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1.
Clin Nutr ; 2020 May 30.
Artigo em Inglês | MEDLINE | ID: mdl-32534949

RESUMO

Since the first TICACOS study, 3 additional studies have been published comparing a medical nutrition therapy guided by indirect calorimetry to a regimen prescribed on the basis of predictive equations. A recent guidelines document included a meta-analysis including these 4 papers and found a trend for improvement (OR 0.98-1.48) in favor of medical nutrition therapy guided by indirect calorimetry in terms of survival. The aim of our study was to perform a multicenter prospective, randomized, controlled non blinded study in critically patients to assess the added value for measuring daily resting energy expenditure as a guide for nutritional support. The primary objective was to decrease infectious rate of these critically ill patients. MATERIAL AND METHODS: This phase III, multi-center, randomized, controlled non blinded study was planned to include 580 newly-admitted, adult ventilated ICU patients that were planned to stay more than 48 h in the ICU departments. The nutritional support was aimed to meet 80-100% of energy requirement measured by indirect calorimetry. The calorie needs were determined by IC in the Study group and by an equation (20-25 kcal/kg ideal body weight/day) in the Control Group. The ICU staff was trained to strive to supply 80-100% of a patient's energy requirements through artificial nutrition, preferably enteral feeding. Primary endpoint was infection rate and secondary endpoints included other morbidities and mortality during ICU, at 90 and 180 days. Comparison between the study and the control group was performed using T test for equality of means (independent samples test). Correlations were performed using the Pearson correlation test. A p level of 0.05 or below was considered as significant. Cross tabs procedure used Chi-square test for testing differences in complication rates, length of stay and length of ventilation. Correlations between energy balances and complications was also be tested using one way analysis as well as ANOVA analysis between groups and within groups. Kaplan Meir curves assessed the proportion of surviving patients in the 2 groups. RESULTS: Seven centers with a calorimeter available participated to the study. Due to slow inclusion rate, the study was stopped after 6 years and after inclusion of 417 patients only. From the 417 intended to treat patients, 339 followed the protocol. There was no differences between control and study groups in terms of age, sex BMI, SOFA (7.1 ± 3.1 vs 7.4 ± 3.3) and APACHE II scores (22.4 ± 7.9 vs 22.2 ± 7.4). The rate of infection (40 vs 31), including pneumonia rate, need for surgery, dialysis requirement, length of ventilation, ICU length of stay, and hospital length of stay were not different between groups. Mortality (30 in the control vs 21 in the study group) was not significantly different between groups. The decreased mortality observed in the study group when added to previous studies may have a positive effect on the meta-analysis previously published. CONCLUSION: Tight Calorie Control guided by indirect calorimetry decreased the rate of infection and mortality but not significantly. This may be explained by the not relatively small sample size. There results together with the previous 4 prospective randomized studies, may improve the results of the meta-analysis exploring the effects of IC guided nutrition on mortality.

4.
Rev Esp Quimioter ; 30(5): 355-367, 2017 Oct.
Artigo em Espanhol | MEDLINE | ID: mdl-28945064

RESUMO

OBJECTIVE: Invasive infections caused by Candida spp. in critically ill patients may significantly worsen their prognosis, so it is of great importance to establish an early detection and a suitable therapeutic strategy. The objective of this study was to define the differential role of echinocandins in treating certain critical patient profiles. METHODS: A scientific committee of 9 experts in infectious diseases, critical care, microbiology, and hospital pharmacy reviewed the existing evidence on the treatment of candidemia and invasive candidiasis in critically ill patients. After that, a questionnaire with 35 items was elaborated to be agreed by 26 specialists in the aforementioned disciplines using a modified Delphi method. RESULTS: After two rounds of evaluation, a consensus was reached in terms of agreement in 66% of the items. Some of the consensuses achieved included: it is not necessary to adjust the dose of echinocandins during renal replacement therapy; the echinocandins are the empirical and/or directed treatment of choice for candidemia and invasive candidiasis associated with biofilms; these drugs may be used in the antifungal prophylaxis of high-risk liver transplantation. In the absence of additional clinical data, it should be noted that micafungin is the echinocandin with the most available scientific evidence. CONCLUSIONS: The experts consulted showed a high degree of agreement on some of the most controversial aspects regarding the management of candidemia and invasive candidiasis in critical patients, which could inform of practical recommendations for their treatment.


