Consenso colombiano de Falla Intestinal Crónica en Síndrome de Intestino Corto / Colombian Consensus on Chronic Intestinal Failure in Short Bowel Syndrome

Introducción. Los términos falla intestinal crónica, síndrome de intestino corto (SIC) y nutrición parenteral total son muy frecuentes en la práctica clínica cotidiana.El objetivo de esta guía fue establecer un marco de referencia de práctica clínica basado en el mejor de nivel de evidencia en pacientes con falla intestinal crónica secundaria a síndrome de intestino corto. Métodos. Se estableció un grupo de expertos interdisciplinarios en el manejo de la falla intestinal crónica quienes, previa revisión de la literatura escogida, se reunieron de manera virtual acogiendo el método Delphi para discutir una serie de preguntas seleccionadas, enfocadas en el contexto terapéutico de la falla intestinal crónica asociada al síndrome de intestino corto. Resultados. La recomendación del grupo de expertos colombianos es que se aconseje a los pacientes con SIC consumir dietas regulares de alimentos integrales que genere hiperfagia para compensar la malabsorción. Las necesidades proteicas y energéticas dependen de las características individuales de cada paciente; la adecuación del régimen debe ser evaluada a través de pruebas clínicas, antropométricas y parámetros bioquímicos. Se sugiere, especialmente a corto plazo después de la resección intestinal, el uso de análogos de somatostatina para pacientes con yeyunostomía de alto gasto en quienes el manejo de líquidos y electrolitos es problemático. En pacientes con SIC, que son candidatos a tratamiento con enterohormonas, Teduglutida es la primera opción. Conclusión. Existen recomendaciones en el manejo integral de la rehabilitación intestinal respaldadas ampliamente por este consenso y es importante el reconocimiento de alternativas terapéuticos enmarcadas en el principio de buenas prácticas clínicas.

Introduction. The terms chronic intestinal failure, short bowel syndrome (SBS), and total parenteral nutrition are very common in daily clinical practice. The objective of this guideline was to establish a reference framework for clinical practice based on the best level of evidence in patients with chronic intestinal failure secondary to short bowel syndrome. Methods. A group of interdisciplinary experts in the management of chronic intestinal failure was established who, after reviewing the selected literature, met virtually using the Delphi method to discuss a series of selected questions, focused on the therapeutic context of chronic intestinal failure associated with short bowel syndrome. Results. The recommendation of the Colombian expert group is that patients with SBS be advised to consume regular diets of whole foods that generate hyperphagia to compensate malabsorption. Protein and energy needs depend on the individual characteristics of each patient; the adequacy of the regimen must be evaluated through clinical, anthropometric tests and biochemical parameters. The use of somatostatin analogue is suggested, especially in the short term after bowel resection, for patients with high-output jejunostomy in whom fluid and electrolyte management is problematic. In SBS, who are candidates for enterohormonal therapy, Teduglutide is the first choice. Conclusion. There are recommendations on the comprehensive management of intestinal rehabilitation that are widely supported by this consensus and it is important to recognize therapeutic alternatives framed in the principle of good clinical practice.

Proceso que vive el paciente quirúrgico abdominal al recibir soporte nutricional artificial / Process experienced by the abdominal surgical patient receiving artificial nutritional support / Processo vivenciado pelo paciente cirúrgico abdominal que recebe suporte nutricional artificial

Introducción: La persona en postoperatorio de cirugía abdominal puede llegar a presentar complicaciones a causa de la patología quirúrgica de base o por la cirugía, impidiendo iniciar o tolerar la vía oral. Una medida que se toma para prevenir o tratar la desnutrición hospitalaria es el manejo con soporte nutricional artificial, evento que transforma la forma de percibir y vivir el proceso de alimentación. Objetivo: comprender el proceso que vive la persona adulta al recibir soporte nutricional artificial en el postoperatorio de cirugía abdominal. Materiales y métodos: se empleó la metodología cualitativa, teoría fundamentada, según postulados de Corbin y Strauss. Se realizaron entrevistas a profundidad a 21 personas adultas en postoperato-rio de cirugía abdominal y manejo con soporte nutricional artificial. Resultados: del análisis de los datos se establecieron 4 etapas del proceso: presentando dificultad para alimentarse, estando desnutrido o en riesgo nutricional, recibiendo el soporte nutricional artificial y anhelando recu-perar la normalidad de la vida. Conclusiones: el proceso tiene un punto de inicio, determinado por las manifestaciones de la enfermedad, luego el paciente pasa a recibir soporte de nutrición artificial, situación que les genera miedo y ansiedad, continúa con la aceptación y el reconoci-miento de los beneficios de la nutrición artificial y finaliza con el inicio de la vía oral.

Introduction: the person in the postoperative period of abdominal surgery may present com-plications due to the underlying surgical pathology or due to the surgery, preventing them from starting or tolerating the oral route. A measure that is taken to prevent or treat hospital malnutrition is management with artificial nutritional support, an event that transforms the way of perceiving and experiencing the feeding process. Objective: to understand the process experienced by adults receiving artificial nutritional support in the postoperative period of ab-dominal surgery. Materials and methods: qualitative methodology was used, fundamental theory, according to Corbin and Strauss postulates. In-depth interviews were conducted with 21 postoperative adults after abdominal surgery and management with artificial nutritional support. Results: From the analysis of the data, 4 stages of the process were established: pre-senting difficulty feeding, malnourished or at nutritional risk, receiving artificial nutritional support and longing to return to normal life.NConclusions: the process has a starting point, determined by the manifestations of the disease, then the patient begins to receive artificial nutrition support, a situation that generates fear and anxiety, continues with the acceptance and recognition of the benefits of nutrition. artificial and ends with the beginning of the oral route

Introdução: A pessoa em pós-operatório de cirurgia abdominal pode apresentar complicações decorrentes da patologia cirúrgica de base ou decorrentes da cirurgia, impedindo-a de iniciar ou tolerar a via oral. Uma medida adotada para prevenir ou tratar a desnutrição hospitalar é o manejo com suporte nutricional artificial, evento que transforma a forma de perceber e vivenciar o processo de alimentação. Objetivo: compreender o processo vivenciado por adultos que re-cebem suporte nutricional artificial no pós-operatório de cirurgia abdominal. Materiais e méto-dos: foi utilizada a metodologia qualitativa, grounded theory, segundo os postulados de Corbin e Strauss. Foram realizadas entrevistas em profundidade com 21 adultos no pós-operatório de ciru-rgia abdominal e manejo com suporte nutricional artificial. Resultados: A partir da análise dos dados foram estabelecidas 4 etapas do processo: apresentar dificuldade para se alimentar, estar desnutrido ou em risco nutricional, receber suporte nutricional artificial e desejar retornar à vida normal. Conclusões: o processo tem um ponto de partida, determinado pelas manifestações da doença, então o paciente começa a receber suporte nutricional artificial, situação que gera medo e ansiedade, continua com a aceitação e reconhecimento dos benefícios da nutrição artificial e termina com o início da via oral

