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Humanos , Sialorreia , Antagonistas Colinérgicos , Derivados da EscopolaminaRESUMO
INTRODUCTION. To report the five-year experience in ambulatory parenteral antimicrobial treatments of a Hospital at Home (HH). METHODS. Prospective, descriptive study in which demographic data, infection types, antibiotics, dosages, treatment duration, administration methods, and complications were recorded. RESULTS. A total of 325 ambulatory parenteral antibiotic treatments were instituted. The mean age of patients was 56 years (range: 4-96). Patients included 225 men and 100 women. The mean duration of treatment was 16 days (range: 1-176 days). The total number of stays was 4,313 days. The sources of the treated infections included: respiratory tract, 40.3%; osteoarticular, 13.2%; digestive tract, 7%; cytomegalovirus, 6.4%; soft tissue, 5.5%; bacteremias, 5,2%; central nervous system, 4.9%; urinary tract, 4.6%; febrile syndromes, 3.7%; postsurgical, 3%; and endocarditis, 2.5%. Ceftriaxone was the antibiotic most widely used. Seventy-nine percent of treatments were throught the intravenous route. In the last two years infusion pumps were used. Treatment was completed in 93.3% of cases, three patients died and 19 patients required readmission. The most common complication was phlebitis, in 12.6% of cases. CONCLUSIONS. Currently, there is the possibility of safely treating a large number of infections at patient's home with parenteral antibiotics.
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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.
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Nutrição Enteral , Serviços de Assistência Domiciliar , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Sistema de Registros , Inquéritos e QuestionáriosRESUMO
Objetivo. Describir la experiencia en tratamientos antimicrobianos parenterales en domicilio de una Unidad de Hospitalización a Domicilio (UHD) en un período de 5 años. Metodología. Se realiza un estudio prospectivo, descriptivo, en el que se recogen datos demográficos, tipos de infección, antibióticos y posología utilizada, duración del tratamiento, método de infusión y complicaciones aparecidas. Resultados. Se han instaurado 325 tratamientos antibióticos parenterales a domicilio. La edad media fue 5 6 años (rango: 4 -9 6 años); por sexos, 2 2 5 varones y 1 0 0 mujeres. La duración media de los tratamientos fue de 1 6 días (rango: 1 -1 7 6 días). El número total de estancias fue 4 .3 1 3 días. Las infecciones tratadas han sido muy variadas: respiratorias, 4 0 ,3 %; osteoarticulares, 1 3 ,2 %; del aparato digestivo, 7 %; por citomegalovirus, 6 ,4 %; de tejidos blandos, 5 ,5 %; bacteriemias, 5 ,2 %; del sistema nervioso central, 4 ,9 %; urinarias, 4 ,6 %; síndromes febriles, 3 ,7 %; posquirúrgicas, 3 %, y endocarditis, 2,5%. El antibiótico más utilizado ha sido la ceftriaxona. El 7 9 % de los tratamientos fue endovenoso. En los 2 últimos años se han utilizado bombas de infusión. Se completó el tratamiento en un 9 3 ,3 % de los casos, falleciendo 3 pacientes y requiriendo reingreso 1 9 . La complicación más frecuente ha sido la flebitis en un 12,6% de los casos. Conclusiones. En la actualidad existe la posibilidad de tratar una gran número de infecciones en el domicilio del paciente con antibióticos parenterales de una manera segura (AU)
Objective. To report the five-year experience in ambulatory parenteral antimicrobial treatments of a Hospital at Home (HH). Methods. Prospective, descriptive study in which demographic data, infection types, antibiotics, dosages, treatment duration, administration methods, and complications were recorded. Results. A total of 325 ambulatory parenteral antibiotic treatments were instituted. The mean age of patients was 5 6 years (range: 4 -9 6 ). Patients included 2 2 5 men and 1 0 0 women. The mean duration of treatment was 1 6 days (range: 1 -1 7 6 days). The total number of stays was 4 ,3 1 3 days. The sources of the treated infections included: respiratory tract, 4 0 .3 %; osteoarticular, 1 3 .2 %; digestive tract, 7 %; cytomegalovirus, 6 .4 %; soft tissue, 5 .5 %; bacteremias, 5 ,2 %; central nervous system, 4 .9 %; urinary tract, 4 .6 %; febrile syndromes, 3 .7 %; postsurgical, 3 %; and endocarditis, 2 .5 %. Ceftriaxone was the antibiotic most widely used. Seventy-nine percent of treatments were throught the intravenous route. In the last two years infusion pumps were used. Treatment was completed in 9 3 .3 % of cases, three patients died and 19 patients required readmission. The most common complication was phlebitis, in 12.6% of cases. Conclusions. Currently, there is the possibility of safely treating a large number of infections at patients home with parenteral antibiotics (AU)