Assuntos
Antifúngicos/administração & dosagem , Antifúngicos/uso terapêutico , Candidemia/tratamento farmacológico , Candidíase Invasiva/tratamento farmacológico , Estado Terminal , Equinocandinas/administração & dosagem , Equinocandinas/uso terapêutico , Candidemia/microbiologia , Candidemia/prevenção & controle , Candidíase Invasiva/microbiologia , Candidíase Invasiva/prevenção & controle , Infecções Relacionadas a Cateter/microbiologia , Infecções Relacionadas a Cateter/prevenção & controle , Consenso , Técnica Delfos , Oxigenação por Membrana Extracorpórea , Humanos , Infecções Intra-Abdominais/tratamento farmacológico , Infecções Intra-Abdominais/microbiologia , Hepatopatias/complicações , Transplante de Fígado/efeitos adversos , Terapia de Substituição Renal , Fatores de Risco , Inquéritos e Questionários
6.
Med. intensiva (Madr., Ed. impr.) ; 39(5): 303-315, jun.-jul. 2015. tab
Artigo em Espanhol | IBECS | ID: ibc-141616

RESUMO

La reanimación con fluidos es esencial para la supervivencia del paciente crítico en shock, independientemente de la causa que lo origine. Hoy en día disponemos de diversos cristaloides y coloides (sintéticos y naturales), existiendo una viva controversia sobre qué tipo de fluidos debemos emplear y los posibles efectos adversos asociados a su uso, especialmente el desarrollo de fracaso renal con necesidad de técnicas de reemplazo renal. Recientemente se han publicado varios ensayos clínicos y metaanálisis que evidencian que el empleo de hidroxietilalmidón (130/0,4) se asocia a un mayor riesgo de muerte e insuficiencia renal, así como datos que muestran un beneficio clínico con el empleo de cristaloides que contienen menor concentración de sodio y cloro que el suero salino. Ello ha contribuido a aumentar la incertidumbre de los clínicos sobre qué tipo de fluido emplear. Por ello, hemos realizado una revisión narrativa de la literatura con el fin de elaborar unas recomendaciones prácticas sobre el empleo de fluidos en la fase de reanimación del paciente crítico adulto y que se presentan en este documento


Fluid resuscitation is essential for the survival of critically ill patients in shock, regardless of the origin of shock. A number of crystalloids and colloids (synthetic and natural) are currently available, and there is strong controversy regarding which type of fluid should be administered and the potential adverse effects associated with the use of these products, especially the development of renal failure requiring renal replacement therapy. Recently, several clinical trials and metaanalyses have suggested the use of hydroxyethyl starch (130/0.4) to be associated with an increased risk of death and kidney failure, and data have been obtained showing clinical benefit with the use of crystalloids that contain a lesser concentration of sodium and chlorine than normal saline. This new information has increased uncertainty among clinicians regarding which type of fluid should be used. We therefore have conducted a review of the literature with a view to developing practical recommendations on the use of fluids in the resuscitation phase in critically ill adults


Assuntos
Humanos , Coloides/uso terapêutico , Reanimação Cardiopulmonar/métodos , Estado Terminal/terapia , Cuidados Críticos/métodos , Choque/terapia , Hidratação/métodos , Soluções para Reidratação/farmacologia
8.
Med Intensiva ; 39(5): 303-15, 2015.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-25683695

RESUMO

Fluid resuscitation is essential for the survival of critically ill patients in shock, regardless of the origin of shock. A number of crystalloids and colloids (synthetic and natural) are currently available, and there is strong controversy regarding which type of fluid should be administered and the potential adverse effects associated with the use of these products, especially the development of renal failure requiring renal replacement therapy. Recently, several clinical trials and metaanalyses have suggested the use of hydroxyethyl starch (130/0.4) to be associated with an increased risk of death and kidney failure, and data have been obtained showing clinical benefit with the use of crystalloids that contain a lesser concentration of sodium and chlorine than normal saline. This new information has increased uncertainty among clinicians regarding which type of fluid should be used. We therefore have conducted a review of the literature with a view to developing practical recommendations on the use of fluids in the resuscitation phase in critically ill adults.


