RESUMO
La nutrición clínica y la alimentación en el ámbito hospitalario deben contar con programas de gestión de calidad que aseguren el máximo beneficio clínico y la máxima seguridad del paciente. En este artículo se da una visión general de la gestión de la calidad en nutrición clínica y en la alimentación hospitalaria. Asimismo, se analizan las claves y los puntos críticos a tener en cuenta en todos los procesos y subprocesos que se llevan a cabo en el soporte nutricional especializado y en la alimentación de los pacientes (AU)
Clinical nutrition and food provision in a hospital environment must be regulated by quality management programs that ensure maximum clinical benefit and maximum patient safety. This article gives an overview of quality management in clinical nutrition and hospital feeding. Likewise, keys and critical points to be taken into account in all the processes and threads that are carried out during specialized nutritional support and alimentation of patients are analyzed (AU)
Assuntos
Humanos , 34002 , Planejamento Alimentar , Serviço Hospitalar de Nutrição/normas , Segurança do PacienteRESUMO
Introduction: Malnutrition is a common complication in cancer patients and can negatively affect the outcome of treatments. This study aimed to reach a consensus on nutritional needs and optimize nutritional care in the management of cancer patients at a national level. Methods: A qualitative, multicenter, two-round Delphi study involving 52 specialists with experience in nutritional support in cancer patients was conducted. Results: Regarding the presence of malnutrition, 57.7% of the participants stated that < 30% of the patients had malnutrition at the time of diagnosis, 40.4% considered that 31-50% had malnutrition during cancer treatment, and 26.9% that > 50% at the end of the treatment. Forty percent of participants believed that the main objective of nutritional treatment was to improve quality of life and 34.6% to improve tolerability and adherence to chemotherapy. The quality nutritional care provided at their centers was rated as medium-low by 67.3%. Enteral and parenteral nutrition was administered to less than 10% and less than 5% of patients in 40.4 and 76.9% of cases, respectively. In relation to nutritional screening at the time of diagnosis, 62.9% of participants considered than screening to assess the risk of malnutrition was performed in < 30% of patients. Conclusions: There is an important variability in the management of cancer patient nutrition, which is associated with the absence of a national consensus on nutritional support in this field. Given the incidence of nutritional disorders in cancer patients, a specialist in clinical nutrition (regardless of his/her specialty) should be integrated into the strategic cancer plan
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Assuntos
Humanos , Desnutrição/dietoterapia , Neoplasias/dietoterapia , Terapia Nutricional/métodos , Desnutrição/epidemiologia , Neoplasias/complicações , Nutrição Enteral , Nutrição ParenteralRESUMO
INTRODUCTION: Malnutrition is a common complication in cancer patients and can negatively affect the outcome of treatments. This study aimed to reach a consensus on nutritional needs and optimize nutritional care in the management of cancer patients at a national level. METHODS: A qualitative, multicenter, two-round Delphi study involving 52 specialists with experience in nutritional support in cancer patients was conducted. RESULTS: Regarding the presence of malnutrition, 57.7% of the participants stated that < 30% of the patients had malnutrition at the time of diagnosis, 40.4% considered that 31-50% had malnutrition during cancer treatment, and 26.9% that > 50% at the end of the treatment. Forty percent of participants believed that the main objective of nutritional treatment was to improve quality of life and 34.6% to improve tolerability and adherence to chemotherapy. The quality nutritional care provided at their centers was rated as medium-low by 67.3%. Enteral and parenteral nutrition was administered to less than 10% and less than 5% of patients in 40.4 and 76.9% of cases, respectively. In relation to nutritional screening at the time of diagnosis, 62.9% of participants considered than screening to assess the risk of malnutrition was performed in < 30% of patients. CONCLUSIONS: There is an important variability in the management of cancer patient nutrition, which is associated with the absence of a national consensus on nutritional support in this field. Given the incidence of nutritional disorders in cancer patients, a specialist in clinical nutrition (regardless of his/her specialty) should be integrated into the strategic cancer plan.
Assuntos
Neoplasias/terapia , Apoio Nutricional , Adulto , Técnica Delphi , Feminino , Humanos , Masculino , Desnutrição/terapia , Pessoa de Meia-Idade , Nutrição ParenteralRESUMO
Los pacientes con quilotórax presentan un riesgo elevado de malnutrición, dado que la pérdida continuada de quilo conlleva un deterioro importante del estado nutricional. Su tratamiento, inicialmente conservador, incluye medidas dietéticas y fármacos como el octreótido que disminuyen su débito. En este trabajo se presenta el caso de un paciente con quilotórax tratado mediante drenaje pleural, nutrición parenteral y octreótido, y se revisa cuál es el soporte nutricional más adecuado, así como la eficacia y seguridad de octreótido en quilotórax. Los tipos de intervención nutricional que pueden realizarse son: dieta baja en grasas suplementada con triglicéridos de cadena media (MCT), NE exenta de grasas o con alto porcentaje de MCT y nutrición parenteral. No existe consenso sobre qué medida es la más adecuada. Encontramos pocos estudios comparativos, estando basada la bibliografía en casos o series de casos. Hay autores que consideran la nutrición parenteral de primera elección, mientras que otros recomiendan empezar con una dieta específica y limitar el uso del soporte parenteral a casos concretos. La nutrición parenteral debe cubrir las necesidades del paciente además de compensar las pérdidas proteicas y energéticas que se producen en el quilotórax. El empleo de emulsiones lipídicas no está contraindicado ya que no acceden al sistema linfático. En cuanto a la NE, las fórmulas pueden ser con bajo contenido lipídico o exentas de lípidos. No hay acuerdo respecto al momento de su inicio un vez que el drenaje quiloso va disminuyendo. Existen casos y series de casos que indican que el empleo de octreótido en quilotórax parece seguro y efectivo. No existe consenso sobre el momento de iniciar el tratamiento, la dosis más adecuada, la duración de la terapia y el momento de su suspensión (AU)
Patients with chylothorax present a high risk for malnourishment since continuous loss of chylo leads to a significant impairment of their nutritional status. Chylothorax treatment, which initially is conservative, includes dietary measures and medications such as octreotide that decreases chylothorax flow. In this paper we present the case of a patient with chylothorax treated by means of pleural drainage, parenteral nutrition, and octreotide, and we review the most appropriate nutritional support as well as the efficacy and safety of octreotide in chylothorax therapy. The types of nutritional intervention that may be done are a low-fat diet supplemented with intermediate-chain triglycerides (ICT), fatfree enteral nutrition or EN with a high percentage of ICT, and parenteral nutrition. There is no consensus on which is the most appropriate measure. We found very few comparative studies, and the literature is based on single cases or case series. Some authors consider parenteral nutrition as the first choice, whereas others recommend starting with a specific diet and using parenteral nutrition only in specific cases. Parenteral nutrition must cover the patient's demands together with compensating the protein and energy losses due to chylothorax. The use of lipid emulsions is no contraindicated since they do not reach the lymphatic system. With regards to EN, the formulations may be lipid-free or with low lipid content. There is no agreement on when to start them once the drainage of chylo decreases. There are cases and case series indicating that octreotide use in chylothorax seems to be safe and effective. There is no consensus on when to start the therapy, the most appropriate dose, or the time to withdraw the treatment (AU)