Profilaxia com lock de etanol em cateter venoso central de longa permanência em crianças com disfunção intestinal grave: relato de seis casos / Ethanol lock prophylaxis in long-stay central venous catheters in children with severe intestinal dysfunction: a report of six cases

Resumo O objetivo deste estudo foi relatar o uso de lock de etanol na profilaxia infecciosa de cateteres venosos de longa permanência em recém-nascidos com disfunção intestinal grave e dependentes de nutrição parenteral total e prolongada, internados em um Centro de Terapia Intensiva Neonatal (nível terciário) entre 2015 e 2020. Das 914 admissões, seis (0,65%) recém-nascidos preencheram os critérios de inclusão. A mediana da idade da passagem do cateter foi de 121,5 dias, sendo dois cateteres PowerPicc (PICC Power Sinergy™, São Paulo), um cateter Groshong (Groshong™ Central Venous Catheter BD, São Paulo) e três cateteres de silicone, todos tunelizados. O tempo de permanência apresentou mediana de 182,5 dias. Cinco pacientes apresentaram pelo menos um episódio de infecção associada ao cateter venoso central, sendo isolados agentes Gram-positivos, negativos e fungos. A mediana de dias de internação foi de 555, e a mortalidade, 33,3%. O lock de etanol não apresentou efeitos colaterais e foi relativamente eficaz na prevenção de infecções relacionadas ao cateter venoso central.

Abstract The aim of this study was to report on use of ethanol lock in long-term catheters in newborns with severe intestinal dysfunction, dependent on total and prolonged parenteral nutrition, in a Neonatal Intensive Care Center (tertiary level), between 2015 and 2020. Six infants (0.65%) out of the 914 admitted during the period met the inclusion criteria. The median age at catheter placement was 121.5 days. Two Powerpicc (PICC Power Sinergy™, São Paulo), one Groshong (Groshong™ Central Venous Catheter BD, São Paulo), and three silicone catheters were used, all tunneled, and the median dwell duration was 182.5 days. Four patients had at least one episode of infection related to the central venous catheter, and Gram-positive, Gram-negative, and fungal agents were isolated. The median length of hospital stay was 555 days and mortality was 33.3%. The ethanol lock did not cause any side effects and was relatively effective in preventing infections related to the central venous catheter.

Efeitos da nutrição parenteral ou enteral, associadas ou não à glutamina, sobre a motilidade gastrintestinal em equinos submetidos à inanição e realimentação / Effects of parenteral or enteral nutrition, associated or not with glutamine, on gastrointestinal motility in horses submmited to starvation and refeeding

Este estudo teve por objetivo avaliar os efeitos da nutrição parenteral total ou enteral, associadas ou não à glutamina, sobre a motilidade gastrintestinal em equinos submetidos à inanição e realimentação. Foram utilizados 16 equinos adultos hígidos, sem raça definida, de ambos os sexos, quatro machos e 12 fêmeas, com idade variando entre quatro e 14 anos e peso corporal médio de 248,40 + 2,28 kg, divididos em quatro grupos, quatro animais por grupo: Grupo I (ENTGL): fluidoterapia enteral com eletrólitos associada a glutamina; Grupo II (PARGL): Nutrição parenteral total (NPT) associada a glutamina; Grupo III (ENTFL): fluidoterapia enteral com eletrólitos; Grupo IV (PARFL): fluidoterapia parenteral. O delineamento experimental foi inteiramente ao acaso, em um esquema fatorial 4x12 (grupos x tempo de colheita), para cada fase, e suas médias comparadas pelo teste de Duncan ao nível de 5% de significância. Independente do grupo experimental ocorreu redução da motilidade gastrintestinal durante a fase de inanição, mais pronunciada nos grupos PARGL e PARFL. Uma vez restabelecida a alimentação a motilidade gastrintestinal retornou à normalidade.

This study aimed to evaluate the effects of enteral or total parenteral nutrition, associated or not with glutamine, on gastrointestinal motility in horses subjected to starvation and refeeding. 16 healthy, mixed-breed adult horses of both sexes, four geldings and 12 mares, with ages ranging from four to 14 years and an average body weight of 248.40 + 2.28 kg, were divided into four groups, four animals per group: Group I (ENTGL): enteral fluid therapy with electrolytes associated with glutamine; Group II (PARGL): total parenteral nutrition (TPN) associated with glutamine; Group III (ENTFL): enteral fluid therapy with electrolytes; Group IV (PARFL): parenteral fluid therapy. The experimental design was entirely randomized, in a 4x12 factorial scheme (groups x harvest time), for each phase, and their means compared by the Duncan test at the level of 5% significance. Regardless of the experimental group, there was a reduction in gastrointestinal motility during the starvation phase, which was more pronounced in the PARGL and PARFL groups. Once the food was restored, gastrointestinal motility returned to normal.

Nutrição parenteral: panorama das amostras analisadas no Instituto Nacional de Controle de Qualidade em Saúde / Parenteral nutrition: overview of the samples analyzed at the National Institute for Quality Control in Health / Nutrición parenteral: panorama de las muestras analizadas en el Instituto Nacional de Control de Calidad en Salud

Justificativa e objetivos: A Nutrição Parenteral Total (NPT) possui grande importância clínica no tratamento e prevenção da desnutrição de pacientes com problemas no sistema digestório. Apesar das boas práticas de manipulação de NPT estarem bem estabelecidas, a contaminação desses produtos ainda ocorre, e esses produto permanecem como um medicamento de alto risco pelo Institute for Safe Medication Practices. O presente estudo teve como objetivo obter um panorama sobre os dados documentais das amostras de nutrição parenteral encaminhadas ao Instituto Nacional de Controle de Qualidade em Saúde da Fundação Oswaldo Cruz. Métodos: Foi realizado um estudo qualitativo descritivo e quantitativo, com base em um coorte transversal de amostras de NPT analisadas no período de 2000 a 2016. Resultados: Foram encaminhadas 134 amostras de NPT no período do estudo. 11,20% das amostras foram encaminhadas em 2001, 0,80%, em 2005, 8,20%, em 2006, 16,40% em 2007, 63,40% em 2013. Seis amostras (4,5%) foram canceladas e 113 submetidas ao ensaio de esterilidade, resultando em 13,3% de amostras insatisfatórias. Conclusão: No período do estudo, quatro eventos suspeitos de contaminação bacteriana por enterobactérias em NPTs administradas em pacientes foram relatados, sendo três deles ainda não descritos na literatura. Para que a segurança dos pacientes que fazem uso de NPT seja garantida, sugere-se que as normas que regulamentam a terapia com NPT sejam revisadas e atualizadas e sejam estabelecidos programas de monitoramento da qualidade dessas preparações.(AU)