Assuntos
Coloides/uso terapêutico , Hidratação , Soluções Isotônicas/uso terapêutico , Ressuscitação/métodos , Choque/terapia , Acidose/induzido quimicamente , Acidose/etiologia , Lesão Renal Aguda/induzido quimicamente , Lesão Renal Aguda/prevenção & controle , Lesão Renal Aguda/terapia , Ensaios Clínicos como Assunto , Coloides/efeitos adversos , Contraindicações , Soluções Cristaloides , Dextranos/efeitos adversos , Dextranos/uso terapêutico , Hipersensibilidade a Drogas , Hidratação/efeitos adversos , Gelatina/efeitos adversos , Gelatina/uso terapêutico , Humanos , Derivados de Hidroxietil Amido/efeitos adversos , Derivados de Hidroxietil Amido/uso terapêutico , Soluções Isotônicas/efeitos adversos , Metanálise como Assunto , Estudos Observacionais como Assunto , Terapia de Substituição Renal , Lactato de Ringer , Solução Salina Hipertônica/efeitos adversos , Solução Salina Hipertônica/uso terapêutico , Albumina Sérica/efeitos adversos , Albumina Sérica/uso terapêutico
9.
Med. intensiva (Madr., Ed. impr.) ; 35(supl.1): 12-16, nov. 2011. tab
Artigo em Espanhol | IBECS | ID: ibc-136003

RESUMO

Los parámetros existentes para valorar el estado nutricional en los pacientes críticos tienen utilidad para evaluar el estado de nutrición previo al momento del ingreso en la unidad de medicina intensiva. Sin embargo, su valor escaso una vez interferidos con los cambios derivados de los procesos agudos y por su tratamiento. Así, los cambios en la distribución hídrica alteran especialmente las variables antropométricas y algo similar ocurre con los principales biomarcadores bioquímicos, que además se ven afectados por los procesos de síntesis y degradación. El incremento plasmático de las proteínas de vida media corta, prealbúmina y retinol, nos puede informar de una respuesta adecuada al soporte nutritivo y su disminución, de nuevas situaciones de estrés metabólico. Los parámetros de estimación funcional, como los de función muscular o los inmunológicos, están interferidos en muchos enfermos por fármacos o por la presencia de infección o polineuropatía. Sin embargo, algunos parámetros sí que se pueden utilizar para monitorizar la respuesta metabólica y la renutrición o bien son de importancia pronóstica (AU)


Current parameters to assess nutritional status in critically-ill patients are useful to evaluate nutritional status prior to admission to the intensive care unit. However, these parameters are of little utility once the patient’s nutritional status has been altered by the acute process and its treatment. Changes in water distribution affect anthropometric variables and biochemical biomarkers, which in turn are affected by synthesis and degradation processes. Increased plasma levels of prealbumin and retinol —proteins with a short half-life— can indicate adequate response to nutritional support, while reduced levels of these proteins indicate further metabolic stress. The parameters used in functional assessment, such as those employed to assess muscular or immune function, are often altered by drugs or the presence of infection or polyneuropathy. However, some parameter scan be used to monitor metabolic response and refeeding or can aid prognostic evaluation (AU)


Assuntos
Humanos , Nutrição Enteral/métodos , Nutrição Enteral/normas , Cuidados Críticos/métodos , Estado Nutricional , Avaliação Nutricional , Nutrição Parenteral/normas , Sociedades Médicas/normas , Sociedades Científicas/normas , Antropometria , Biomarcadores , Estado Terminal/terapia , Testes Imunológicos , Unidades de Terapia Intensiva , Desnutrição/sangue , Desnutrição/diagnóstico , Desnutrição/prevenção & controle , Proteínas Musculares/metabolismo , Debilidade Muscular/sangue , Debilidade Muscular/diagnóstico , Nutrição Parenteral/métodos , Admissão do Paciente , Espanha
10.
Nutr. hosp ; 26(supl.2): 12-15, nov. 2011.
Artigo em Inglês | IBECS | ID: ibc-104834

