[Head and neck cancer patients included at home enteral nutrition by tube]. / Pacientes afectos de neoplasia de cabeza-cuello con nutrición enteral domiciliaria por sonda.

OBJECTIVE: To know characteristics and the patients' evolution with head and neck cancer who received radiotherapy treatment and they were included at a home enteral nutrition (HEN) by feeding tube programme. To analyse the weight evolution according to the start of HEN before or after radiotherapy. METHODS: Observational study of tube feeding patients with head and neck cancer who were included in HEN programme in our hospital for two years. Variables analysed: gender, age, Body Mass Index (BMI), Karnofsky Index (KI), reason for nutritional support, type of feeding tube, formula used and prescribed caloric contribution, necessity to change access device and HEN days. RESULTS: 62 patients were studied (77.4% men; 22.6% women). Age 64 +/- 10.1 years (rang: 39-90). The dysphagia was the main cause to begin enteral nutrition by feeding tube in these patients. Naso-gastric tube was prevalence (67.7%). The most used formula was polymeric hypercaloric diet with a mean of caloric contribution of 1,629 +/- 267.09 kcal/day. Overall, there was a weight loss in all patients during the study period time. However, patients who began the HEN by feeding tube before the radiotherapy treatment, the BMI did not decrease. CONCLUSION: All patients who began feeding tube before oncological treatment didn't lose weight for the period of study.

[Catheter-related infection in home-based parenteral nutrition: outcomes from the NADYA group and presentation of a new protocol]. / Infección asociada al catéter en nutrición parenteral domiciliaria: resultados del grupo NADYA y presentación del nuevo protocolo.

Hom parenteral nutrition (HPN) is a nutritional support modality that allows for the supply of parenteral nutrition bags to the patient's home. Since its first use in the late 60s, this therapy has allowed maintaining patients with intestinal failure alive that previously were doomed to death. In our country, this therapy is used by 2.15 patients pmp. According to the NADYA data, catheter-related infections account for 50% of all HPN-related complications. In larger series, infection rates are 0.5-2 infections/1000 days or 0.3-0.5 infections/patient/year. Most of them are produced by gram-positive organisms that migrate from the skin or from catheter connections to the tip. These infections are diagnosed by means of clinical data and with different microbiological cultures. When treating these infections, it is important to keep the catheter in place, and administering antibiotics through it, conventionally or with the antibioticolade technique.

[Conclusions of the III SENPE Debate Forum on specialized nutritional support: ethical issues]. / Conclusiones del III Foro de Debate SENPE. Soporte nutricional especializado: aspectos eticos.

Conclusions of the III SENPE-Abbott Debate Forum on several ethical issues of specialized nutritional support in hospitalized patients and outpatients. An insight in the principle of equity is given depending on geographical location, in its indications both as a primary therapy and palliative care, and in informed consent.

[Conclusions to the first Baxter-Senpe workshop on: ready-to-use (RTU) products for parenteral nutrition]. / Conclusiones de la Primera Mesa de Trabajo BAXTER-SENPE sobre productos listos para uso (RTU) en Nutrición Parenteral.

Conclusions to the workshop on ready-to use (RTU) products for parenteral nutrition. An approximation is done to the definition and advantages in comparison to other parenteral nutrition models. Issues related to management, RTU composition and hospital- and home-based indications are highlighted.

[Malnutrition and evaluation of the nutritional status]. / Malnutrición y valoración del estado nutricional.

Malnutrición is assessed from its concept to the main causes thereof. The different types and degrees of malnutrition are described as well as their clinical presentation. The prevalence of malnutrition is defined, how this affects both the hospitalized and the non-hospitalized population, and the factors that contribute to the variability of the results of the prevalence thereof. The objectives of the nutritional assessment are analyzed, as were the requirements that should be met by the ideal nutritional marker, and the different nutritional markers used. Among these are the classic anthropometric measurements all the way up to the serum proteins or the immunological parameters. The nutritional indexes that allow an assessment of the existence of a risk for the developing malnutrition are described also. A special emphasis is made on the assessment of the clinical history from the nutritional point of view, on the subjective global assessment, and on dietary questionnaires. The role of the muscle function as a nutritional marker is also analyzed, as well as the possibility of using other methods of body composition assessment. The importance of establishing special considerations in view of the collectives to be analyzed is notable. Finally, the clinical and economic consequences of malnutrition are analyzed.