Background and objectives: Total parenteral nutrition (TPN) has great clinical importance in malnutrition treatment and prevention in patients with digestive problems. Although good practices for handling TPN are well established, contamination of these products still occurs, and this product remains listed as a higher risk drug by the Institute for Safe Medication Practices. The present study aimed to obtain an overview of the documentary data of the parenteral nutrition samples sent to the National Institute for Quality Control in Health (INCQS) of Fundação Oswaldo Cruz. Methods: This is a qualitative descriptive and quantitative study carried out based on a cross-section of TPN samples analyzed from 2000 to 2016. Results: A total of TPN 134 samples were sent during the study period. 11.20% of the samples were sent in 2001, 0.80% in 2005, 8.20% in 2006, 16.40% in 2007, 63.40% in 2013. Six samples (4.5%) were canceled and 113 submitted to sterility testing, resulting in 13.3% unsatisfactory samples. Conclusion: During the study period, four suspected events of enterobacterial contamination in TPNs administered to patients were reported, three of which have not yet been described in the scientific literature. For the safety of patients using TPN to be guaranteed, it is suggested that the norms that regulate TPN therapy be reviewed and updated, and programs to monitor the quality of these preparations should be established.(AU)

Justificatión y objetivos: La Nutrición Parenteral Total (NPT) tiene una gran importancia clínica en el tratamiento y la prevención de la desnutrición en pacientes con problemas en el sistema digestivo. Aunque las buenas prácticas para el manejo del TNP están bien establecidas, la contaminación de estos productos aún ocurre, y este producto sigue siendo catalogado como un medicamento de alto riesgo por el Institute for Safe Medication Practices. El presente estudio tuvo como objetivo obtener una visión general de los datos documentales de muestras de nutrición parenteral enviadas a Instituto Nacional de Control de Calidad en Salud (INCQS) por Fundação Oswaldo Cruz. Métodos: Se realizó un estudio descriptivo cualitativo y cuantitativo basado en una sección transversal de muestras de NPT analizadas entre 2000 y 2016. Resultados: Se enviaron un total de 134 muestras de NPT durante el período de estudio. 11,20% de las muestras enviadas en 2001, 0,80%, en 2005, 8,20%, en 2006, 16,40%, en 2007, 63,40%, en 2013. Seis muestras (4,5%) fueron cancelados y 113 sometidos a la prueba de esterilidad, resultando en 13,3% de muestras insatisfactorias. Conclusión: Durante el período de estudio, se informaron cuatro eventos sospechosos de contaminación por enterobaterias en NPT administrados a pacientes, tres de los cuales aún no se han descrito en la literatura. Para garantizar la seguridad de pacientes que usan NPT, se sugiere revisar y actualizar las normas que regulan la terapia de NPT y se deben establecer programas para controlar la calidad de estas preparaciones.(AU)

Multimídia interativa em saúde: capacitação de enfermeiros sobre cuidados dos pacientes em nutrição parenteral total / Interactive health multimedia: nursing training on patient care in nutrition total parenteral

A multimídia interativa é uma medida no âmbito da tecnologia de informação e comunicação adotada atualmente de forma ampla, com a proposta de difundir conhecimentos de forma muito mais acessível e uniforme a toda comunidade, interligada pela aplicação prática do conhecimento científico. Utilizando-se desse mecanismo de ampliação de conhecimentos, a ciência da saúde vêm empregando esses avanços tecnológicos na capacitação de profissionais, especialmente enfermeiros, no caso da presente pesquisa, na temática da Nutrição Parenteral Total. O objetivo do estudo foi estruturar e testar uma multimídia interativa construída no site Fábrica de Aplicativos, como estratégia de capacitação de enfermeiros que cuidam de clientes submetidos à nutrição parenteral. Metodologia: estudo intervencional, em instituição federal do Rio de Janeiro. Os participantes foram avaliados sobre a temática, em pré teste, foi aplicado a multimídia interativa, realizada no site Fábrica de aplicativos, após isso, um pós teste, onde foi analisado as competências adquiridas após a implementação da multimídia interativa

Interactive multimedia is a measure in the field of information technology and communication currently widely adopted, with the proposal of disseminating knowledge in a much more accessible and uniform way to the whole community, interlinked by the practical application of scientific knowledge. Using this mechanism of knowledge enhancement, health science has been employing these technological advances in the training of professionals, especially nurses, in the case of the present research, in the theme of Total Parenteral Nutrition. The objective of the study is to structure and test an interactive multimedia built on the Application Factory site, as a training strategy for nurses who care for clients submitted to parenteral nutrition. Methodology: interventional study, in a federal institution of Rio de Janeiro. Participants Will be evaluated on the subject, in pre-test, will be applied to interactive multimedia, held in the Application Factory site, in a new moment, a post test, where will be analyzed the skills acquired after the implementation of interactive multimedia

Uso de varfarina em pediatria: características clínicas e farmacológicas / Use of warfarin in pediatrics: clinical and pharmacological characteristics

RESUMO Objetivo: Descrever como as crianças respondem à anticoagulação oral com varfarina, verificando a influência da idade, da condição clínica, da via de administração da varfarina e do uso de Nutrição Parenteral Total (NPT), e apresentar a presença de fatores de risco para eventos tromboembólicos (TE). Métodos: Estudo transversal retrospectivo com pacientes ≤18 anos que iniciaram o uso da varfarina em um hospital universitário. Os pacientes foram divididos conforme condição clínica, idade, forma de administração do medicamento e uso de NPT. Foram utilizados os dados dos prontuários dos pacientes, considerando os fatores de risco para TE já descritos na literatura, o tempo e a dose necessária para atingir a primeira Razão Normalizada Internacional (INR) no alvo e eventos adversos nesse período. No período posterior ao alcance de INR, foi verificada a manutenção da anticoagulação, por meio da dose prescrita e dos exames de INR. Resultados: Vinte e nove pacientes foram incluídos no estudo. O principal fator de risco para TE foi o uso de cateter venoso central, em 89,6% dos pacientes. Os pacientes com síndrome do intestino curto e em uso de NPT necessitaram de doses significativamente maiores (p≤0,05) para atingir e manter a INR no alvo. Os pacientes com ≤1 ano levaram mais tempo e necessitaram de uma dose maior para anticoagular e para manter o INR no alvo que os pacientes mais velhos. A mediana de exames de INR abaixo do alvo foi de 48,2% nos grupos estudados. Conclusões: A complexidade da terapia anticoagulante reforça a necessidade da elaboração de protocolos que orientem a prática clínica.