RESUMO

Current parameters to assess nutritional status in critically-ill patients are useful to evaluate nutritional status prior to admission to the intensive care unit. However, these parameters are of little utility once the patient’s nutritional status has been altered by the acute process and its treatment. Changes in water distribution affect anthropometric variables and biochemical biomarkers, which in turn are affected by synthesis and degradation processes. Increased plasma levels of prealbumin and retinol —proteins with a short half-life— can indicate adequate response to nutritional support, while reduced levels of these proteins indicate further metabolic stress. The parameters used in functional assessment, such as those employed to assess muscular or immune function, are often altered by drugs or the presence of infection or polyneuropathy. However, some parameters can be used to monitor metabolic response and refeeding or can aid prognostic evaluation (AU)


Los parámetros existentes para valorar el estado nutricional en los pacientes críticos tienen utilidad para evaluar el estado de nutrición previo al momento del ingreso en la unidad de medicina intensiva. Sin embargo, su valores escaso una vez interferidos con los cambios derivados de los procesos agudos y por su tratamiento. Así, los cambios en la distribución hídrica alteran especialmente las variables antropométricas y algo similar ocurre con los principales biomarcadores bioquímicos, que además se ven afectados por los procesos de síntesis y degradación. El incremento plasmático de las proteínas de vida media corta, prealbúmina y retinol, nos puede informar de una respuesta adecuada al soporte nutritivo y su disminución, de nuevas situaciones de estrés metabólico. Los parámetros de estimación funcional, como los de función muscular o los inmunológicos, están interferidos en muchos enfermos por fármacos o por la presencia de infección opolineuropatía. Sin embargo, algunos parámetros sí que se pueden utilizar para monitorizar la respuesta metabólica y la renutrición o bien son de importancia pronóstica (AU)


Assuntos
Humanos , Avaliação Nutricional , Estado Nutricional , Biomarcadores/análise , Transtornos Nutricionais/diagnóstico , Estado Terminal/terapia , Apoio Nutricional/métodos , Prática Clínica Baseada em Evidências/métodos , Padrões de Prática Médica
11.
Nutr Hosp ; 26 Suppl 2: 12-5, 2011 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-22411512

RESUMO

Current parameters to assess nutritional status in critically-ill patients are useful to evaluate nutritional status prior to admission to the intensive care unit. However, these parameters are of little utility once the patient's nutritional status has been altered by the acute process and its treatment. Changes in water distribution affect anthropometric variables and biochemical biomarkers, which in turn are affected by synthesis and degradation processes. Increased plasma levels of prealbumin and retinol -proteins with a short half-life- can indicate adequate response to nutritional support, while reduced levels of these proteins indicate further metabolic stress. The parameters used in functional assessment, such as those employed to assess muscular or immune function, are often altered by drugs or the presence of infection or polyneuropathy. However, some parameters can be used to monitor metabolic response and refeeding or can aid prognostic evaluation.


Assuntos
Estado Terminal/terapia , Avaliação Nutricional , Apoio Nutricional/métodos , Antropometria , Índice de Massa Corporal , Peso Corporal , Consenso , Cuidados Críticos , Proteínas na Dieta/administração & dosagem , Humanos , Imunidade/fisiologia , Proteínas Musculares/metabolismo , Músculo Esquelético/metabolismo , Músculo Esquelético/fisiologia , Estado Nutricional , Prognóstico
12.
Med Intensiva ; 35 Suppl 1: 12-6, 2011 Nov.
Artigo em Espanhol | MEDLINE | ID: mdl-22309746

RESUMO

Current parameters to assess nutritional status in critically-ill patients are useful to evaluate nutritional status prior to admission to the intensive care unit. However, these parameters are of little utility once the patient's nutritional status has been altered by the acute process and its treatment. Changes in water distribution affect anthropometric variables and biochemical biomarkers, which in turn are affected by synthesis and degradation processes. Increased plasma levels of prealbumin and retinol -proteins with a short half-life- can indicate adequate response to nutritional support, while reduced levels of these proteins indicate further metabolic stress. The parameters used in functional assessment, such as those employed to assess muscular or immune function, are often altered by drugs or the presence of infection or polyneuropathy. However, some parameters can be used to monitor metabolic response and refeeding or can aid prognostic evaluation.


