Global availability of parenteral nutrition: Pre- and post-COVID-19 pandemic surveys

Klek S 1 , Del Rio Requejo IM 2 , Hardy G 3 , Francisco LMP 4 , Abbasoglu O 5 , Acosta JCA 6 Show all authors , Granados LMB 7 , Boeykens K 8 , Carey S 9 , Chourdakis M 10 , Compher C 11 , De Cloet J 12 , Dubrov S 13 , Fuentes C 14 , Sámano AKG 2 , Velasquez MEG 15 , Goos C 16 , Reyes JGG 17 , Joon LV 18 , Klimasauskas A 19 , Komsa R 20 , Krznaric Z 21 , Ljubas D 22 , Moscoso CPM 23 , Larreategui R 24 , Mirea L 25 , Meier R 26 , Nyulasi I 27 , Oivind I 28 , Panisic-Sekeljic M 29 , Poulia KA 30 , Rasmussen HH 31 , Savino P 32 , Singer P 33 , Tamasi P 34 , Uyar M 35 , Thu NVQ 36 , Waitzberg D 37 , Weimann A 38 , Wong T 39 , Yu J 40 , Wojcik P 41 , Schneider S 42

Affiliations 

  • 1 Surgical Oncology Clinic, Maria Sklodowska-Curie National Cancer Research Institute, Krakow, Poland. Electronic address: st.klek@gmail.com
  • 2 Clinical Nutrition Team, Centro Médico Nacional 20 de Noviembre, Institute for Social Security and Services for State Workers (ISSSTE), Mexico City, Mexico
  • 3 Ipanema Research Trust, Auckland, New Zealand
  • 4 Nutrition Support Committee, Asian Hospital and Medical Center, Manila, Philippines
  • 5 Clinical Nutrition Master's Program, Hacettepe University, Ankara, Turkey
  • 6 General and Laparoscopic Gastrointestinal Surgery, Clinica del Country, Bogota, Colombia
  • 7 Department of Food and Nutrition, Pontificia Universidad Javeriana, Cali, Colombia
  • 8 Nutrition Support Team, Vitaz Hospital, Sint-Niklaas, Belgium
  • 9 Royal Prince Alfred Hospital University, Sydney, Australia
  • 10 School of Medicine, Faculty of Health Sciences, Aristotle University, Thessaloniki Greece
  • 11 School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA; Clinical Nutrition Support Service, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
  • 12 Hospital Pharmacy, Ghent University Hospital, Gent, Belgium
  • 13 Bogomolets National Medical University, Kyiv, Ukraine
  • 14 Nutrition Support Team, Internal Medicine Department, Hospital Cliníço de la Fuerza Aérea, Las Condes, Chile; Nutrition Department, School of Medicine, Universidad de Chile, Indepencia, Chile
  • 15 Clinical Nutrition Department, Kennedy Group Hospital, Guayaquil, Ecuador
  • 16 Fresenius Kabi Canada, Toronto, Canada
  • 17 Nutritional Support Unit, General Hospital, Salvadoran Social Security Institute, San Salvador, El Salvador
  • 18 Aseptic Unit, Pharmacy Department, Hospital Sungai Buloh, Kuala Lumpur, Malaysia
  • 19 Center of Anaesthesiology, Intensive Therapy and Pain Management, Vilnius University, Vilnius, Lithuania
  • 20 Medical University, Pleven, Bulgaria
  • 21 School of Medicine, University of Zagreb, Zagreb, Croatia
  • 22 Unit of Clinical Nutrition, Department of Internal Medicine, University Hospital Centre Zagreb, Zagreb, Croatia
  • 23 Division of Education and Research, Centro Médico Militar, Guatemala City, Guatemala
  • 24 Nutritional Support Unit, Ciudad de la Salud, Caja de Seguro Social, Panama City, Panama
  • 25 Anaesthesia and Intensive Care Clinic, University of General Medicine, Clinical Emergency Hospital, Bucharest, Romania
  • 26 Gastroenterology Unit, University of Basel, Basel, Switzerland
  • 27 La Trobe University, Melbourne, Australia; Monash University, Melbourne, Australia
  • 28 Department of Gastroenterological Surgery, University Hospital of North Norway, Tromso, Norway
  • 29 National Society for Clinical Nutrition, Belgrade, Serbia
  • 30 Laboratory of Dietetics and Quality of Life, Department of Food Science and Human Nutrition, School of Food and Nutritional Sciences, Agricultural University of Athens, Athens, Greece
  • 31 Center for Nutrition and Intestinal Failure, Aalborg University Hospital, Aalborg University, Aalborg, Norway; Dietitians and Nutritional Research Unit, EATEN, Herlev and Gentofte Hospital, University of Copenhagen, Denmark
  • 32 Centro Latinoamericano de Nutrición (CELAN), Colombian National Academy for Medicine, Bogotá, Colombia
  • 33 Intensive Care Unit, Herzlia Medical Center, Ramat Gan, Israel; Department of Critical Care, Rabin Medical Center, Petah Tikva, Israel; Institute for Nutrition Research, Beilinson Hospital Israel, Rabin Medical Center, Petah Tikva, Israel; Department of Anesthesia and Critical Care, School of Medicine, Tel Aviv University, Tel Aviv, Israel
  • 34 Intensive Care Unit, Peterfy Hospital, Budapest, Hungary
  • 35 Department of Anesthesiology and Intensive Care, Ege University Hospital, Bornova, Turkey
  • 36 Department of Nutrition and Dietetics, FV Hospital, Ho Chi Minh City, Vietnam
  • 37 Gastroenterology Department, University of São Paulo School of Medicine, São Paulo, Brasil
  • 38 Department of General, Visceral and Oncological Surgery, Hospital St. George, Leipzig, Germany
  • 39 Department of Gastroenterology and Nutrition, Birmingham Women's & Children's, Birmingham, UK
  • 40 Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, P. R. China
  • 41 University Clinical Center, Medical University of Warsaw, Warsaw, Poland
  • 42 Gastroenterology and Nutrition, Centre Hospitalier Universitaire de Nice, Université Côte d'Azur, Nice, France
Nutrition, 2024 Feb 26;123:112396.
PMID: 38554461 DOI: 10.1016/j.nut.2024.112396

