Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 27
Filtrar
Más filtros










Base de datos
Tipo de estudio
Intervalo de año de publicación
3.
Clin Nutr ; 2019 Mar 25.
Artículo en Inglés | MEDLINE | ID: mdl-30992207

RESUMEN

BACKGROUND & AIMS: The safety and effectiveness of a home parenteral nutrition (HPN) program depends both on the expertise and the management approach of the HPN center. We aimed to evaluate both the approaches of different international HPN-centers in their provision of HPN and the types of intravenous supplementation (IVS)-admixtures prescribed to patients with chronic intestinal failure (CIF). METHODS: In March 2015, 65 centers from 22 countries enrolled 3239 patients (benign disease 90.1%, malignant disease 9.9%), recording the patient, CIF and HPN characteristics in a structured database. The HPN-provider was categorized as health care system local pharmacy (LP) or independent home care company (HCC). The IVS-admixture was categorized as fluids and electrolytes alone (FE) or parenteral nutrition, either commercially premixed (PA) or customized to the individual patient (CA), alone or plus extra FE (PAFE or CAFE). Doctors of HPN centers were responsible for the IVS prescriptions. RESULTS: HCC (66%) was the most common HPN provider, with no difference noted between benign-CIF and malignant-CIF. LP was the main modality in 11 countries; HCC prevailed in 4 European countries: Israel, USA, South America and Oceania (p < 0.001). IVS-admixture comprised: FE 10%, PA 17%, PAFE 17%, CA 38%, CAFE 18%. PA and PAFE prevailed in malignant-CIF while CA and CAFE use was greater in benign-CIF (p < 0.001). PA + PAFE prevailed in those countries where LP was the main HPN-provider and CA + CAFE prevailed where the main HPN-provider was HCC (p < 0.001). CONCLUSIONS: This is the first study to demonstrate that HPN provision and the IVS-admixture differ greatly among countries, among HPN centers and between benign-CIF and cancer-CIF. As both HPN provider and IVS-admixture types may play a role in the safety and effectiveness of HPN therapy, criteria to homogenize HPN programs are needed so that patients can have equal access to optimal CIF care.

4.
Clin Nutr ; 2019 Apr 02.
Artículo en Inglés | MEDLINE | ID: mdl-31000340

RESUMEN

BACKGROUND & AIMS: Short bowel syndrome patients (SBS) receiving parenteral nutrition (PN) often have dyslipidaemia and can develop intestinal failure-associated liver disease (IFALD). These patients demonstrate increased cholesterol synthesis and hepatic lipogenesis. These lipid disturbances may be due to a decreased concentration of the bile acid pool or malabsorption. The aim of this pilot study was to evaluate the effect of bile acid administration on lipid synthesis in patients with SBS. METHODS: The 24 h fractional synthesis rate (FSR) of cholesterol and triglycerides was measured by the isotopic method (deuterated water) before and after 4 months of ursodeoxycholic acid (UDCA) treatment (20 mg/kg/day). Five short bowel patients (age: 53.4 ± 19.2 years) who had normal liver function and lipid plasmatic profiles received 1920 ± 300 ml of PN for 151 ± 74 days (mean PN energy intake was 27.0 ± 6.0 kcal/kg body weight, composed with 3.87 ± 1.38 g/kg of carbohydrate, 0.72 ± 0.25 g/kg of fat and 1.10 ± 0.23 g/kg of amino acids). Plasma metabolites, liver enzymes, 7-α-OH-cholesterol and steatosis levels were also evaluated before and after treatment. Student's t-tests were performed, and the results were expressed in means (±SD). RESULTS: After treatment, decreases in the absolute values of cholesterol synthesis (0.31 ± 0.12 mmol L-1 to 0.24 ± 0.11 mmol L-1; p < 0.05), FSR of cholesterol (31.6 ± 4.7% to 26.4 ± 4.7%; p = 0.06) and FSR of triglycerides (12.8 ± 5.8% to 9.2 ± 5.5%; p < 0.01) were observed. Cholesterol and alanine aminotransferase concentrations also decreased (ALT) (p < 0.05). The absolute values of triglyceride synthesis and triglyceride concentrations remained unchanged. CONCLUSIONS: In SBS patients, UDCA decreases the hepatic synthesis of triglycerides and cholesterol. These results suggest that UDCA could prevent the onset of the IFALD.

