Program of gastrointestinal rehabilitation and early postoperative enteral nutrition: a prospective study.

Nutritional depletion is commonly observed in patients undergoing surgical treatment for a gastrointestinal malignancy. An appropriate nutritional intervention could be associated with improved postoperative outcomes. The study was aimed to determine the effect of a program of gastrointestinal rehabilitation and early postoperative enteral nutrition upon complications and clinical outcomes in patients who experienced gastrointestinal surgery for cancer. This is a prospective study (2013 January-2015 December) of 465 consecutive patients submitted to gastrointestinal surgery for cancer and admitted to an Oncological Intensive Care Unit. The program of gastrointestinal rehabilitation and early postoperative enteral nutrition consisted on: (1) general rules: pain relive, early mobilization, antibiotic prophylaxis, deep vein thrombosis prophylaxis and respiratory physiotherapy; and (2) gastrointestinal rules: gastric protection, control of postoperative nausea and vomiting, early nasogastric tube remove and early enteral nutrition. The most frequent surgical sites were colorectal (44.9%), gynecological with intestinal suturing (15.7%) and esophagus/stomach (11.0%). Emergency surgery was performed in 12.7% of patients. The program of intestinal rehabilitation and early postoperative enteral nutrition reduced major complications (19.2 vs. 10.2%; p = 0.030), respiratory complications (p = 0.040), delirium (p = 0.032), infectious complications (p = 0.047) and gastrointestinal complications (p < 0.001). Intensive care unit mortality (p = 0.018), length of intensive care unit stay (p < 0.001) and length of hospitalization (p < 0.001) were reduced as well. A program of gastrointestinal rehabilitation and early postoperative enteral nutrition is associated with reduced postoperative complications and improved clinical outcomes in patients undergoing gastrointestinal surgery for cancer.

Clinical characteristics and outcomes of cancer patients requiring intensive care unit admission: a prospective study.

PURPOSE: The study was aimed to describe the characteristics of cancer patients admitted to the oncological ICU and to identify clinical features associated with outcomes. METHODS: This is a prospective study (January 2014 to December 2015) of 522 cancer patients consecutively admitted to the oncological ICU. Patients with a length of oncological ICU stay ≤ 1 day were excluded. Demographic and clinical variables were obtained at oncological ICU admission. The primary outcome of interest was hospital mortality. Logistic regression analysis was performed to identify independent risk factors for hospital mortality. RESULTS: The study cohort consisted of 492 (94.3%) patients with solid tumours and 30 patients (5.7%) with haematological malignancies. Advanced cancer was observed in 53.3%. Unplanned admission accounted for 25.3%. Hospital mortality rate was 13.0% (n = 68), and it was higher for patients with unplanned admission than those for electively admitted patients (35.6% vs. 5.4; p < 0.0001). Stage IV of cancer (OR 5.28; 95% CI 2.71-10.28; p < 0.0001), patients from the emergency department (OR 3.33; 95% CI 1.68-6.61; p = 0.001), unplanned admission (OR 7.99; 95% CI 4.45-14.33; p < 0.0001), non-malignancy-related admission (OR 5.80; 95% CI 3.26-10.32; p < 0.0001), sepsis (OR 4.81; 95% CI 2.28-10.16; p < 0.0001), chemotherapy-induced adverse event (OR 5.64; 95% CI 2.33-13.66; p < 0.0001), and invasive mechanical ventilation (OR 18.70; 95% CI 9.93-35.21; p < 0.0001) were independently associated with increased hospital mortality in multivariate logistic regression analysis. CONCLUSIONS: ICU admission of cancer patients should be based on potential chance of recovering from the acute problem. Clinical predictor for mortality could support this purpose (UIN: researchregistry3484).

Betabloqueadores perioperatorios en cirugía no cardiaca: recomendaciones basadas en la evidencia / Preoperative Betablockers in non cardiac surgery: recommendations base don evidence

Introducción: los eventos cardiacos perioperatorios son desórdenes frecuentes y asociados a un incremento de la mortalidad. Los b- bloqueadores se han utilizado para la prevención de estas complicaciones. Objetivo: determinar el valor de la evidencia actual, sobre la eficacia/seguridad del uso perioperatorio de b- bloqueadores en cirugía no cardiaca, para la prevención de complicaciones cardiacas. Métodos: se buscó en MEDLINE, Cochrane Library y CINAHL los ensayos clínicos controlados (2000-actualidad) y los meta-análisis (2008- actualidad) recientes, que evaluaron la eficacia de los b- bloqueadores perioperatorios en cirugía no cardiaca, en términos de eventos cardiacos y eventos adversos. Resultados: los b-bloqueadores perioperatorios disminuyen el riesgo de infarto miocárdico, aunque su eficacia en la reducción de otros eventos cardiacos, la mortalidad cardiaca y la mortalidad general, es contradictoria. Estos resultados dependen del riesgo clínico y quirúrgico de los pacientes incluidos. Con excepción del esmolol, todos los b-bloqueadores estudiados se asocian a un incremento del riesgo de eventos adversos (bradicardia, hipotensión). Conclusiones: la administración perioperatoria de b-bloqueadores ajustados a la frecuencia cardiaca y presión arterial, es razonable en pacientes con riesgo quirúrgico alto, independientemente de la categoría de riesgo clínico. En el resto de los pacientes, se debe considerar su uso, especialmente si se encuentran taquicardicos de manera prolongada. En los pacientes que previamente consumen b- bloqueadores, se debe continuar el tratamiento en el post- operatorio.

Introduction: preoperative cardiac events are frequent disorders associated to the increase of mortality. b- blockers have been used for the prevention of these complications. Objective: determine the value of present evidence about the efficacy/security of the use of b- blockers in the preoperative period in non cardiac surgery for the prevention of cardiac complications. Methods: it was looked up in MEDLINE, Cochrane Library and CINAHL controlled clinical trials (2000-today) and the recent meta- analysis (2008- today) which evaluated the efficacy of preoperative b- blockers in non cardiac surgery, in terms of cardiac events and side events. Results: preoperative b-blockers diminish the risk of myocardial infarction, though the reduction of other cardiac events, the cardiac mortality and mortality in general is contradictory. The results depend on the clinical and surgical risks of the patients included. With the exception of esmolol, all b-blockers studied are associated to an increase of side events risks (bradichardia, hypotension). Conclusion: the preoperative administration of b-blockers adjusted to the hear rate and blood pressure is reasonable in patients with high surgical risk, apart from the category of clinical risk. Its use must be considered in the rest of the patients, especially if they are tachicardic in a prolonged way. In patients who previously takeb- blockers, the treatment must continue Hill the postoperative period.