[The effect of fatty emulsions with distinct triglyceride compositions on the lipid metabolism of the septic patient]. / Influencia de dos emulsiones grasas con distinta composición de triglicéridos sobre el metabolismo lipídico del paciente séptico.

OBJECTIVE: To assess the effects on the intravascular lipid mechanism of fatty emulsions with an identical lipid concentration and a different triglyceride composition administered as part of the total parenteral nutrition (TPN) in septicemic patients hospitalized in the intensive care unit (ICU). One emulsion will be made up of long chain triglycerides, LCT (20% Intralipid) (group I) and the other will be made up by a mixture of medium- and long-chain triglycerides, MCT/LCT (1:1) (20% Lipofundina) (group II). AREA: Vall d'Hebrón General University Hospital. Intensive care unit, Biochemistry laboratory, nutritional support unit, and Department of Pharmacy. PATIENTS: 12 septicemic patients who required TPN were studied, and these patients were randomly given one of the two lipid emulsions for a five day period. Prior to initiating the TPN and before ending it, blood samples were drawn for the analysis of the lipoprotein components VLDL, LDL, and HDL isolated by ultracentrifugation, and the basic lipid and nutritional parameters. RESULTS: The baseline statistical analysis shows that even though both groups are not comparable, the composition of the VLDL, LDL, and HDL lipoproteins differs from the reference values. After five days of TPN, the metabolic behavior of the groups is different, in group I the concentrations of reactive C protein (RCP) decreased as did the HDL phospholipids, while group II presented an increase in the plasma triglyceride levels, the VLDL cholesterol, the LDL triglycerides, and the HDL proteins. CONCLUSIONS: Septicemic patients present in altered lipoprotein pattern that tends to normalize after 5 days of lipid emulsions administration.

[Acute respiratory distress syndrome. Nutritional and metabolic support]. / Síndrome de distrés respiratorio agudo. Soporte nutro-metabólico.

The application of artificial nutritional treatment in critical patients, nowadays is a completely accepted fact. To a large degree this is due to the advances made in the understanding of the metabolic response shown by patients against a severe and persistent aggression. One of the entities which presents the highest mortality in critical patients, is the Acute Respiratory Distress Syndrome (ARDS), which one understands as the pulmonary response to different types of aggression. To understand the metabolic implications in the face of the development of this syndrome, would permit a better understanding of the need to treat these patients and to establish the nutritional standards which are most adequate to each different metabolic alteration. It would not only be important to understand the most effective method for calculating the caloric needs of these patients, but we shall also have to deepen our understanding of possible harmful effects of the different substrates, which undoubtedly could condition morbidity. This is why in this review we focus on the intimate pulmonary mechanism, both in healthy conditions as in those of disease, in order to extrapolate conclusions which are potentially applicable to patients suffering from an acute pulmonary lesion, as those suffering from ARDS: A main role shall be played the assessment of the administration of macronutrients in the form carbohydrates, lipids, and amino acid particles, due to the implications which each of these may have on the lesioned lung and its ventilatory capacity.

[Home enteral nutrition. Annual report 1999. NADYA-SENPE Group]. / Nutrición enteral domiciliaria. Informe anual 1999. Grupo NADYA-SENPE.