5.
Nutrition ; 62: 146-151, 2019 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-30889456

RESUMEN

OBJECTIVES: Some patients with short bowel syndrome (SBS) develop hyperphagic behavior. Such an increase in food intake stimulates intestinal adaptation and limits dependence on parenteral nutrition (PN). The aim of this study was to determine the factors modulating food consumption in patients with SBS. METHODS: The associations between oral energy intake (OEI) and anthropometric, metabolic, nutritional, and intestinal absorption-related characteristics were determined in a monocentric cohort of patients with SBS on PN with a stable nutritional status. Body composition was assessed by dual x-ray absorptiometry. Data were retrospectively collected from clinical records. RESULTS: After screening, 38 adult patients with a SBS on PN were included in this study. OEI ranged from 577 to 4054kcal/d. OEI correlated positively with weight, fat-free mass, handgrip strength, and resting energy expenditure (REE) and negatively with free triiodothyronine and C-reactive protein using Spearman correlation. Fat-free mass and thyroid-stimulating hormone remained positively correlated with OEI independently of all other parameters in a multilinear regression model. CONCLUSIONS: Fat-free mass is a strong predictor of OEI in patients with SBS on PN and without debilitating gastrointestinal symptoms. Increasing fat-free mass could be a way to stimulate OEI in these patients. Further studies are needed to assess this assumption.

6.
Trials ; 20(1): 808, 2019 Dec 30.
Artículo en Inglés | MEDLINE | ID: mdl-31888740

RESUMEN

BACKGROUND: Home parenteral nutrition (HPN) is a life-preserving therapy for patients with chronic intestinal failure (CIF) indicated for patients who cannot achieve their nutritional requirements by enteral intake. Intravenously administered lipid emulsions (ILEs) are an essential component of HPN, providing energy and essential fatty acids, but can become a risk factor for intestinal-failure-associated liver disease (IFALD). In HPN patients, major effort is taken in the prevention of IFALD. Novel ILEs containing a proportion of omega-3 polyunsaturated fatty acids (n-3 PUFA) could be of benefit, but the data on the use of n-3 PUFA in HPN patients are still limited. METHODS/DESIGN: The HOME study is a prospective, randomized, controlled, double-blind, multicenter, international clinical trial conducted in European hospitals that treat HPN patients. A total of 160 patients (80 per group) will be randomly assigned to receive the n-3 PUFA-enriched medium/long-chain triglyceride (MCT/LCT) ILE (Lipidem/Lipoplus® 200 mg/ml, B. Braun Melsungen AG) or the MCT/LCT ILE (Lipofundin® MCT/LCT/Medialipide® 20%, B. Braun Melsungen AG) for a projected period of 8 weeks. The primary endpoint is the combined change of liver function parameters (total bilirubin, aspartate transaminase and alanine transaminase) from baseline to final visit. Secondary objectives are the further evaluation of the safety and tolerability as well as the efficacy of the ILEs. DISCUSSION: Currently, there are only very few randomized controlled trials (RCTs) investigating the use of ILEs in HPN, and there are very few data at all on the use of n-3 PUFAs. The working hypothesis is that n-3 PUFA-enriched ILE is safe and well-tolerated especially with regard to liver function in patients requiring HPN. The expected outcome is to provide reliable data to support this thesis thanks to a considerable number of CIF patients, consequently to broaden the present evidence on the use of ILEs in HPN. TRIAL REGISTRATION: ClinicalTrials.gov, ID: NCT03282955. Registered on 14 September 2017.

9.
Clin Nutr ; 37(2): 728-738, 2018 04.
Artículo en Inglés | MEDLINE | ID: mdl-28483328

RESUMEN

BACKGROUND & AIMS: The aim of the study was to evaluate the applicability of the ESPEN 16-category clinical classification of chronic intestinal failure, based on patients' intravenous supplementation (IVS) requirements for energy and fluids, and to evaluate factors associated with those requirements. METHODS: ESPEN members were invited to participate through ESPEN Council representatives. Participating centers enrolled adult patients requiring home parenteral nutrition for chronic intestinal failure on March 1st 2015. The following patient data were recorded though a structured database: sex, age, body weight and height, intestinal failure mechanism, underlying disease, IVS volume and energy need. RESULTS: Sixty-five centers from 22 countries enrolled 2919 patients with benign disease. One half of the patients were distributed in 3 categories of the ESPEN clinical classification. 9% of patients required only fluid and electrolyte supplementation. IVS requirement varied considerably according to the pathophysiological mechanism of intestinal failure. Notably, IVS volume requirement represented loss of intestinal function better than IVS energy requirement. A simplified 8 category classification of chronic intestinal failure was devised, based on two types of IVS (either fluid and electrolyte alone or parenteral nutrition admixture containing energy) and four categories of volume. CONCLUSIONS: Patients' IVS requirements varied widely, supporting the need for a tool to homogenize patient categorization. This study has devised a novel, simplified eight category IVS classification for chronic intestinal failure that will prove useful in both the clinical and research setting when applied together with the underlying pathophysiological mechanism of the patient's intestinal failure.


