[Recommendations for nutritional assessment and specialized nutritional support of critically ill patients]. / Recomendaciones para la valoración nutricional y el soporte nutricional especializado de los pacientes críticos.

Due to the characteristics of critically ill patients, elaborating recommendations on nutritional support for these patients is difficult. Usually the time of onset of nutritional support or its features are not well established, so that its application is based on experts' opinion. In the present document, recommendations formulated by the Metabolism and Nutrition Working Group of the Spanish Society of Intensive and Critical Medicine and Coronary Units (SEMICYUC) are presented. Recommendations are based on the literature analysis and further discussion by the working group members in order to define, consensually, the more relevant issues of metabolic and nutritional support of patients in a critical condition. Several clinical situations have been considered which are developed in the following articles of this publication. The present recommendations aim at providing a guideline for the less experienced clinicians when considering the metabolic and nutritional issues of critically ill patients.

[Nutritional support in the critically ill patient: to whom, how, and when?]. / Soporte nutricional del paciente crítico: a quién, cómo y cuándo?

Existing data about indication and time of onset of nutritional support are not homogeneous. However, the presence of a deterioration of the nutritional status is accompanied by harmful effects so that, broadly speaking, specialized nutritional support onset would be advisable if a fasting period longer than 5-7 days is foreseen. Parenteral nutrition routinely administered to critically ill patients may increase their morbidity and mortality. Whenever possible, enteral nutrition should be the preferred route of nutrients intake since it has been shown to have a favorable effect on infectious complications rates. Enteral nutrition should be started early on (within the first 36 hours of admission). Although transpyloric nutrients administration may however reduce bronchoaspiration and increase the diet effective volume received by patients, there are no data for recommending routinary usage of the transpyloric route for nutritional support in the critically ill patients.

[Parenteral nutrition in hematologic patients treated with hematopoietic stem cell transplantation]. / Nutrición parenteral en pacientes hematológicos sometidos a trasplante de células progenitoras hematopoyéticas (TCPH).

The transplant of haematopoyetic parent cells is on common way of treating haematological neoplasias and other types of immunological and tumoural disorders. The aggressive nature of the treatment, leading to peculiar nutritional and metabolic conditions in these patients, as well as the notable incidence of complications, have meant that nutritional support is included in the therapeutic armoury. As in other clinical situations, we are currently able to go beyond merely ensuring the necessary nutritional support. We can also influence the progress of the illness by means of the provision of specific substrates which interfere in a positive manner with the disturbed intermediate metabolism. Even more, in some of these substrates we can find a nutrient drug action.

[The usefulness of cholesterol as a nutritional-metabolic marker in the septic patient]. / Utilidad del colesterol como marcador nutrometabólico en el paciente séptico.

We studied the behavior of the cholesterol of 118 septic patients on entering Intensive Care and on receiving parenteral nutritional support, to establish its utility as malnutrition and/or monitoring marker. On admission, there was more intensive hypocholesterolemia (104 +/- 39 mg/dl) in those who had developed multi-organ failure (87 +/- 34 mg/dl, p < 0.001). There was no correlation between cholesterol and gravity (APACHE II). Basal cholesterol values were correlated with transferrin (r = 0.58), prealbumin (r = 0.43), retinol-linked protein (r = 0.32) and albumin (r = 0.32) and albumin (r = 0.54). During twelve days' parenteral nutrition, cholesterol and visceral protein levels recovered, and the good correlation was maintained between cholesterol and transferrin while that between cholesterol and prealbumin increased and that between cholesterol and retinol-linked virtually disappeared. There ceased to be a relation between albumin and cholesterol as from day six. In cases where the septic situation was maintained, with clinical deterioration, cholesterol levels did not rise. This, along with the close correlation with transferrin, led us to think that cholesterol is influenced by inflammation mediators, acting as a marker for this more as nutritional parameter. However, in practice, it provides the same information as short-life visceral proteins, and its determination is more accessible.(ABSTRACT TRUNCATED AT 250 WORDS)