Intensive Care Unit, Department of Anesthesia, Riyadh Armed Forces Hospital, Riyadh, Saudi Arabia

Berni Lee, S.R.N.

Nutrition Support Service, Department of Surgery, and Intensive Care Unit, Department of Anesthesia, Riyadh Armed Forces Hospital, Riyadh, Saudi Arabia

Sydney Jacobs, F.F.A.R.C.S.

Nutrition Support Service, Department of Surgery, and Intensive Care Unit, Department of Anesthesia, Riyadh Armed Forces Hospital, Riyadh, Saudi Arabia

This study attempted to improve patient selection for total parenteral nutrition (TPN) by identifying ICU patients whose prognoses were so hopeless that they would not or would no longer benefit from TPN. Computerized trend analysis of daily Apache II scores, corrected for the presence, number, and duration of major organ system failures was used to predict individual hospital outcome among 50 intensive care unit patients treated with TPN. Thirteen of the 18 deaths were correctly predicted without any false predictions. During the study, the results of predictions were not used to influence clinical decision making. If TPN was withheld in the five patients predicted to die before starting TPN, or withdrawn in the eight patients when they were predicted to die, $28,350 or 11.5% of the cost of TPN during the study period would have been saved. This hypothetical study shows that elimination of inappropriate treatment of patients with hopeless prognosis with the aim of avoiding the prolongation of the process of dying and unnecessary suffering is a compassionate patient-selection strategy that can result in major savings in healthcare resources. (Journal of Parenteral and Enteral Nutrition 13:535-538, 1989)

Journal of Parenteral and Enteral Nutrition, Vol. 13, No. 5, 535-538 (1989)
DOI: 10.1177/0148607189013005535
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This article has been cited by other articles:


Home page
 JPEN J Parenter Enteral NutrHome page
J. Maurer, F. Weinbaum, J. Turner, T. Brady, B. Pistone, V. D'Addario, W. Lun, and B. Ghazali
Reducing the Inappropriate Use of Parenteral Nutrition in an Acute Care Teaching Hospital
JPEN J Parenter Enteral Nutr, July 1, 1996; 20(4): 272 - 274.
[Abstract] [PDF]