Asunto(s)
Enfermedades Intestinales/dietoterapia , Enfermedades Intestinales/patología , Nutrición Parenteral en el Domicilio/métodos , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Australasia , Enfermedad Crónica , Estudios Transversales , Europa (Continente) , Femenino , Humanos , Intestinos/patología , Israel , Masculino , Persona de Mediana Edad , América del Sur , Estados Unidos , Adulto Joven
12.
JPEN J Parenter Enteral Nutr ; 41(2): 258-262, 2017 02.
Artículo en Inglés | MEDLINE | ID: mdl-26962058

RESUMEN

Severe nutrition complications after bariatric surgery remain poorly described. The aim of this case series was to identify specific factors associated with nutrition complications after bariatric surgery and to characterize their nutrition disorders. We retrospectively reviewed all people referred to the clinical nutrition intensive care unit of our university hospital after bariatric surgery from January 2013 to June 2015. Twelve persons who required artificial nutrition supplies (ie, enteral nutrition or parenteral nutrition) were identified. Seven persons underwent a "one-anastomosis gastric bypass" (OAGB) or "mini gastric bypass," 2 underwent a Roux-en-Y gastric bypass, 2 had a sleeve gastrectomy, and 1 had an adjustable gastric band. This case series suggests that OAGB could overexpose subjects to severe nutrition complications requiring intensive nutrition care and therefore cannot be considered a "mini" bariatric surgery. Even if OAGB is often considered a simplified surgical technique, it obviously requires as the other standard bariatric procedures a close follow-up by experimented teams aware of its specific complications.


Asunto(s)
Cirugía Bariátrica/efectos adversos , Cuidados Críticos/métodos , Trastornos Nutricionales/terapia , Terapia Nutricional/métodos , Cuidados Posoperatorios/métodos , Femenino , Derivación Gástrica/efectos adversos , Derivación Gástrica/métodos , Hospitales Universitarios , Humanos , Masculino , Persona de Mediana Edad , Trastornos Nutricionales/etiología , Estado Nutricional , Obesidad/cirugía , Complicaciones Posoperatorias/terapia , Estudios Retrospectivos , Pérdida de Peso
13.
Clin Nutr ; 36(4): 1165-1169, 2017 08.
Artículo en Inglés | MEDLINE | ID: mdl-27624996

RESUMEN

BACKGROUND & AIMS: Home parenteral nutrition (HPN) improves survival and quality of life in patients with chronic intestinal failure (IF). Few cases of pregnancy on HPN have been published. The aim of this study was to report pregnancy cases on long-term HPN in benign IF. METHODS: This retrospective study included all pregnant patients on HPN from 4 HPN referral centers. Data on demographics, ongoing pathology, HPN type, maternal and newborn complications were collected. RESULTS: From 1984 to 2014, 21 pregnancies occurred in 15 patients (short bowel syndrome (n = 11), motility disorders (n = 3), mucosal disease (n = 1)) of whom 14 occurred after 2010. Median follow-up was 12 years. Median HPN duration before pregnancy was 8 years. HPN was adapted monthly during pregnancy, with close monitoring and supplementations. Energy intake was regularly increased and median maternal weight gain was 10 kg. Median age at the first pregnancy was 27 years. In 55% of cases, the newborn was preterm. Maternal complications occurred in 67% of cases (mainly due to underlying disease or HPN complications). There were 3 post-partum hemorrhages and 6 hypotrophic newborns. Eighteen infants were healthy and 2 chronic intestinal pseudo-obstruction (CIPO) were suspected. CONCLUSION: Our series, the largest reported to date, shows that pregnancy is possible in HPN patients but the complication rate is high. A specific support is necessary, particularly in CIPO patients. As pregnancies have increased over the last 15 years, physicians practicing in HPN referral centers should be aware of the need for implementing a specific multidisciplinary monitoring in HPN patients considering pregnancy.


