RESUMO
Traditionally, the initiation of enteral nutrition after a percutaneous endoscopic gastrostomy (PEG) is performed between 12 and 24 hours. Different research suggests that early initiation might be a safe option. Our aim was to determine whether starting enteral nutrition 4 hours after performing PEG is a safe practice in terms of risk of intolerance, complications, or death, compared to starting it at 12 hours. We carried out a prospective, randomized, multicenter study in third and fourth level institutions in Bogotá and Cundinamarca, between June 2020 and May 2022, 117 patients were included who were randomized into 2 groups, group A with early nutrition initiation (4 hours), and standard group B (12 hours). The most frequent mechanism of dysphagia was cerebrovascular disease (43%), followed by complications of COVID19 infection (26%). There were no statistically significant differences between the groups evaluated regarding the percentage of intolerance to nutrition, RR = 0.93 (CI 0.30-2.90), there were also no differences in terms of postoperative complications, (RR) = 0.34 (CI 0.09-1.16), and no differences were found in mortality between the evaluated groups, (RR) = 1.12 (CI 0.59-2.15). In conclusion, early initiation of nutrition through the gastrostomy, 4 hours after performing the PEG, is a safe behavior that is not related to greater intolerance to nutrition, complications, or death, compared to later initiation.
Assuntos
Nutrição Enteral , Gastrostomia , Humanos , Gastrostomia/efeitos adversos , Estudos Prospectivos , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Fatores de TempoRESUMO
Tradicionalmente, el inicio de nutrición enteral, luego de una gastrostomía endoscópica percutánea (GEP) se realiza entre 12 a 24 horas. Diferentes investigaciones sugieren que iniciarla más temprano podría ser una opción segura. El objetivo es determinar si el inicio de nutrición enteral a las 4 horas después de realizar GEP es una conducta segura en cuanto al riesgo de intolerancia, complicaciones o muerte, comparado con iniciarla a las 12 horas. Realizamos un estudio prospectivo, aleatorizado, multicéntrico en instituciones de tercer y cuarto nivel de Bogotá y Cundinamarca, entre junio de 2020 y mayo de 2022, se incluyeron 117 pacientes que fueron aleatorizados en 2 grupos, el grupo A de inicio temprano de nutrición (4 horas), y el grupo B de inicio estándar (12 horas). El mecanismo más frecuente de disfagia fue la enfermedad cerebrovascular (43%), seguido por complicaciones de infección por COVID-19 (26%). No hubo diferencias estadísticamente significativas entre los grupos evaluados respecto al porcentaje de intolerancia a la nutrición, RR = 0,93 (IC 0,30-2,90), tampoco hubo diferencias en términos de complicaciones posoperatorias, (RR) = 0,34 (IC 0,09-1,16), y no se encontraron diferencias en la mortalidad entre los grupos evaluados, (RR) = 1,12 (IC 0,59 - 2,15). En conclusión, el inicio de nutrición a través de la gastrostomía de forma temprana, 4 horas después de la realización de la GEP es una conducta segura que no se relaciona con una mayor intolerancia a la nutrición, complicaciones o muerte, en comparación con un inicio más tardío.
Traditionally, the initiation of enteral nutrition after a percutaneous endoscopic gastrostomy (PEG) is performed between 12 and 24 hours. Different research suggests that early initiation might be a safe option. Our aim was to determine whether starting enteral nutrition 4 hours after performing PEG is a safe practice in terms of risk of intolerance, complications, or death, compared to starting it at 12 hours. We carried out a prospective, randomized, multicenter study in third and fourth level institutions in Bogotá and Cundinamarca, between June 2020 and May 2022, 117 patients were included who were randomized into 2 groups, group A with early nutrition initiation (4 hours), and standard group B (12 hours). The most frequent mechanism of dysphagia was cerebrovascular disease (43%), followed by complications of COVID19 infection (26%). There were no statistically significant differences between the groups evaluated regarding the percentage of intolerance to nutrition, RR = 0.93 (CI 0.30-2.90), there were also no differences in terms of postoperative complications, (RR) = 0.34 (CI 0.09-1.16), and no differences were found in mortality between the evaluated groups, (RR) = 1.12 (CI 0.59-2.15). In conclusion, early initiation of nutrition through the gastrostomy, 4 hours after performing the PEG, is a safe behavior that is not related to greater intolerance to nutrition, complications, or death, compared to later initiation.