ABSTRACT Objective: To describe how children respond to oral anticoagulation with warfarin, verifying the influence of age, clinical condition, route of administration of warfarin and use of total parenteral nutrition (TPN), as well as to describe risk factors for the occurrence of thrombotic events (TE) in childhood. Methods: A retrospective descriptive study including all patients ≤18 years old for whom warfarin was prescribed in a university hospital. Patients were divided according to clinical condition, age, route of medication administration and use of TPN. Data was collected from the patients' medical records and the analysis considered the risk factors for TE already described in the literature, the time and the dose required in order to reach the first International Normalized Ratio (INR) in the target and the adverse events in this period. After reaching the INR, the maintenance of anticoagulation was verified by the prescribed dose and INR tests. Results: Twenty-nine patients were included in the study. The major risk factor for TE was the use of a central venous catheter in 89.6% of the patients. Patients with short bowel syndrome and total parenteral nutrition required significantly higher doses (p≤0.05) to achieve and maintain the INR in the target. Patients ≤1 year old needed longer periods and required an increased dose of anticoagulation and maintenance than older patients. The mean number of INR examinations below the target was 48.2% in the groups studied. Conclusions: The observed complexity of anticoagulant therapy reinforces the need to develop protocols that guide clinical practice.

Incidence and treatment of chylothorax in children undergoing corrective surgery for congenital heart diseases

Abstract Introduction: Chylothorax is a lymphatic extravasation into pleural cavity and its incidence is 0.25%-5.3% in children undergoing cardiac surgery. Objective: To evaluate the incidence of chylothorax in pediatrics patients operated, linking it in each surgical intervention. Evaluate treatment types and efficiency. Methods: Retrospective study using medical records of children undergoing cardiac surgery in the Hospital do Coração between 2004 and 2014. For statistical analysis, qualitative variables by absolute frequency and relative frequency; quantitative variables, by median of 25 and 75 percentiles, as they did not present normal distribution (Shapiro-Wilk, P<0.05). The Chi-square test was used for the association between type of treatment and result. The adopted confidence level was 95%. Results: Incidence of chylothorax was 2.1% (0.9% in intracardiac surgery, 1.7% correction of patent ductus arteriosus and aortic coarctation, 8.3% Glenn's surgery, 11.8% total cavopulmonary surgery and 3% in others). Among treatments, fasting associated with total parenteral nutrition (TPN) resolved 51% of the cases. Hypoglossal diet had failed treatment and surgical referral in 22% of the cases. Fasting with TPN associated with octreotide had success in the treatment of chylothorax in a period exceeding 15 days in 78% of cases, and 3.7% were referred for surgery. Conclusion: According to the results, incidence of chylothorax was 2.18%. Treatment with fasting and TPN leads to resolutions in 86.5%, and the association with octreotide was successful in 85.1% of cases, showing an efficient option, while the treatment with hypoglossal diet had therapeutic failure in 22% of the cases in which it was used.

Los días de exposición a nutrición parenteral aumentan el riesgo de bacteriemia asociada a catéter venoso central / Exposition to total parenteral nutrition increases the risk of catheter-related bloodstream infection

Background: Infectious complications associated to central venous catheter (CVC) increase morbidity, mortality and costs. Total parenteral nutrition (TPN) is one of the risk factors described for catheter-related bloodstream infection (CR-BSI). The aim of this study was explore if TPN and time of exposition, are risk factors for CR-BSI among patient exposed to this therapy. Patients and Methods: Cohort study of patients with CVC exposed and not exposed to TPN with calculation of the relative risk (RR) for CR-BSI and percentage of CR-BSI according to different times of exposition to TPN. Study encompassed years 2010-2015 and only adult patients were included. Results: During the study period 51 events of CR-BSI were identified, with 27 occurring among those exposed to TPN and 24 among those not exposed. CR-BSI incidence rate was 6.3 in the group with TPN and 1.2 in those without this therapy (RR 5.4; IC 95 3.6-8.2). The percentage of patients with CR-BSI increased in parallel to exposition time (Pearson coefficient +0.91) and the OR increased for expositions ≥ 7 days (OR 2.8; IC 95 1.047.4; p < 0.05). Conclusions: Exposition to TPN increases the risk to CR-BSI in adult patients with CVC and this risk raise with exposition time.

Antecedentes: Las complicaciones infecciosas asociadas a dispositivos vasculares centrales tienen impacto en morbi-mortalidad y costos. Diferentes factores de riesgo han sido identificados en las ITS/CVC, incluyendo la nutrición parenteral total (NPT). Objetivo: Determinar si la NPT y el tiempo de exposición constituyen factores de riesgo para desarrollar ITS/CVC. Pacientes y Método: Estudio de cohortes de diseño prospectivo, de pacientes adultos con catéter venoso central (CVC) convencional, internados en el Hospital Militar entre los años 2010 y 2015 y que estuvieron expuestos o no expuestos a NPT, calculando el riesgo relativo (RR) y la distribución porcentual de las ITS/CVC a diferentes intervalos de exposición de NPT con análisis de coeficiente de correlación y cálculo de Odds Ratio (OR). Resultados: Durante el período de estudio se registraron 51 eventos de ITS/CVC en pacientes adultos con CVC, de los cuales 27 estuvieron expuestos a NPT y 24 no. Incidencia de 6,3 por 1.000 días en expuestos a NPT vs 1,2 en no expuestos (RR de 5,4; IC 95 3,6 a 8,2). La proporción de pacientes con ITS/CVC aumentó a medida que aumentaba la exposición a NPT (coeficiente correlación r = +0,91), siendo significativa para exposiciones ≥ 7 días (OR 2,8; IC 95 1,04-7,4; p < 0,05). Conclusiones: La exposición a NPT aumenta el riesgo de ITS/CVC en pacientes adultos hospitalizados respecto a aquellos pacientes que no reciben NPT, además este riesgo aumenta con el tiempo de exposición.

