Efficacy of SNS in Different Disease States Efficacy studies have shown that malnourished patients undergoing major thoracoabdominal surgery benefit from SNS. Critical illness requiring ICU care including major burns, major trauma, severe sepsis, closed head injury, and severe pancreatitis [positive CT scan and Acute Physiology and Chronic Health Evaluation II (APACHE II) 10] all benefit by early SNS, as indicated by reduced mortality and morbidity. In critical illness, initiation of SNS within 24 h of injury or ICU admission is associated with a ~50% reduction in mortality. Patients with nitrogen accumulation disorders of renal and hepatic failure have a. | Chapter 073. Enteral and Parenteral Nutrition Part 3 Efficacy of SNS in Different Disease States Efficacy studies have shown that malnourished patients undergoing major thoracoabdominal surgery benefit from SNS. Critical illness requiring ICU care including major burns major trauma severe sepsis closed head injury and severe pancreatitis positive CT scan and Acute Physiology and Chronic Health Evaluation II APACHE II 10 all benefit by early SNS as indicated by reduced mortality and morbidity. In critical illness initiation of SNS within 24 h of injury or ICU admission is associated with a 50 reduction in mortality. Patients with nitrogen accumulation disorders of renal and hepatic failure have a likelihood of PCM of 50 and at least a moderate SRI. Improvements in morbidity including infection rates encephalopathy liver or renal function and length of hospital stay have been found with SNS. Inflammatory bowel disease including Crohn s disease particularly and to a lesser degree ulcerative colitis often produce PCM. In the outpatient setting SNS in Crohn s disease can improve nutritional status quality of life and the likelihood of remission. With pulmonary disease in the critically ill SNS improves ventilatory status and in acute lung injury the use of omega 3 fats as a component of SNS improves gas exchange and respiratory dynamics and reduces the need for mechanical ventilation. Low body weight in chronic obstructive pulmonary disease is associated with diminished pulmonary status and exercise capacity and higher mortality rates. However there is little convincing evidence that SNS as caloric supplementation improves nutrition or pulmonary function. PCM is also common in the course of cancer and HIV disease although less so in the latter with the advent of highly active antiretroviral therapy. When PCM develops as a consequence of SRI in these conditions there is limited likelihood of substantial efficacy or benefit from SNS. However when PCM develops as a .