Abstract

OBJECTIVE: Parenteral nutrition represents a therapeutic option for patients with type 3 intestinal failure. If used exclusively, parenteral nutrition has to be complete to provide all essential nutrients. The aim was to assess the availability of parenteral nutrition in all parts of the world, to better comprehend the global situation, and to prepare an action plan to increase access to parenteral nutrition.

METHODS: An international survey using an electronic questionnaire was conducted in August 2019 and repeated in May 2022. An electronic questionnaire was sent to 52 members or affiliates of the International Clinical Nutrition Section of the American Society for Parenteral and Enteral Nutrition. Questions addressed the availability of parenteral nutrition admixtures and their components, reimbursement, and prescribing pre- and post-COVID-19 pandemic. All participating countries were categorized by their economic status.

RESULTS: Thirty-six country representatives responded, answering all questions. Parenteral nutrition was available in all countries (100%), but in four countries (11.1%) three-chamber bags were the only option, and in six countries a multibottle system was still used. Liver-sparing amino acids were available in 18 (50%), kidney-sparing in eight (22.2%), and electrolyte-free in 11 (30.5%) countries (30.5%). In most countries (n = 28; 79.4%), fat-soluble and water-soluble vitamins were available. Trace elements solutions were unavailable in four (11.1%) countries. Parenteral nutrition was reimbursed in most countries (n = 33; 91.6%). No significant problems due to the coronavirus pandemic were reported.

CONCLUSIONS: Despite the apparent high availability of parenteral nutrition worldwide, there are some factors that may have a substantial effect on the quality of parenteral nutrition admixtures. These shortages create an environment of inequality.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

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