Nutritional assessment as predictor of complications after hematopoietic stem cell transplantation

ABSTRACT Introduction: Nutritional support is pivotal in patients submitted to hematopoietic stem cell transplantation. Nutritional status has been associated with time of engraftment and infection rates. In order to evaluate the association between nutritional parameters and clinical outcomes after transplantation a cohort of transplant patients was retrospectively evaluated. Methods: All 50 patients transplanted between 2011 and 2014 were included. The nutritional status before transplantation, ten days after transplantation and before discharge was assessed including anthropometry, body mass index, albumin, prealbumin and total urinary nitrogen. Results: The median follow-up time was 41 months and the median age of patients was 41 years. Thirty-two underwent allogeneic and 18 autologous transplants. Diagnoses included acute leukemias (n = 27), lymphoma (n = 7), multiple myeloma (n = 13), and aplastic anemia (n = 3). Thirty-seven patients developed mucositis (three Grade 1, 15 Grade 2, 18 Grade 3 and one Grade 4), and twenty-two allogeneic, and five autologous transplant patients required total parenteral nutrition. Albumin and total urinary nitrogen were associated with length of hospital stay and platelet and neutrophil engraftment. None of the nutritional parameters evaluated were associated with overall survival. Non-relapse mortality was 14% and overall survival was 79% at 41 months of follow-up. Conclusions: After hematopoietic stem cell transplantation, high catabolism was associated with longer length of hospital stay, the need of total parenteral nutrition and platelet and neutrophil engraftment times. Nutritional parameters were not associated with overall survival.

Registro de la utilización de nutrición parenteral en el Hospital de Pediatría Juan P. Garrahan / Registry of the use of parenteral nutrition at the Pediatric Hospital Juan P. Garrahan

La nutrición parenteral (NPT) en pediatría es un recurso que permite mantener el sostén clínico de aquellos pacientes que por la complejidad de la patología que presentan no pueden utilizar la vía enteral. El objetivos es analizar el registro de utilización de NPT en el Hospital de Pediatría Juan P. Garrahan. Estudio retrospectivo descriptivo. Se analizaron 95 solicitudes de NPT durante el período julio-agosto 2011. Se accedió a las historias clínicas, donde se constataron las variables principales: edad (meses), sexo, área de internación, patología asociada a su uso, duración promedio (días), tipo de NPT (Standard o personalizada) y evidencia de complicaciones. Se definió colestasis a valores de Bilirrubina directa mayor a 2 mg%. Sobre un total 114 indicaciones médicas de NPT, se accedió a 95 historias clínicas. Perfil de uso: Neonatología 34,5%, Cuidados Intensivos 35,7% y Cuidados Intermedios y moderados 29,8%. La media de edad 39 meses (0-192). Las patologías más frecuentes son quirúrgicas 52,6%, hematológicas y oncológicas 28,4%. La duración total de la indicación fue en promedio 16,5 días (0-187). Las soluciones personalizadas (a la carta) 83%. Las soluciones con lípidos sumaron un total de 73 (76%). Como complicaciones se observaron 13 casos de colestasis (13,68%) los cuales se asociaron a soluciones con lípidos. La mayoría de los pacientes que requirieron uso de NPT presentaron patologías que requerían cuidados críticos neonatales o pediátricos. Las soluciones personalizadas o "a la carta" fueron las más utilizadas. El tiempo de administración fue muy variable, la presencia de colestasis se relacionó con los usos más prolongados; superior a los 71 días promedio (AU)

In pediatrics, total parenteral nutrition (TPN) is a resource that allows to clinically support those patients who, due to the severity of their disease, do not tolerate the enteral route. The aim of this study was to analyze the registry of TPN use at the Pediatric Hospital Dr. Juan P. Garrahan. A retrospective descriptive study was conducted. Ninety-five requests for TPN made in July and August 2011 were analyzed. Clinical charts of the patients were assessed recording the main variables: Age (months), sex, area the child was admitted to, pathology associated with TPN use, duration of TPN (days), type of TPN (standard or personalized), and evidence of complications. Cholestasis was defined as direct bilirubin greater than 2 mg%. For a total of 114 medical indications for PN, access to 95 clinical charts was obtained. User's profile: Neonatology 34.5%, intensive care 35.7%, intermediate and moderate care 29.8%. Mean age of the patients was 39 months (0-192). The most common pathologies were surgical in 52.6% and hematological and oncological in 28.4%. Mean duration of TPN was 16.5 days (0-187). Personalized formulations ("a la carte") were used in 83%. Overall, 73 (76%) formulations with lipids were used. Complications observed were 13 cases of cholestasis (13.68%) that were associated with the use of lipid formulations. Most patients that needed TPN had pathologies requiring neonatal or pediatric critical care. Personalized or "a la carte" formulations were most often used. The duration of TPN administration was variable. Cholestasis was related with longer TPN use, with a mean of 71 days (AU)

Conocimientos y prácticas sobre medidas de bioseguridad que aplica la enfermera durante la administración de la NTP y la NET en pacientes del Servicio de UCI. HNDAC-2014 / Knowledge and practices about biosecurity measures applied by the nurse during the administration of the NTP and the NET in the patients of ICU Service. HNDAC-2014

El estudio "Conocimientos y prácticas sobre medidas de bioseguridad que aplican las enfermeras en la administración de la NPT y la NET en pacientes del servicio de UCI-HNDAC-2014" tuvo como objetivos determinar los conocimientos sobre medidas de bioseguridad que aplican las enfermeras en la administración de la NPT y la NET en pacientes del Servicio de UCI-Hospital Nacional Daniel Alcides Carrión-2014 y determinar las prácticas sobre medidas de bioseguridad que aplican las enfermeras en la administración de la NPT y la NET en pacientes del Servicio de UCI-Hospital Nacional Daniel Alcides Carrión-2014. Material y Método: El estudio es de nivel aplicativo, tipo cuantitativo, método descriptivo de corte transversal. La población estuvo conformada por 22 enfermeras. La técnica fue la observación y la encuesta, y los instrumentos una lista de cotejo y un cuestionario, los cuales fueron aplicados previo consentimiento informado. Resultados: Del 100 por ciento (22) enfermeras, 45,5 por ciento (10) conocen y 54,5 por ciento (12) no conocen sobre las medidas de bioseguridad en la administración de la NPT y la NET. Respecto a las prácticas de medidas de bioseguridad 27,3 por ciento (6) tienen prácticas inadecuadas y 72,7 por ciento (16) prácticas adecuadas. Conclusiones: Respecto a los conocimientos de las enfermeras sobre medidas de bioseguridad en la administración de la NPT y la NET, el mayor porcentaje no conoce, mientras la mayoría no conoce sobre generalidades sin embargo conocen la aplicación de la bioseguridad...