GOAL: During 1999, as in previous years, the NADYA-SENPE Group has maintained an annual register of patients with Artificial Nutrition at Home in order to keep up to date our available knowledge of this therapy. The present paper analyzes the results of the sixth National Register of patients under treatment with Enteral Nutrition at Home corresponding to 1999, produced with the co-operation of twenty-three centres in the Spanish national health network. MATERIAL AND METHODS: The data were collected through a closed questionnaire included on our web site (www.nadya-senpe.com). Apart from epidemiological information, the form includes the indication that led to the prescription of nutrition, nutritional treatment, access path, complications and admissions to hospital, follow-up of the treatment, patients' quality of life and progress. All of the data are processed by the co-ordinating team. The Nutrition Unit at La Paz Teaching Hospital in Madrid has acted as the group co-ordinator. RESULTS: During 1999, a total of 2,262 patients at the twenty-three collaborating centres followed treatment with Home Enteral Nutrition (NED in its Spanish acronym). The mean age was 63.6 (19.67 years (males: 57.6%; females: 42.3%). The mean time with nutritional treatment is 5.89 (4.25 months. The neurological alterations (37.5%) and neoplasias (36.8%) were the most frequent indications for NED. Most patients used oral administration (50.7%), the use of artificial routes is less frequent, with 5NG being used on 27.9% and PEG on 12.7%. The polymeric formulas are the ones most commonly used (87.7%). The number of complications recorded amounted to 1,403 episodes, representing 0.62 complications per patient per year, of which 40.8% were gastro-intestinal (0.26 complications per patient per year) and 18.7% were mechanical complications, with only 9 recorded cases of bronchoaspiration. It was necessary to admit patients to hospital on 836 occasions (0.38 admissions per patient), albeit generally for causes not associated with nutrition (86.1%). At year-end, 51.4% of patients continued to receive nutritional support. CONCLUSIONS: Enteral nutrition at home is a safe technique whose use is growing in Spain. It requires the existence of appropriately equipped nutrition teams as well as the collaboration of the Primary Health Care services and the suitable training of patients and relatives. It is essential to progress more deeply into the development and application of clinical routes that provide a clear and concise methodology covering all nutrition-related aspects. In itself, nutrition is a therapeutic alternative regardless of whether access is obtained through a natural or an artificial route. It is necessary for the persons responsible for health-care administration to realize that the appropriate nutrition of patients leads to an improvement in their general health, a shorter course for their illness and, therefore, a reduction in costs.

Prevalence and costs of malnutrition in hospitalized patients; the PREDyCES Study.

BACKGROUND AND AIMS: The main objective of the PREDyCES study was twofold. First, to analyse the prevalence of hospital malnutrition in Spain, both at admission and at discharge, and second, to estimate the hospital costs associated with disease-related malnutrition. METHODS: The study was a nationwide, cross-sectional, observational, multicentre study in routine clinical practice, which assessed the prevalence of hospital malnutrition both at patient admission and discharge using NRS-2002. A study extension analysed the incidence of complications associated with malnutrition, excess hospital stay and healthcare costs associated with hospital malnutrition. RESULTS: Malnutrition was observed in 23.7% of patients according to NRS-2002. Multivariate analysis revealed that age, gender, presence of malignant disease, diabetes mellitus, dysphagia and polymedication were the main factors associated with the presence of malnutrition. Malnutrition was associated with an increase in length of hospital stay, especially in patients admitted without malnutrition but who presented malnutrition at discharge (15.2 vs. 8.0 days, p < 0.001), with an associated additional cost of €5,829 per patient. CONCLUSION: In Spanish hospitals, almost one in four patients is malnourished. This condition is associated with increased length of hospital stay and associated costs, especially in patients developing malnutrition during hospitalization. Systematic screening for malnutrition should be generalised in order to implement nutritional interventions with well-known effectiveness.

The burden of hospital malnutrition in Spain: methods and development of the PREDyCES® study.

It is well known that hospital malnutrition is a highly prevalent condition associated to increase morbidity and mortality as well as related healthcare costs. Although previous studies have already measured the prevalence and/or costs of hospital nutrition in our country, their local focus (at regional or even hospital level) make that the true prevalence and economic impact of hospital malnutrition for the National Health System remain unknown in Spain. The PREDyCES® (Prevalence of hospital malnutrition and associated costs in Spain) study was aimed to assess the prevalence of hospital malnutrition in Spain and to estimate related costs. Some aspects made this study unique: a) It was the first study in a representative sample of hospitals of Spain; b) different measures to assess hospital malnutrition (NRS2002, MNA as well as anthropometric and biochemical markers) where used both at admission and discharge and, c) the economic consequences of malnutrition where estimated using the perspective of the Spanish National Health System.

[Protocol for the diagnosis and treatment of catheter related infections in patients with home parenteral nutrition]. / Protocolo para el diagnóstico y tratamiento de las infecciones relacionadas con el catéter en el paciente con nutrición parenteral domiciliaria.

One of the most frequent complications of home parenteral nutrition is parenteral nutrition catheter infection. Prevention of these complications by adequate protocols on the catheter cares manages to decrease significantly the number of infections. Diagnosis and treatment of these infections should be done early to avoid loss of central venous accesses that may affect the treatment with this nutritional support modality in the long term. The existence of a protocol for the diagnosis and treatment of infections related with the catheter is, thus, of great value in the treatment of these patients.