Asunto(s)
Enfermedades Intestinales/terapia , Fenómenos Fisiologicos Nutricionales Maternos , Nutrición Parenteral Total en el Domicilio/efectos adversos , Complicaciones del Embarazo/terapia , Embarazo de Alto Riesgo , Adulto , Estudios de Cohortes , Femenino , Retardo del Crecimiento Fetal/epidemiología , Retardo del Crecimiento Fetal/etiología , Estudios de Seguimiento , Francia/epidemiología , Humanos , Recién Nacido , Enfermedades Intestinales/fisiopatología , Seudoobstrucción Intestinal/epidemiología , Seudoobstrucción Intestinal/etiología , Masculino , Hemorragia Posparto/epidemiología , Hemorragia Posparto/etiología , Embarazo , Complicaciones del Embarazo/epidemiología , Complicaciones del Embarazo/etiología , Complicaciones del Embarazo/fisiopatología , Nacimiento Prematuro/epidemiología , Nacimiento Prematuro/etiología , Estudios Retrospectivos , Riesgo , Índice de Severidad de la Enfermedad , Síndrome del Intestino Corto/fisiopatología , Síndrome del Intestino Corto/terapia
14.
J Pain Symptom Manage ; 49(2): 183-191.e2, 2015 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-24945492

RESUMEN

CONTEXT: Patients with gastrointestinal cancer are at high risk for deterioration of nutrition. Home parenteral nutrition (HPN) could improve nutritional status and quality of life (QoL). OBJECTIVES: The purpose of this study was 1) to evaluate the impact of HPN on QoL, 2) to assess changes in nutritional status, and 3) to assess proxy perception of patient well-being. METHODS: We conducted a prospective, observational, and a multicenter study. Inclusion criteria were adult patients with gastrointestinal cancer, for whom HPN was indicated and prescribed for at least 14 days. The physician, the patient, and a family member completed questionnaires at inclusion and 28 days later. The QoL was assessed by the patients using the Functional Assessment of Cancer Therapy-General questionnaire, at inclusion and 28 days later. RESULTS: The study included 370 patients with gastrointestinal cancer. The HPN was indicated for cancer-related undernutrition in 89% of the patients and was used as a complement to oral intake in 84%. After 28 days of parenteral intake, global QoL was significantly increased (48.9 at inclusion vs. 50.3, P=0.007). The patients' weight improved significantly by 2.7% (P<0.001). The nutrition risk screening also decreased significantly (3.2±1.1 vs. 2.8±1.3, P=0.003). CONCLUSION: HPN could provide benefit for malnourished patients with gastrointestinal cancer. However, randomized controlled studies are required to confirm this benefit and the safety profile.


Asunto(s)
Neoplasias Gastrointestinales/dietoterapia , Neoplasias Gastrointestinales/fisiopatología , Desnutrición/dietoterapia , Desnutrición/fisiopatología , Nutrición Parenteral en el Domicilio , Calidad de Vida , Anciano , Peso Corporal , Femenino , Neoplasias Gastrointestinales/psicología , Humanos , Masculino , Desnutrición/psicología , Persona de Mediana Edad , Estado Nutricional , Satisfacción del Paciente , Estudios Prospectivos , Encuestas y Cuestionarios , Resultado del Tratamiento
15.
Curr Opin Crit Care ; 20(4): 438-43, 2014 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-24999793

RESUMEN

PURPOSE OF REVIEW: This clinical review focuses on the nutritional management of surgical patients with a severe postoperative complication. These patients having a succession of aggressions are at high risk of malnutrition. Our aim, following ICU patient studies, was to report the elements that could be applied for these patients. RECENT FINDINGS: Although early enteral nutrition is recommended, recent data focus more on parenteral nutrition. Because these patients probably had a poor nutritional intake for several days, the prescription of parenteral nutrition would appear to be valid in cases of inadequate or impossible enteral nutrition. Lipid emulsion decreasing long-chain triglyceride intake should be used. Moreover, administration of fish oil should be considered. Intravenous glutamine, decreasing new infections and hospital length of stay, should be prescribed only in patients without shock. Several studies and meta-analyses have suggested that a parenteral selenium supplementation in a severe patient can reduce mortality. SUMMARY: In severe surgical complicated patients, special care must be taken vis-à-vis nutritional intake. Such patients are likely to have an energy deficit and are at high risk of malnutrition. Nutritional assistance is necessary and should be quickly implemented with the usual recommendations.