Assuntos
Cuidados Críticos , Nutrição Enteral/normas , Avaliação Nutricional , Nutrição Parenteral/normas , Sociedades Médicas/normas , Sociedades Científicas/normas , Antropometria , Biomarcadores , Cuidados Críticos/métodos , Estado Terminal/terapia , Nutrição Enteral/métodos , Humanos , Testes Imunológicos , Unidades de Terapia Intensiva , Desnutrição/sangue , Desnutrição/diagnóstico , Desnutrição/prevenção & controle , Proteínas Musculares/metabolismo , Debilidade Muscular/sangue , Debilidade Muscular/diagnóstico , Estado Nutricional , Nutrição Parenteral/métodos , Admissão do Paciente , Espanha
13.
Nutr Hosp ; 25(4): 540-2, 2010.
Artigo em Espanhol | MEDLINE | ID: mdl-20694288

RESUMO

The 7th Abbott-SENPE Forum is structured facing the new regulations of the European Space of High Education regarding the studies on Nutrition in the different degrees (Medicine, Pharmacology, Nutrition, Nursing) and post-doctoral education. A multi-professional and multidisciplinary discussion on the current situation of university education on nutrition, and its capabilities and limitations, is carried out. The value of the role of continuous medical education, the inhouse training programme, masters, and of scientific societies is also assessed. It is concluded that there is a need to urge academic authorities, the National Commission of Medical Specialties, the persons in charge of continuous medical education, and scientific societies of the importance of the studies relating to nutrition, feeding, and dietetics at both pre-graduate and post-graduate educational levels, and to implement and develop these studies in their areas of influence.


Assuntos
Ciências da Nutrição/educação , Europa (Continente)
14.
Nutr. hosp ; 25(4): 540-542, jul.-ago. 2010.
Artigo em Espanhol | IBECS | ID: ibc-95498

RESUMO

De cara a las nuevas normas del Espacio Europeo de Educación Superior en su relación con los estudios de nutrición tanto en los diferentes grados (medicina, farmacia, nutrición, enfermería) como en el postgrado, se estructura el VIIo FORO Abbott-SENPE. Se efectúa una reflexión multiprofesional y multidisciplinar sobre la actual situación de la formación universitaria en nutrición, sus posibilidades y límites. También se valora el papel de la formación continuada, del sistema de residencia, de los másteres y de las sociedades científicas. Se concluye en instar a las autoridades académicas, a la Comisión Nacional de Especialidades, a los responsables de formación continuada y a las sociedades científicas a reflexionar sobre la importancia de los estudios relacionados con la nutrición, alimentación y dietética tanto en el pregrado como en el postgrado y a implementarlos y desarrollarlos en sus áreas de influencia (AU)


The 7th Abbott-SENPE Forum is structured facing the new regulations of the European Space of High Education regarding the studies on Nutrition in the different degrees (Medicine, Pharmacology, Nutrition, Nursing) and post-doctoral education. A multi-professional and multidisciplinary discussion on the current situation of university education on nutrition, and its capabilities and limitations, is carried out. The value of the role of continuous medical education, the inhouse training programme, masters, and of scientific societies is also assessed. It is concluded that there is a need to urge academic authorities, the National Commission of Medical Specialties, the persons in charge of continuous medical education, and scientific societies of the importance of the studies relating to nutrition, feeding, and dietetics at both pre-graduate and post-graduate educational levels, and to implement and develop these studies in their areas of influence (AU)