RESUMO
A finales de 2019 surgió en Wuhan (China) el SARS-CoV-2, un nuevo coronavirus causante del COVID-19. Al 13 de abril 2020 ha causado en el mundo 1.807.308 infecciones y 119.410 muertes. Por la forma de transmisión del virus y teniendo en cuenta que los servicios de gastroenterología y endoscopia digestiva son una fuente de fácil diseminación, dado a la exposición con aerosoles de manera constante que se emiten durante los procedimientos generando un mayor riesgo tanto para los profesionales de la salud como para los pacientes intervenidos. Es de gran importancia establecer herramientas de prevención dentro de los servicios de gastroenterología y endoscopia digestiva , teniendo en cuenta la evidencia al día de hoy y reconociendo que se está en una búsqueda constante de medidas que disminuyan el riesgo de contagio que permitan generar un ambiente seguro al personal de salud y pacientes. Se realizó una búsqueda en Pubmed con los siguientes términos: ("COVID-19" OR "coronavirus" OR "SARS-Cov-2") y ("gastrointestinal" OR "transmission" OR "intestinal" OR "digestive" OR "endoscopy" OR "esophagogastroduodenoscopy" OR "colonoscopy"). Por lo anterior se debe considerar que todos los pacientes llevados a procedimientos endoscópicos son de alto riesgo y se dará a conocer las herramientas de prevención actuales a nivel mundial.
In late 2019, SARS-CoV-2, a new coronavirus causing COVID-19, emerged in Wuhan (China). As of April 13 2020 it has caused 1.807.308 infections and 119.410 deaths worldwide. Due to the way this virus is transmitted and considering gastroenterology and digestive endoscopy services are a source of easy dissemination given the constant exposure with aerosols that are emitted during procedures there is an increased risk for both health care professionals and patients undergoing endoscopy. It is of great importance to establish prevention tools within the gastroenterology and digestive endoscopy services, based on the evidence gathered to date and recognizing that we are in a constant search for measures to reduce risk of infection that will provide a safe environment to staff and patients. Pubmed database was searched for the following terms: ("COVID-19" OR "coronavirus" OR "SARS-Cov-2") and "gastrointestinal" OR "transmission" OR "intestinal" OR "digestive" OR "endoscopy" OR "esophagogastroduodenoscopy" OR "colonoscopy"). Therefore, all patients brought in to undergo endoscopic procedures should be considered high-risk and current prevention tools will be made known worldwide.
Assuntos
Infecções por Coronavirus , Endoscopia , Transmissão de Doença Infecciosa , Aerossóis , Gastroenterologia , HipertensãoRESUMO
La trombosis venosa es una condición clínica en la cual un trombo se genera y ocluye la luz de un vaso venoso con el consecuente riesgo de embolia pulmonar. La fisiopatología se relaciona con estados de hipercoagulabilidad, alteraciones del flujo sanguíneo y lesiones vasculares endoteliales, conocida como la triada de Virchow. Dentro de los factores de riesgo se encuentran el cáncer, la estancia hospitalaria prolongada, la cirugía mayor, el trauma mayor y las trombofilias; sin embargo en el 25-50% de los casos es imposible identificar el factor etiológico. Presentamos el caso de un hombre con clínica y diagnóstico de trombosis venosa profunda en manejo extrainstitucional con cumínicos, que acude al Hospital Infantil Universitario de San José por incremento de los signos inflamatorios en el miembro inferior derecho. Al ingreso hay aumento de la extensión de la trombosis venosa y niveles subterapéuticos de INR, a pesar de dosis óptimas de cumínicos. La evolución trascurrió con taquicardia y episodios de diaforesis. Se documenta y realiza el diagnóstico de hipertiroidismo asociado con elevación del factor viii de coagulación. Conclusión: Se considera que la trombosis venosa profunda está favorecida por un estado de hipercoagulación determinado por hipertiroidismo.
Venous thrombosis is a clinical condition that occurs when a thrombus forms and obstructs the lumen of a vein constituting a risk for pulmonary embolism. Pathophysiology features Virchow's triad, that is, hypercoagulability, blood flow alterations and vascular endothelial damage. Risk factors include, cancer, prolonged length of hospital stay, major surgery, major trauma and thrombophilias, although, identifying the etiological factor is impossible in 25 to 50% of all cases. A case is presented in a man with clinical presentation and diagnosis of deep venous thrombosis who had been managed with coumarin before consulting to our institution. He came to Hospital Infantil Universitario de San José for presenting an increase of the inflammatory signs on his right leg. At admission, a greater areawas affected by venous thrombosis and subtherapeutic INR values were evidenced despite patient had received optimal doses of coumarin derivatives. He presented tachycardia and episodes of diaphoresis during his hospital stay. A diagnosis of hyperthyroidism associated with high concentrations of coagulation factor VIII was documented. Conclusion: It is considered that DVT is favored by hypercoagulable states determined by hyperthyroidism.
