Australasian Society for Parenteral and Enteral Nutrition guidelines for supplementation of trace elements during parenteral nutrition.

This work represents the first part of a progressive review of AuSPEN's 1999 Guidelines for Provision of Micronutrient Supplementation in Adult Patients receiving Parenteral Nutrition, in recognition of the developments in the literature on this topic since that time.A systematic literature review was undertaken and recommendations were made based on the available evidence and with consideration to specific elements of the Australian and New Zealand practice environment. The strength of evidence underpinning each recommendation was assessed. External reviewers provided feedback on the guidelines using the AGREE II tool.Reduced doses of manganese, copper, chromium and molybdenum, and an increased dose of selenium are recommended when compared with the 1999 guidelines. Currently the composition of available multi-trace element formulations is recognised as an obstacle to aligning these guidelines with practice. A paucity of available literature and limitations with currently available methods of monitoring trace element status are acknowledged. The currently unknown clinical impact of changes to trace element contamination of parenteral solutions with contemporary practices highlights need for research and clinical vigilance in this area of nutrition support practice.Trace elements are essential and should be provided daily to patients receiving parenteral nutrition. Monitoring is generally only required in longer term parenteral nutrition, however should be determined on an individual basis. Industry is encouraged to modify existing multi-trace element solutions available in Australia and New Zealand to reflect changes in the literature outlined in these guidelines. Areas requiring research are highlighted.背景：这项工作代表了澳大利亚肠内肠外营养学会自1999 年出台《对接受肠 道外营养的成年患者微量元素补充指南》以来对该领域进展的认可按文献进行 逐步综述的第一部分。方法：通过系统文献综述，基于现有证据并考虑对澳大 利亚和新西兰执业环境的具体内容提出建议。对每项建议的证据力度进行评 估。外部评审人员通过AGREE II 针对指南提供反馈。结果：相比于1999 年 的指南，建议减少锰、铜、铬和钼的剂量，增加硒的剂量。目前市面上多元微 量元素配方的成分是公认的指南实践中的障碍。现有文献的缺乏及监测微量元 素状况的方法存在局限性，使用的肠外营养中微量元素污染对临床的影响不清 楚，需要进一步研究及临床实践。结论：接受肠外营养的患者需要每天补充微 量元素。在结合个体情况基础上，只需对接受长期肠外营养的患者进行监测， 然而要个案处理。在澳大利亚和新西兰，鼓励企业根据新的研究成果修订的指 南调整多元微量元素溶液。该领域需要加大研究投入。