Assuntos
Humanos , 52503/educação , Especialização/tendências , Universidades , Currículo/tendências , Dietética/educação
15.
Nutr Hosp ; 24(5): 596-606, 2009.
Artigo em Espanhol | MEDLINE | ID: mdl-19893871

RESUMO

OBJECTIVE: To quantify by means of the so-called "Healthy lifestyle pyramid" and after two educational interventions, the changes in food intake, daily activities, and hygiene and health habits in the short and long terms in a cohort of healthy children. MATERIALS AND METHOD: prospective longitudinal study with baseline assessment of dietary and lifestyle habits, and two assessments after two educational interventions. RESULTS: 52 children participated, mean age 7.9 years, 15.4% of them being obese. There was a statistically significant reduction in whole milk intake in both the short and long term. There was a significant decrease in the short term in the intake of processed cold meat and an increase in fruit intake. There was a significant reduction in sweets intake in the short term. There was a statistically significant change in hand washing in the short and long terms, as well as in beach bathing after eating. There also was a significant change in achieving an appropriate posture and not bathing too far away, both in the long run. Finally, there was a significant change in the short term in not using inappropriate sports playing fields. The frequency at which they practise sports in the long term was significantly increased as well as the number of weekly sports, in the short term. CONCLUSIONS: After two educational interventions, the children did significant modifications of their health habits in the short term or the long term, which contributes to modify the risk factors for disease in the adulthood.


Assuntos
Ingestão de Alimentos , Comportamento Alimentar , Educação em Saúde , Higiene , Atividade Motora , Criança , Feminino , Humanos , Masculino , Estudos Prospectivos , Inquéritos e Questionários
16.
Nutr. hosp ; 24(5): 596-606, sept.-oct. 2009. tab, ilus
Artigo em Espanhol | IBECS | ID: ibc-76621

RESUMO

Objetivo: Cuantificar tras dos intervenciones educacionales, con la denominada ‘Pirámide de estilo de vida saludable’, los cambios en ingesta, actividades diarias y hábitos de higiene y salud, a corto y largo plazo, en una cohorte de niños sanos. Material y métodos: Es un estudio longitudinal prospectivo con una evaluación basal de hábitos dietéticos y de vida, y dos evaluaciones posteriores tras las dos intervenciones educacionales. Resultados: Participaron 52 niños, con una media de 7,9 años y el 15,4% eran obesos. Hubo una reducción estadísticamente significativa en la ingesta de leche entera, tanto a corto como a largo plazo. Fue significativo a corto plazo la reducción en la ingesta de embutidos y un aumento de frutas. Hubo una reducción significativa en ingesta de dulces, a corto plazo. Hubo significación estadística en lavado de manos, a corto y a largo plazo, al igual que el baño en la playa tras comer. También lo hubo en lograr una postura adecuada y no nadar muy adentro, ambos a largo plazo; y por último a corto plazo, en no utilizar campos de deporte inadecuados. La frecuencia con que practican deportes, a largo plazo, tuvo un incremento significativo y también lo hubo en el número de ejercicios semanales, a corto plazo. Conclusiones: Los niños hicieron tras dos intervenciones educacionales modificaciones significativas de sus hábitos de salud a corto, o largo plazo lo que contribuye a modificar factores de riesgo de enfermedad en la vida adulta (AU)


Objective: To quantify by means of the so-called ‘Healthy lifestyle pyramid’ and after two educational interventions, the changes in food intake, daily activities, and hygiene and health habits in the short and long terms in a cohort of healthy children. Materials and method: prospective longitudinal study with baseline assessment of dietary and lifestyle habits, and two assessments after two educational interventions. Results: 52 children participated, mean age 7.9 years, 15.4% of them being obese. There was a statistically significant reduction in whole milk intake in both the short and long term. There was a significant decrease in the short term in the intake of processed cold meat and an increase in fruit intake. There was a significant reduction in sweets intake in the short term. There was a statistically significant change in hand washing in the short and long terms, as well as in beach bathing after eating. There also was a significant change in achieving an appropriate posture and not bathing too far away, both in the long run. Finally, there was a significant change in the short term in not using inappropriate sports playing fields. The frequency at which they practise sports in the long term was significantly increased as well as the number of weekly sports, in the short term. Conclusions: After two educational interventions, the children did significant modifications of their health habits in the short term or the long term, which contributes to modify the risk factors for disease in the adulthood (AU)