Asunto(s)
Lípidos/administración & dosificación , Nutrición Parenteral , Complicaciones Posoperatorias/dietoterapia , Procedimientos Quirúrgicos Operativos , Nutrición Enteral , Aceites de Pescado/administración & dosificación , Glutamina/administración & dosificación , Humanos , Selenio/administración & dosificación
16.
Bull Cancer ; 101(3): 243-9, 2014 Mar.
Artículo en Francés | MEDLINE | ID: mdl-24691188

RESUMEN

Malnutrition is a bad prognostic factor that reduces the quality of life (QoL) in patients with cancer. The objective was to assess the impact of home parenteral nutrition (HPN) on the QoL of elderly malnourished patients with cancer. This French prospective observational study included patients, aged 70 years or older, with cancer, for whom HPN was prescribed for at least 14 days. The patient, the physician and a family member or home caregiver had to fill in a questionnaire at inclusion and 28 days later. Included patients (n = 221) were mainly suffering from a digestive cancer. After HPN intake, improved weight was noticed in 68% and 14% of patients had reached the target weight. Improved global QoL was reported in 59% of patients. Physicians noticed a significant improvement for the same compounds. These results suggest a benefit of the HPN on the nutritional status and QoL in elderly patients with cancer. Further controlled randomised trials are needed to prove the benefit of HPN in the routine management of these patients.


Asunto(s)
Desnutrición/terapia , Neoplasias/complicaciones , Nutrición Parenteral en el Domicilio , Calidad de Vida , Anciano , Anciano de 80 o más Años , Neoplasias del Sistema Digestivo/complicaciones , Femenino , Francia , Humanos , Masculino , Desnutrición/etiología , Estado Nutricional , Neoplasias Orofaríngeas/complicaciones , Nutrición Parenteral en el Domicilio/efectos adversos , Estudios Prospectivos , Neoplasias del Sistema Respiratorio/complicaciones , Encuestas y Cuestionarios , Aumento de Peso
17.
World J Gastroenterol ; 19(44): 8034-41, 2013 Nov 28.
Artículo en Inglés | MEDLINE | ID: mdl-24307797

RESUMEN

AIM: To describe and analyse factors associated with Clostridium difficile infection (CDI) severity in hospitalised medical intensive care unit patients. METHODS: We performed a retrospective cohort study of 40 patients with CDI in a medical intensive care unit (MICU) at a French university hospital. We include patients hospitalised between January 1, 2007 and December 31, 2011. Data on demographics characteristics, past medical history, CDI description was collected. Exposure to risk factors associated with CDI within 8 wk before CDI was recorded, including previous hospitalisation, nursing home residency, antibiotics, antisecretory drugs, and surgical procedures. RESULTS: All included cases had their first episode of CDI. The mean incidence rate was 12.94 cases/1000 admitted patients, and 14.93, 8.52, 13.24, 19.70, and 8.31 respectively per 1000 admitted patients annually from 2007 to 2011. Median age was 62.9 [interquartile range (IQR) 55.4-72.40] years, and 13 (32.5%) were women. Median length of MICU stay was 14.0 d (IQR 5.0-22.8). In addition to diarrhoea, the clinical symptoms of CDI were fever (> 38 °C) in 23 patients, abdominal pain in 15 patients, and ileus in 1 patient. The duration of diarrhoea was 13.0 (8.0-19.5) d. In addition to diarrhoea, the clinical symptoms of CDI were fever (> 38 °C) in 23 patients, abdominal pain in 15 patients, and ileus in 1 patient. Prior to CDI, 38 patients (95.0%) were exposed to antibiotics, and 12 (30%) received at least 4 antibiotics. Fluoroquinolones, 3(rd) generation cephalosporins, coamoxiclav and tazocillin were prescribed most frequently (65%, 55%, 40% and 37.5%, respectively). The majority of cases were hospital-acquired (n = 36, 90%), with 5 cases (13.9%) being MICU-acquired. Fifteen patients had severe CDI. The crude mortality rate within 30 d after diagnosis was 40% (n = 16), with 9 deaths (9 over 16; 56.3%) related to CDI. Of our 40 patients, 15 (37.5%) had severe CDI. Multivariate logistic regression showed that male gender [odds ratio (OR): 8.45; 95%CI: 1.06-67.16, P = 0.044], rising serum C-reactive protein levels (OR = 1.11; 95%CI: 1.02-1.21, P = 0.021), and previous exposure to fluoroquinolones (OR = 9.29; 95%CI: 1.16-74.284, P = 0.036) were independently associated with severe CDI. CONCLUSION: We report predictors of severe CDI not dependent on time of assessment. Such factors could help in the development of a quantitative score in ICU's patients.