Estudio costo-beneficio de las estrategias de nutrición parenteral total en la Unidad de Cuidados Intensivos Neonatales del Hospital Nacional Dos de Mayo / Cost-benefit study of the strategies of total parenteral nutrition in the Neonatal Intensive Care Unit of the National Hospital Dos de Mayo

OBJETIVO: Comparar el Costo-Beneficio de dos estrategias de NPT en la UCIN del Hospital Nacional Dos de Mayo (HNDM), maximizar su eficiencia, y propiciar el financiamiento para una Unidad de NPT propia. MATERIAL Y MÉTODOS: Se determinó los costos y beneficios para evitar la Desnutrición en un paciente tipo, hospitalizado en la UCINûHNDM administrando 2 estrategias de NPT, evaluándose su relación Costo-Beneficio y rentabilidad. RESULTADOS: La estrategia actual de NPT, subsidiada por el Aseguramiento Universal en Salud (AUS) adiciona 4.5 Kcal/Kg/d equivalente a incrementar: 0.5 cc/h de Dextrosa 10% a la Nutrición Parenteral Parcial (NPP) con sólo 4% del costo de esos lípidos. Su pobre oferta energéticoûproteica estática impone muy elevados costos (4.3 veces), un alto riesgo de malnutrición crónica 0.5 gr/Kg/d=4.5 Kcal/Kg/d, frente a los 3.8gr/Kg/d=35 Kcal/Kg/d de la segunda estrategia (E2). La relación Costo- Beneficio (B/C) es muy favorable para la E2 (3.29 vs 0.77). Y el ahorro en un solo caso permitiría adquirir una Cámara de Flujo Laminar auto fabricada a partir del 3ºdía y marca Labotec desde el 15º-30º días.CONCLUSIONES: La estrategia actual de NPT para el paciente subsidiado por el AUS, es costosa e ineficiente. La segunda estrategia para NPT û HNDM permitiría un ahorro en costos significativo: atendería a 5 pacientes en lugar de 1, mejoraría la calidad de manejo nutricional reduciendo su morbiûmortalidad, y con los mismos recursos financiaría una Unidad de NPT, mejorando la seguridad del paciente neonatal.

OBJETIVES: To compare the cost-effectiveness of two strategies in the NICU TPN National Hospital Dos de Mayo (NHDM), maximize efficiency, and facilitating funding for a unit TPN itself.METHODS: We determined the costs and benefits to prevent malnutrition in a typical patient, hospitalized in the NICU-NHDM giving 2 TPN strategies, evaluating their cost-effectiveness and profitability. RESULTS: The current strategy of TPN, subsidized by the Universal Health Insurance (UHI) added 4.5 kcal/kg/d equivalent increase: 0.5 cc/hr of Dextrose 10% Partial Parenteral Nutrition (PPN) with only 4% of cost of these lipids. His poor static protein energy supply imposes very high costs (4.3 times), a high risk of chronic malnutrition 0.5 g/kg/d = 4.5 kcal/kg/d, compared with 3.8 gr/Kg/d = 35 Kcal/Kg/d for the second strategy (E2). The cost-benefit ratio (B/C) is very favorable for E2 (3.29 vs 0.77). And savings in a single case would acquire a laminar flow hood car manufactured from 3rd day and mark Labotec from 15º - 30º days. CONCLUSIONS: The current strategy for the patient TPN subsidized UHI is expensive and inefficient. The second strategy for TPN - NHDM allow significant cost savings: 5 patients would attend instead of one, would improve the quality of nutritional management reducing morbidity and mortality, and with the same resources would fund a unit TPN, improving safety neonatal patient.

Total parenteral nutrition - an integrative literature review

Aim: To characterize publications about total parenteral nutrition by identifying the main complications presented by patients who underwent this therapy and describe the main nursing care for these patients. Method: An integrative literature review from 1995 to 2011; Databases: LILACS, SciELO and BDENF. Results: Final sample was composed of 19 articles. Discussion: The central venous catheter infection, liver disorders, lung disorders, thromboembolic events, extravasation during infusion of the solution and hematological disorders were the main complications presented by patients who received total parenteral nutrition. Nursing care were related to the control of central venous catheter infection, clinical management of patients with total parenteral nutrition and infusion control. Conclusion: The administration of total parenteral nutrition involves simple actions. The nurse must assume its role with the team, ensuring performance, instruction and training to promote effective service to patients. Descriptors: Nursing; Parenteral Nutrition, Total; Parenteral Nutrition.

Infecciones del torrente sanguíneo asociadas a catéter venoso central en pacientes que reciben nutrición parenteral del instituto de Salud del Niño durante el periodo de Enero del 2006 a Diciembre del 2010 / Infections of the blood torrent associated with venous central catheter in patients who receive nutrition parenteral of the institute of Health of the Child during the period from January, 2006 to December, 2010

Objetivo: Determinar la tasa de infecciones del torrente sanguíneo (ITS) asociados a catéter venoso central (CVC) en pacientes que recibieron nutrición parenteral total (NPT) del Instituto Nacional de Salud del Niño (INSN), así como las características clínico-epidemiológicas de dichos pacientes. Materiales y Métodos: Estudio observacional retrospectivo realizado en pacientes que recibieron NPT a través de CVC en el INSN durante el periodo de Enero del 2006 a Diciembre del 2010. Resultados: Se revisaron 148 historias de pacientes que recibieron NPT, encontrándose 37 casos con ITS asociada a CVC. La tasa de ITS asociada a CVC fue de 22.7 infecciones por 100 días uso CVC. El grupo etareo más afectado fueron los menores de 12 meses (59.5 por ciento). El sexo femenino predominó ligeramente sobre el masculino (54 por ciento versus 46 por ciento). El sitio de inserción del CVC más frecuente fue la subclavia (46 por ciento). El germen aislado con mayor frecuencia fue el staphylococcus coagulasa negativo (N: 21) seguido de candida sp (N: 9). Se encontró que el staphylococcus coagulasa negativo y el S. aureus fueron resistentes a la penicilina G en el 100 por ciento de cepas aisladas, mientras que para la oxacilina fueron resistentes en 90 por ciento y 80 por ciento respectivamente...

Objetive: To determine the rate of catheter associated bloodstream infections (CABSI) in patients receiving total parental nutrition (TPN), of Instituto Nacional de Salud del Niño (INSN), as well as clinical and epidemiological characteristics of such patients. Material and methods: Retrospective observational study in patients who received TPN through CVC in the INSN during the period January 2006 to December 2010. Results: we reviewed 148 cases of patients who received. TPN, finding 37 cases with CABSI. The rate of CABSI was 22.7 infections per 1000 CVC days use. The most affected age group were younger than 12 months (59.5 per cent). The female sex predominated slightly over males (54 per cent versus 46 per cent). The site of central venous catheter (CVC) insertion of the most frequent was the subclavian (46 per cent). The most frequently isolated microorganism was staphylococcus and S. aureus were resistant to penicillin G at 100 por ciento of isolates, whereas for oxacillin were resistant to 90 per cent and 80 per cent respectively...