Assuntos
Humanos , Masculino , Feminino , Criança , Ingestão de Alimentos , Comportamento Alimentar , Educação em Saúde , Higiene , Atividade Motora , Estudos Prospectivos , Inquéritos e Questionários
17.
Eur J Clin Microbiol Infect Dis ; 28(3): 233-42, 2009 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-18758831

RESUMO

The purpose of this paper is to determine the incidence of fungal colonization and infection in non-neutropenic critically ill patients and to identify factors favoring infection by Candida spp. A total of 1,655 consecutive patients (>18 years of age) admitted for > or = 7 days to 73 medical-surgical Spanish intensive care units (ICUs) participated in an observational prospective cohort study. Surveillance samples were obtained once a week. One or more fungi were isolated in different samples in 59.2% of patients, 94.2% of which were Candida spp. There were 864 (52.2%) patients with Candida spp. colonization and 92 (5.5%) with proven Candida infection. In the logistic regression analysis risk factors independently associated with Candida spp. infection were sepsis (odds ratio [OR] = 8.29, 95% confidence interval [CI] 5.07-13.6), multifocal colonization (OR = 3.49, 95% CI 1.74-7.00), surgery (OR = 2.04, 95% CI 1.27-3.30), and the use of total parenteral nutrition (OR = 4.37, 95% CI 2.16-8.33). Patients with Candida spp. infection showed significantly higher in-hospital and intra-ICU mortality rates than those colonized or non-colonized non-infected (P < 0.001). Fungal colonization, mainly due to Candida spp., was documented in nearly 60% of non-neutropenic critically ill patients admitted to the ICU for more than 7 days. Proven candidal infection was diagnosed in 5.5% of cases. Risk factors independently associated with Candida spp. infection were sepsis, multifocal colonization, surgery, and the use of total parenteral nutrition.


Assuntos
Estado Terminal , Fungos/isolamento & purificação , Micoses/epidemiologia , Adulto , Idoso , Estudos de Coortes , Feminino , Fungos/classificação , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Micoses/microbiologia , Micoses/mortalidade , Estudos Prospectivos , Fatores de Risco , Espanha
18.
Nutr. hosp ; 23(3): 203-205, mayo-jun. 2008. ilus
Artigo em Espanhol | IBECS | ID: ibc-68161

RESUMO

En un debate multidisciplinario y tras revisar la evidencia disponible así como la experiencia de los expertos se establecen las indicaciones y pautas de manejo de la Nutrición Parenteral Complementaria (NPC) en el paciente críticamente enfermo. Se concluye en la importancia de su indicación en todos los casos en que la nutrición enteral (NE) sea insuficiente para cubrir al menos el 60% del objetivo calórico-proteico. El paciente debe cubrir con la NE y la NPC al menos el 80% de sus objetivos calóricos, recomendándose el objetivo del 100%


In the setting of a multidisciplinary debate, and after reviewing the available evidence as well as the experience from experts, the indications and management guidelines for Complementary Parenteral Nutrition (CPN) in the critically ill patient are established. The conclusion refers to the importance of its indication in all the cases where enteral nutrition (EN) is insufficient to cover at least 60% of the caloric-protein target. At least 80% of the patient’s caloric requirements should be covered with EN and CPN, with the recommendation of targeting 100% of the demands


Assuntos
Humanos , Nutrição Parenteral/métodos , Estado Terminal/terapia , Apoio Nutricional/métodos , Cuidados Críticos/métodos , Nutrição Enteral/métodos
19.
Nutr Hosp ; 20 Suppl 2: 5-8, 2005 Jun.
Artigo em Espanhol | MEDLINE | ID: mdl-15981840

