title: Nutritional therapy in patients with acute pancreatitis requiring critical care unit management: a prospective observational study in Australia and New Zealand.
abstract: OBJECTIVE
  To determine nutritional therapy practices of patients with severe acute pancreatitis (defined as those receiving critical care management in an intensive care unit or high-dependency unit) in Australia and New Zealand with focus on the choice of enteral nutrition or parenteral nutrition.
  
  
  METHODS
  Prospective observational multicentered study performed at 40 sites in Australia and New Zealand over 6 months.
  
  
  METHODS
  Intensive care units or high-dependency units within Australia and New Zealand.
  
  
  METHODS
  Those with severe acute pancreatitis diagnosed by elevated lipase and/or amylase. Patients with chronic pancreatitis were excluded.
  
  
  METHODS
  The primary outcome was the proportion of patients who received enteral nutrition, parenteral nutrition, or concurrent enteral nutrition/parenteral nutrition. Secondary outcomes included other aspects of nutritional therapy and the severity and clinical outcomes of acute pancreatitis.
  
  
  RESULTS
  We enrolled 121 patients and 117 were analyzed. The mean age was 61 (sd 17) years and 53% were men. Enteral nutrition was delivered to 58 (50%; 95% confidence interval [CI], 41-59%) and parenteral nutrition to 49 (42%; 95% CI, 33-51%) patients. Parenteral nutrition was more frequently used as the initial therapy (58%; 95% CI, 49-67%) than enteral nutrition (42%; 95% CI, 33-51%). The most common reason for parenteral nutrition prescription was the treating doctor's preference (60%). Enteral nutrition (74%) was more often used than parenteral nutrition (40%) on any individual study day. Concurrent enteral nutrition and parenteral nutrition occurred in 28 (24%) patients on 14% of days. Complications of acute pancreatitis requiring critical care unit management were observed in 45 (39%) patients. The median (interquartile range) duration of intensive care unit and hospital stay were 5 (2-10) and 19 (9-31) days, respectively. The hospital mortality rate was 15% (95% CI, 8-21%), and there was a tendency toward higher mortality for patients who only received parenteral nutrition than for those who only received enteral nutrition (28% vs. 7%, p=.06).
  
  
  CONCLUSIONS
  For patients with acute pancreatitis requiring critical care unit management in Australian and New Zealand intensive care units, enteral nutrition is used most commonly, but parenteral nutrition is more often used as the initial route of nutritional therapy. Given that clinical practice guidelines currently recommend enteral nutrition as the initial route of nutritional therapy in severe acute pancreatitis, improved education about and dissemination of these guidelines seems warranted.
authors.affiliation: Australian and New Zealand Intensive Care Research Centre, Monash University, and the Department of Intensive Care, The Alfred Hospital, Melbourne, Australia. A.Davies@monash.edu
authors.forename: Andrew R
authors.initials: AR
authors.lastname: Davies
authors.forename: Siouxzy S
authors.initials: SS
authors.lastname: Morrison
authors.forename: Emma J
authors.initials: EJ
authors.lastname: Ridley
authors.forename: Michael
authors.initials: M
authors.lastname: Bailey
authors.forename: Merrilyn D
authors.initials: MD
authors.lastname: Banks
authors.forename: David J
authors.initials: DJ
authors.lastname: Cooper
authors.forename: Gil
authors.initials: G
authors.lastname: Hardy
authors.forename: Kerry
authors.initials: K
authors.lastname: McIlroy
authors.forename: Andrew
authors.initials: A
authors.lastname: Thomson
mesh_terms: D001315:Australia; D016009:Chi-Square Distribution; D016001:Confidence Intervals; D003422:Critical Care / Q000379:methods* / Q000706:statistics & numerical data; D004750:Enteral Nutrition / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009520:New Zealand; D010195:Pancreatitis / Q000628:therapy*; D010288:Parenteral Nutrition / Q000706:statistics & numerical data; D011446:Prospective Studies; D018709:Statistics, Nonparametric; D016896:Treatment Outcome