Conocimientos y prácticas de la enfermera sobre medidas de bioseguridad durante la administración de la NPT y la NET en pacientes hospitalizados en el Servicio de UCI 2C HNERM - EsSalud Lima - Perú / Knowledge and practices of the nurse about biosecurity measures for the administration of the NPT and the NET in hospitalized patients in the Service ICU 2C - HNERM - EsSalud Lima - Peru

El estudio "Conocimientos y prácticas de la enfermera sobre medidas de bioseguridad en la administración de NPT y NET en pacientes hospitalizados en la UCI 2C HNERM-ESSALUD 2009" tuvo como objetivo determinar los conocimientos y prácticas que tiene la enfermera sobre las medidas de bioseguridad durante la administración de la NPT y la NET. Material y Método: El estudio de nivel aplicativo, tipo cuantitativo, método descriptivo de corte transversal. La población estuvo conformada por 29 enfermeras que laboran en el servicio de UCI 2C de HNERM. La técnica fue la observación y la encuesta; los instrumentos una lista de Chequeo y un Cuestionario, los cuales fueron aplicados previo consentimiento informado. Resultados: Del 100 por ciento (29) enfermeras, 59 por ciento (17) conocen y 41 por ciento (12) no conocen sobre las medidas de bioseguridad durante la administración de la NPT-NET; respecto a las prácticas de medidas de bioseguridad en la administración de la NPT-NET 52 por ciento (15) tienen practicas inadecuadas y 48 por ciento (14) practicas adecuadas. Conclusiones: El mayor porcentaje de los enfermeras conocen sobre medidas de bioseguridad durante la administración de la NPT y la NET, para que este soporte nutricional sea preciso y seguro, seguido de un porcentaje significativo que no conoce sobre las principales barreras de protección que se aplican durante la administración de la NPT-NET, las complicaciones más frecuentes con la NET, en cuanto a las prácticas de medidas de bioseguridad durante la administración de la NPT-NET, un gran porcentaje de enfermeras tienen prácticas inadecuadas; ya que no evalúan la saturación oxígeno del paciente en cada turno, no se colocan mandilón, guantes estériles, mascarilla y gorra al inicio la NPT-NET, ni calibran la bomba infusora en cada turno, siendo un riesgo todo el procedimiento, predisponiendo de esta manera al paciente critico a adquirir infecciones intrahospitalarias y retardar su proceso de recuperación.

The study, "Knowledge and practices of the nurse on biosecurity measures in the TPN and TEN in patients hospitalized in the ICU 2C HNERM-ESSALUD 2009" aimed to determine the knowledge and practices that have the nurse about biosecurity measures during administration of the NPT and the NET. Methods: The study-Ievel application, quantitative, cross-sectional descriptive method. The sample consisted of 29 nurses working in the ICU service HNERM 2C. The technique was the observation and the survey instruments a checklist and a questionnaire, which were applied prior informed consent. Results: 100 per cent (29) nurses, 59 per cent (17) know and 41 per cent (12) do not know about biosecurity measures during administration of TPN-NET; regarding biosecurity practices in the administration of TPN-NET 52 per cent (15) have inadequate practices and 48 per cent (14) practices. Conclusions: The highest percentage of nurses know about biosecurity measures for the administration of the NPT and the NET, this nutritional support for accurate and safe, followed by a significant percentage who do not know about the main barriers of protection that apply during the TPN administration-NET the most common complications with the NET, in terms of biosecurity practices during the administration of the NPT-NET, a large percentage of nurses have inadequate practices, and do not assess the patient's oxygen saturation every turn, not placed gown, sterile gloves, mask and cap to top the NPT-NET infuser pump calibrated every shift, being a risk throughout the procedure, thus predisposing the patient to acquire critical nosocomial infections and slow your recovery process.

Nutrición en el paciente con pancreatitis aguda grave: guía de manejo clínico / Nutrition in the patient with severe acute pancreatitis: clinical management guideline

Objetivo: proponer una guía de manejo para la nutrición en los pacientes con pancreatitis aguda grave basada en la mejor evidencia disponible. Diseño: revisión sistemática y guía de práctica clínica. Población: pacientes críticos con pancreatitis aguda grave hospitalizados en la unidad de cuidados intensivos. Intervenciones y controles: nutrición entérica Vs. parenteral; dieta hipocalórica Vs. normocalórica; glutamina Vs. sin glutamina; arginina Vs. sin arginina; ácidos grasos omega 3/omega 6 Vs. omega 6 solamente; prebióticos o probióticos Vs. dieta estándar. Desenlaces: mortalidad, estancia hospitalaria y en la unidad de cuidados intensivos y, infecciones y sepsis, disfunción de órganos. Materiales y métodos: búsqueda en bases de datos médicas en línea. Resultados: las 765 referencias iniciales fueron filtradas con las palabras clave y quedaron 69 artículos. Cinco artículos más de autores latinoamericanos o de habla hispana fueron también revisados por considerarlos pertinentes. Conclusiones: los pacientes con pancreatitis aguda grave se benefician del soporte nutricional y la vía entérica es de elección con dietas normocalóricas de inicio temprano, preferencialmente en los primeros tres días. La intervención nutricional pudiera ser un determinante al disminuir la morbilidad y la mortalidad elevada en esta patología pero aún faltan estudios bien diseñados que permitan determinar con claridad el efecto de cada uno de sus componentes.

Objective: to propose a clinical practice guideline of nutrition for patients with severe acute pancreatitis derived from the best available evidence. Design: systematic review and clinical practice guideline.Setting: critically ill patients at the intensive care unit. Patients: with severe acute pancreatitis. Intervention: enteral or parenteral nutrition. Glutamine or no glutamine. Arginine or no arginine. Omega 3 fatty acid or control. Outcome: mortality, pulmonary, catheter associated or pancreatic infection, sepsis, ICU or hospital length of stay.Methodology: medical database online search.Results: 765 initial references were filtered with key words and 69 remained. 5 other articles in Spanish were considered pertinent. Conclusions: patients with severe acute pancreatitis benefit from nutritional support, and isocaloric early enteral route is of choice during the first 3 days. Nutritional intervention could be a determinant in lowering the high morbidity and mortality rates linked with this entity, but well designed trials that elucidate the true individual effect of each constituent are scarce.

