title: Safety of home parenteral nutrition in patients with amyotrophic lateral sclerosis: a French national survey.
abstract: We carried out a retrospective multicentre study to assess the safety of home parenteral nutrition (HPN) in patients with ALS. We reviewed the case records of patients from French ALS centres treated with HPN by central venous catheter (CVC) using an implantable port between January 2005 and October 2009. Seventy-three patients received HPN for a total of 11,908 catheter days. Twenty-seven patients experienced a total of 37 CVC related complications resulting in an incidence rate of 3.11 CVC complications/1000 catheter days, including 1.93 septic complications and 1.09 mechanical complications/1000 catheter days. Metabolic complications were frequent but without serious consequences on mortality. The use of the catheter for intravenous therapies in addition to HPN was identified as a septicaemia's risk factor (relative risk (RR) = 2.54, confidence interval (CI) 1.56-4.14, p = 0.04). In conclusion, HPN is an alternative procedure to PEG in advanced ALS patients. The incidence of complications appears to be comparable to data from the literature on HPN in other diseases. A prospective study comparing HPN and radiologic inserted gastrostomy (RIG) would allow comparison of the relative risk-benefit and survival of these procedures. The relation of CVC and RIG placement timing and the complications' occurrence should also be investigated.
authors.affiliation: APHP, Hôpital de la Pitié-Salpêtrière, Département des Maladies du Système Nerveux, Centre SLA de Paris.
authors.forename: Maya
authors.initials: M
authors.lastname: Abdelnour-Mallet
authors.forename: Annie
authors.initials: A
authors.lastname: Verschueren
authors.forename: Nathalie
authors.initials: N
authors.lastname: Guy
authors.forename: Marie-Hélène
authors.initials: MH
authors.lastname: Soriani
authors.forename: Myriam
authors.initials: M
authors.lastname: Chalbi
authors.forename: Paul
authors.initials: P
authors.lastname: Gordon
authors.forename: François
authors.initials: F
authors.lastname: Salachas
authors.forename: Gaelle
authors.initials: G
authors.lastname: Bruneteau
authors.forename: Nadine
authors.initials: N
authors.lastname: le Forestier
authors.forename: Timothée
authors.initials: T
authors.lastname: Lenglet
authors.forename: Claude
authors.initials: C
authors.lastname: Desnuelle
authors.forename: Pierre
authors.initials: P
authors.lastname: Clavelou
authors.forename: Jean
authors.initials: J
authors.lastname: Pouget
authors.forename: Vincent
authors.initials: V
authors.lastname: Meininger
authors.forename: Pierre-François
authors.initials: PF
authors.lastname: Pradat
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000690:Amyotrophic Lateral Sclerosis / Q000178:diet therapy* / Q000503:physiopathology; D002405:Catheterization, Central Venous / Q000009:adverse effects; D005260:Female; D005602:France; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D016331:Parenteral Nutrition, Home / Q000009:adverse effects* / Q000706:statistics & numerical data; D012189:Retrospective Studies; D018570:Risk Assessment; D012449:Safety