RESUMO

There are different parameters aimed at assessing nutritional status. These parameters may be of some help to assess nutritional status prior to patients' admission. However, their application in the critically ill patient is troublesome since results interpretation is interfered by changes originated by the acute disease or treatment measures. This is particularly true in relation to anthropometrical variables that are severely affected by changes in water distribution in the critical patient. Biochemical markers (creatinine/height index, serum albumin, etc.) are also interfered as a result of the metabolic changes that modify the synthesis and degradation processes. Short half-life proteins (prealbumin, retinol-bound protein) are not indicative of the nutritional status although they do inform about an appropriate response to nutrients intake and concurrence of new conditions of metabolic stress. Functional assessment parameters, such as muscular function test, are also difficult to apply in a great number of patients. Subjective global assessment, although it requires some degree of expertise, may be an appropriate tool. Some theoretically more accurate methods, such as bioelectrical impedance, need further investigation in these patients before being recommended.


Assuntos
Estado Terminal/terapia , Avaliação Nutricional , Transtornos Nutricionais/diagnóstico , Ensaios Clínicos como Assunto , Cuidados Críticos/métodos , Cuidados Críticos/normas , Estado Terminal/reabilitação , Humanos , Transtornos Nutricionais/terapia , Estado Nutricional
20.
Nutr. hosp ; 20(supl.2): 5-8, jun. 2005. tab
Artigo em Espanhol | IBECS | ID: ibc-039145

RESUMO

Existen diferentes parámetros destinados a la valoración del estado nutricional. Estos parámetros pueden ser de utilidad para valorar el estado nutricional previo al ingreso de los pacientes. No obstante, su aplicación en los pacientes críticos es problemática, debido a que la interpretación de los resultados se encuentra interferida por los cambios originados por la enfermedad aguda y por las medidas de tratamiento. Esto es particularmente cierto en lo que se refiere a las variables antropométricas, que se encuentran muy afectadas por las alteraciones en la distribución hídrica de los pacientes críticos. Los marcadores bioquímicos (índice creatinina/altura, albúmina sérica, etc..) se encuentra también interferidos como consecuencia de los cambios metabólicos que modifican los procesos de síntesis y degradación. Las proteínas de vida media corta (prealbúmina, proteína ligada al retinol) no son indicativas de estado nutricional aunque sí informan sobre la adecuada respuesta al aporte de nutrientes y sobre la concurrencia de nuevas situaciones de estrés metabólico. Los parámetros de estimación funcional, como los test de función muscular, son también difíciles de aplicar en un gran número de pacientes críticos debido al tratamiento con fármacos que afectan a la función muscular o a la presencia de polineuropatía. Todo ello indica que no existen parámetros fiables para la valoración del estado nutricional en estos pacientes. La valoración global subjetiva, aunque requiere un cierto grado de experiencia, puede ser un método adecuado. Otros métodos teóricamente más precisos, como la impedancia bioeléctrica, requieren ser más estudiados en estos pacientes antes de poder ser recomendados (AU)


There are different parameters aimed at assessing nutritional status. These parameters may be of some help to assess nutritional status prior to patients' admission. However, their application in the critically ill patient is troublesome since results interpretation is interfered by changes originated by the acute disease or treatment measures. This is particularly true in relation to anthropometrical variables that are severely affected by changes in water distribution in the critical patient. Biochemical markers (creatinine/height index, serum albumin, etc.) are also interfered as a result of the metabolic changes that modify the synthesis and degradation processes. Short half-life proteins (prealbumin, retinol-bound protein) are not indicative of the nutritional status although they do inform about an appropriate response to nutrients intake and concurrence of new conditions of metabolic stress. Functional assessment parameters, such as muscular function test, are also difficult to apply in a great number of patients. Subjective global assessment, although it requires some degree of expertise, may be an appropriate tool. Some theoretically more accurate methods, such as bioelectrical impedance, need further investigation in these patients before being recommended (AU)


Assuntos
Humanos , Estado Terminal/terapia , Avaliação Nutricional , Transtornos Nutricionais/diagnóstico , Estado Terminal/reabilitação , Cuidados Críticos/métodos , Cuidados Críticos/normas , Transtornos Nutricionais/terapia , Estado Nutricional
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