Enteroplastía transversa seriada como alternativa en el tratamiento del síndrome de intestino corto: caso clínico / Serial transverse enteroplasty for short bowel syndrome: case report

Among patients with short bowel syndrome, surgical small intestine lengthening techniques are employed to increase the absorptive surface. Among these, serial transverse enteroplasty involves transecting the bowel transversally, preserving the blood supply of the small intestine and creating a longer segment of bowel. We report a 51-year-old woman with a short bowel syndrome and multiple hospital admissions for complications. She was subjected to a serial transverse enteroplasty, increasing small intestinal length from 140 to 180 cm. During the postoperative period, she presented intra abdominal blood collections and a septic episode with bacterial endocarditis. One month after the operation, total parenteral nutrition was discontinued and nutritional and fuid balances were achieved using exclusively the oral route. During the ambulatory follow up, the patient continues with exclusive oral feeding and fve bowel movements per day.

Cuidados nutricionais na pancreatite crônica: uma atualização / Cuidados alimenticios en pancreatitis crónica: una actualización / Nutritional cares in chronic pancreatitis: an update

A pancreatite crônica (PC) é caracterizada por lesões anatômicas de caráter irreversível e, muitas vezes, de forma progressiva. Sua incidência é estimada entre 5 e 10/100.000 indivíduos por ano, sendo seu cuidado terapêutico de alto custo. O álcool é a sua principal etiologia. O cuidado nutricional na PC é considerado um desafio pela presença de: hipercatabolismo, disfunções endócrinas e exócrinas e subnutrição. O objetivo deste estudo foi descrever as recomendações literárias atuais sobre os cuidados nutricionais desses indivíduos. Foi elaborado a partir darevisão da literatura sistemática com início em 1997, sendo empregada a técnica booleana e busca em sites eletrônicos de confiabilidade científica.Destacam-se como resultados que a avaliação nutricional desses indivíduos deve considerar o emagrecimento ao longo do tempo, valores antropométricos e laboratoriais. A orientação dietética e a medicação são eficazes no tratamento de 80 por cento dos casos. Recomenda-se dieta: normoa hiperproteica (1.0 a 1.5g/kg /dia), normoglicídica, (havendo restrições nos casos de hiperglicemia ou diabetes) e normolipídica (30 por cento de lipídeos).A principal fonte de lípides é de origem vegetal, sendo indicado o uso de Triglicérides de Cadeia Média (TCM) em casos de esteatorreia. Deve-se atentar à suplementação de vitaminas (especialmente as lipossolúveis) e de minerais, especialmente cálcio, magnésio e zinco. Concluiu-se que não há consenso literário quanto: às quantidades estabelecidas de fibras; a quantidade recomendada quando do uso de TCM e conduta dietética nos casos de azotorreia. São necessários mais estudos para compreensão da patogênese dessa doença a fim de contribuir para: sua prevenção esurgimento de novas terapias mais específicas e eficazes, especialmente dietéticas, no cuidado dessa população.Palavras-chave: Avaliação nutricional. Pancreatite crônica. Terapia nutricional.

Chronic pancreatitis (CP) is characterized by anatomical injuries of an irreversible character and many times in a progressive way. Itsincidence is esteem enters the 5 10/100,000 individuals per year, being its therapeutic care a high cost one. Alcohol is its main etiology. Nutritionalcare in CP is considered a challenge due to the presence of hypercatabolism, endocrine and exocrine dysfunctions and malnutrition. The objective of this study was to describe the current recommendations on nutritional cares of these individuals made by literature. It was elaborated from a systematic survey of works published since 1997, using a Boolean technique and searches in electronic sites of scientific trustworthiness. Results emphasize that nutritional evaluation of these individuals must consider a condition of weight loss throughout time, and anthropometric and laboratorial values. Dietary instructions and medication used are efficient in the treatment of 80 per cent of cases. Recommended diet goes from normoproteic to hyperproteic (1.0-1.5g/kg/day), normoglucidic (with restrictions in cases of hyperglycemia or diabetes) and normolipidic (30 per centof lipids). The main source of lipids has vegetal origin, being indicated the use of Medium Chain Triglycerides (MCT) in cases of steatorhea. One must be alert as to the needs of vitamins supplementation of (especially liposoluble ones) and minerals, specially Calcium, Magnesium and Zinc. One concluded that there is no consensus in the literature regarding the established amounts of fibers; the recommended amount when MCTs are used and dietary behavior in azotorrhea cases. More studies for understanding the pathogenesis of this illness are necessary in order to contribute to its prevention and the development of new more specific and efficient therapies, especially dietary, in the care of this population. Keywords: Nutrition assessment. Pancreatitis, chronic. Nutrition therapy.

La pancreatitis crónica (PC) es caracterizada por lesiones anatómicas de carácter irreversible y muchas veces de una manera progresiva. Su incidencia es estimada en 5-10/100.000 individuos por año, y su terapéutica requiere grandes gastos. El alcohol es su etiología principal. El cuidado alimenticio en la PC se considera un desafío debido a la presencia de hipercatabolismo, disfunciones endocrinas y exocrinas y desnutrición. El objetivo de este estudio fue describir las recomendaciones actuales en cuidados alimenticios de estos individuos hechos por la literatura. Se elaborado un examen sistemático de los trabajos publicados desde 1997, utilizando una técnica booleana y búsquedas en sitios electrónicos defiabilidad científica. Los resultados acentúan que la evaluación alimenticia de estos individuos debe considerar una condición de pérdida de peso a través del tiempo, y los valores de exámenes antropométricos y de laboratorio. Las instrucciones dietéticas y la medicación usadas son eficientes en el tratamiento del 80 por ciento de casos. La dieta recomendada va de normoproteica a hiperproteica (1.0-1.5g/kg/día), normoglicídica (con restriccionesen casos de hiperglicemia o de la diabetes) y normolipídica (30 por ciento de lípidos). La fuente principal de lípidos tiene origen vegetal, siendo indicadoel uso de triglicéridos de cadena media (TCM) en casos de esteatorrea. Uno debe estar alerta en cuanto a las necesidades de suplementación devitaminas (especialmente las liposolubles) y de los minerales, especialmente calcio, magnesio y cinc. No hay consenso en la literatura respecto a las cantidades establecidas de fibras; la cantidad recomendada cuando se utilizan TCMs y el comportamiento dietético en casos del azotorrea. Más estudios para entender la patogénesis de esta enfermedad son necesarios para contribuir a su prevención y al desarrollo de nuevas terapias más específicas y más eficientes, especialmente dietéticas, en el cuidado de esta población.