Early developments and clinical applications of total parenteral nutrition.
BACKGROUND
This article recounts the conditions and status of surgical nutrition support in the 1960s and the antecedent basic and clinical investigational work leading to the development of a practical and efficacious method of adequate nourishment entirely by vein in Beagle puppies; describes the subsequent clinical application of the knowledge, techniques, and technology to the first successful long-term total parenteral nutrition (TPN) support of critically ill pediatric and adult patients; and admonishes nutritionists of all backgrounds that some need for parenteral nutrition will likely always exist and that it is incumbent upon everyone to continue endeavors to advance the germinal methodology to perfection.


METHODS
The relevant indications, limitations, hindrances, motivational factors, and studies regarding the development of TPN are reviewed, and the fundamental investigational work culminating in the first successful growth and development of Beagle puppies and a human infant fed entirely by vein are described firsthand. The details of the orderly and logical scientific development of the principles and components of the techniques in animals, infants, and adults are related.


RESULTS
Knowledge, techniques, and technologic constituents of the first successful long-term TPN system were developed in the basic biochemical and animal laboratories initially in 6 puppies and subsequently adapted clinically for the efficacious long-term i.v. support of 6 critically ill surgical adult patients and a newborn infant before its widespread clinical application.


CONCLUSIONS
Long-term TPN was inaugurated successfully as a safe and effective i.v. feeding technique nearly 4 decades ago. However, basic and clinical investigations must continue to be encouraged, supported, and carried out in the quest to perfect the current rudimentary technology, methodology, and outcomes.
Dudrick
Stanley J
SJ
Program in Surgery, St. Mary's Hospital, Yale University School of Medicine, Waterbury, Connecticut 06706, USA. sdudrick@stmh.org
D000818:Animals; D002404:Catheterization / Q000295:instrumentation; D016638:Critical Illness / Q000628:therapy; D004285:Dogs; D005260:Female; D049673:History, 20th Century; D006801:Humans; D007231:Infant, Newborn; D018529:Nutritional Support / Q000266:history; D009994:Osmolar Concentration; D010289:Parenteral Nutrition, Total / Q000009:adverse effects / Q000266:history*; D011182:Postoperative Care; D011300:Preoperative Care; D012996:Solutions
D012996:Solutions