Asunto(s)
Clostridium difficile/aislamiento & purificación , Infección Hospitalaria/microbiología , Enterocolitis Seudomembranosa/microbiología , Hospitalización , Unidades de Cuidados Intensivos , Anciano , Antibacterianos/efectos adversos , Biomarcadores/sangre , Proteína C-Reactiva/metabolismo , Distribución de Chi-Cuadrado , Infección Hospitalaria/sangre , Infección Hospitalaria/diagnóstico , Infección Hospitalaria/mortalidad , Enterocolitis Seudomembranosa/sangre , Enterocolitis Seudomembranosa/diagnóstico , Enterocolitis Seudomembranosa/mortalidad , Femenino , Francia/epidemiología , Hospitales Universitarios , Humanos , Incidencia , Modelos Logísticos , Masculino , Persona de Mediana Edad , Análisis Multivariante , Oportunidad Relativa , Pronóstico , Estudios Retrospectivos , Factores de Riesgo , Índice de Severidad de la Enfermedad , Factores Sexuales , Regulación hacia Arriba
18.
Clin Nutr ; 32(6): 1050-4, 2013 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-23313357

RESUMEN

BACKGROUND & AIMS: Parenteral nutrition is known as a high-risk factor for central venous catheter-related bloodstream infection (CVC-RBSI) in cancer patients. Owing to ethical and technical problems, the studies in the literature have nonrandomized designs and are therefore often confounded by biases. We performed a propensity score analysis to estimate the effect of parenteral nutrition on CVC-RBSI in digestive cancer patients who underwent chemotherapy. METHODS: Data were collected prospectively. A logistic regression model was used to calculate a propensity score, which was the probability of receiving parenteral nutrition. Kaplan-Meier survival and Cox regression model were used to estimate the effect of the parenteral nutrition on CVC-RBSI after adjustment for the propensity score. RESULTS: Before the propensity score analysis, the differences between patients with (n = 113) and without (n = 312) parenteral nutrition were identified including: male gender, body weight, weight loss, performance status, location of primary cancer, FOLFIRI, and previous long-term corticotherapy. After propensity score stratification, all of the covariates were balanced within each stratum. After adjustment, patients with parenteral nutrition were at a higher risk for CVC-RBSI. CONCLUSION: By using the propensity score analysis, this study confirmed that parenteral nutrition was an independent risk factor for CVC-RBSI in digestive cancer patients.


Asunto(s)
Infecciones Relacionadas con Catéteres/patología , Catéteres Venosos Centrales/efectos adversos , Neoplasias del Sistema Digestivo/terapia , Nutrición Parenteral Total/efectos adversos , Anciano , Infecciones Relacionadas con Catéteres/etiología , Neoplasias del Sistema Digestivo/fisiopatología , Femenino , Humanos , Modelos Logísticos , Masculino , Persona de Mediana Edad , Puntaje de Propensión , Modelos de Riesgos Proporcionales , Estudios Prospectivos , Factores de Riesgo
19.
Clin Nutr ; 32(2): 224-31, 2013 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-22796064

RESUMEN

PRECIS: The aim of this study was to evaluate the safety and tolerance of a soybean/MCT/olive/fish oil emulsion in intestinal failure patients on long-term parenteral nutrition. 73 patients took part in a randomized, double-blind, multi-centre study. The study demonstrates that the lipid emulsion containing four different types of oils is safe and well tolerated in long-term PN. BACKGROUND & AIM: Long-term safety and efficacy of a lipid emulsion containing soybean oil, medium-chain triglycerides (MCT), olive oil and fish oil and enriched in vitamin E have not yet been evaluated in adult patients requiring long-term parenteral nutrition (PN). METHODS: Randomised, controlled, double-blind, multicentre study in 73 patients with stable intestinal failure, requiring PN with either soybean/MCT/olive/fish emulsion (SMOFlipid, n = 34) or soybean emulsion (Intralipid, control n = 39) for 4 weeks. Safety and tolerance were monitored with standard clinical laboratory parameters, adverse events (AEs, according to the Common Terminology Criteria for Adverse Events (CTCAE) classification v 3.0) and vital signs. Fatty acid pattern in red blood cell phospholipids and plasma lipoproteins, serum Vitamin E, Interleukin (IL)-6, and soluble tumour necrosis (s-TNF)-receptor(R)II were also evaluated. RESULTS: Mean concentrations of alanine transaminase (ALT), aspartate transaminase (AST) and total bilirubin, whilst remaining within the reference range, were significantly lower with soybean/MCT/olive/fish (SMOF) oil emulsion after the treatment period compared to control. Eicosapentaenoic acid, docosahexaenoic acid and n-3/n-6 fatty acid ratio increased in the SMOF group, while they remained unchanged in the control in plasma and RBC. Serum α-tocopherol concentrations significantly increased in the study group compared to control (p = 0.0004). IL-6 and sTNF-RII levels did not change during the study period. Grade 4 (serious) adverse events occurred in 2 SMOF patients and in 8 control patients (p = 0.03). CONCLUSIONS: Soybean/MCT/olive/fish emulsion was safe and well tolerated over 4 weeks and leads to positive change in fatty acids profile.


Asunto(s)
Emulsiones Grasas Intravenosas/administración & dosificación , Soluciones para Nutrición Parenteral/administración & dosificación , Nutrición Parenteral/efectos adversos , Fosfolípidos/administración & dosificación , Aceite de Soja/administración & dosificación , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Alanina Transaminasa/sangre , Aspartato Aminotransferasas/sangre , Bilirrubina/sangre , Ácidos Docosahexaenoicos/sangre , Método Doble Ciego , Ácido Eicosapentaenoico/sangre , Emulsiones/administración & dosificación , Ácidos Grasos Omega-6/sangre , Femenino , Aceites de Pescado/administración & dosificación , Humanos , Interleucina-6/sangre , Hígado/efectos de los fármacos , Hígado/metabolismo , Masculino , Persona de Mediana Edad , Aceite de Oliva , Aceites Vegetales/administración & dosificación , Receptores del Factor de Necrosis Tumoral/sangre , Triglicéridos/administración & dosificación , Vitamina E/administración & dosificación , Vitamina E/sangre , Adulto Joven
20.
Am J Infect Control ; 40(10): 935-9, 2012 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-22633131

RESUMEN

BACKGROUND: Central venous access port-related bloodstream infection (CVAP-BSI) is associated with morbidity and mortality in patients with cancer. This study examined the incidence rates and risk factors for CVAP-BSI in adult patients with digestive cancer. METHODS: This prospective observational cohort study was performed from 2007 to 2011 in 2 oncology units of a university hospital. Incidence rate was expressed as number of CVAP-BSI per 1,000 catheter-days. A Cox regression model was used to identify risk factors for CVAP-BSI. RESULTS: A total of 315 patients were included. CVAP-BSI occurred in 41 patients (13.0%). The overall incidence rate was 0.76/1,000 catheter-days. The rate was higher in patients with esophageal cancer (1.28. P = .05) and pancreatic cancer (1.24; P = .007). Risk factors independently associated with CVAP-BSI were World Health Organization performance status between 2 and 4, catheter utilization-days in the previous month, pancreatic cancer, and parenteral nutrition. Coagulase-negative Staphylococci and enterobacteria were the main microorganisms isolated. CONCLUSIONS: In adult patients with digestive cancer, pancreatic cancer, cumulative catheter utilization-days, World Health Organization performance status, and parenteral nutrition were identified as independent risk factors for CVAP-BSI. Patients with any of these risk factors could be candidates for preventive strategies.


Asunto(s)
Bacteriemia/epidemiología , Infecciones Relacionadas con Catéteres/epidemiología , Neoplasias/complicaciones , Dispositivos de Acceso Vascular/microbiología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Bacteriemia/microbiología , Bacterias/clasificación , Bacterias/aislamiento & purificación , Infecciones Relacionadas con Catéteres/microbiología , Estudios de Cohortes , Femenino , Hospitales Universitarios , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Factores de Riesgo , Adulto Joven
SELECCIÓN DE REFERENCIAS
DETALLE DE LA BÚSQUEDA