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1.
Med. clín (Ed. impr.) ; 154(5): 157-162, mar. 2020. tab
Artigo em Espanhol | IBECS | ID: ibc-186627

RESUMO

Objetivo: Identificar los factores predictivos de hiperglucemia en pacientes que reciben nutrición parenteral (NP). Material y métodos: Estudio observacional retrospectivo (enero 2016-diciembre 2016) realizado en un hospital universitario de 450 camas. Se incluyeron los pacientes adultos hospitalizados que recibieron NP total por vía central durante al menos 48h de duración. Se recogieron las variables necesarias para caracterizar a los pacientes, y aquellas referentes a la NP recibida y se definió hiperglucemia como 3 glucemias consecutivas superiores a 150mg/dl o 2 superiores a 180mg/dl. Se realizó un análisis estadístico descriptivo, comparativo bivariante, y un análisis multivariante mediante regresión logística binaria (SPSS.v.24.). Resultados: Se incluyeron 234 pacientes. La prevalencia de hiperglucemia en la población bajo estudio fue del 44%. Las principales diferencias observadas en el análisis bivariante entre los pacientes hiperglucémicos y normoglucémicos se relacionaron con edad, comorbilidades previas, servicio médico, presencia de sepsis, duración y aporte de glucosa en la NP, así como los valores analíticos de glucemia y el tratamiento con corticoides. Los factores predictivos de hiperglucemia obtenidos tras el análisis multivariante fueron: aclaramiento renal (OR=0,982; IC95% 0,968-0,996; p=0,010), glucemia previa a la NP (OR=1,039; IC95% 1,026-1,051; p<0,001), diabetes mellitus (OR=11,016; IC95% 3,028-31,697; p<0,001), medicina intensiva (OR=3,303; IC95% 1,183-9,219; p=0,023), corticoides (OR=3,115; IC95% 1,179-8,226; p=0,022). Conclusiones: El aclaramiento renal disminuido, la glucemia previa elevada, la diabetes, la utilización de corticoides y el paciente crítico son factores predictores de hiperglucemia, por lo que sería conveniente considerarlos en el diseño de la fórmula de inicio de NP


Objective: To identify the predictive factors of hyperglycaemia in patients receiving parenteral nutrition (PN). Material and methods: Retrospective observational study (January 2016-December 2016) conducted in a 450-bed university hospital. Adult hospitalized patients who received total PN through a central line for at least 48hours were included. The required variables to characterize patients, and those related to the PN received were collected and hyperglycaemia was defined as 3 consecutive glycaemias greater than 150mg/dl or 2 greater than 180mg/dl. A descriptive, comparative bivariate statistical analysis was carried out, as well as a multivariate analysis using binary logistic regression (SPSS.v.24.) Results: 234 patients were included. The prevalence of hyperglycaemia in the population under study was 44.0%. The main differences observed in the bivariate analysis between hyperglycaemic and normoglycemic patients were related to age, previous comorbidities, medical department, presence of sepsis, duration and glucose contribution in PN, as well as blood glucose levels and corticosteroids. The predictors of hyperglycaemia obtained after the multivariate analysis were: renal clearance (OR=.982, 95% CI .968-.996, P=.010), pre-PN glycaemia (OR=1.039, 95% CI 1.026-1.051, P<.001), diabetes mellitus (OR=11.016, 95% CI 3.028-31.697, P<.001), intensive medicine (OR=3.303, 95% CI 1.183-9.219, P=.023), corticosteroids (OR=3.155, 95% CI 1.179-8.226, P=.022). Conclusions: Decreased renal clearance, high blood glucose levels, diabetes, corticosteroid use, and critical patients are predictors of hyperglycaemia, therefore it would be advisable to consider them in the design of PN start formula


Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Hiperglicemia/dietoterapia , Hiperglicemia/diagnóstico , Nutrição Parenteral/métodos , Valor Preditivo dos Testes , Estudos Retrospectivos , Análise Multivariada , Modelos Logísticos , Hiperglicemia/epidemiologia , Corticosteroides
2.
Medicine (Baltimore) ; 99(10): e19404, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32150089

RESUMO

INTRODUCTION: Colonic intramural hematomas are rarely encountered clinical entity. Colonic intramural hematomas are frequently associated with blunt trauma, and they could occur spontaneously in patients under anticoagulant therapy or with bleeding diathesis. There were few reports on synchronous colon cancer and intramural hematoma. Intramural hematomas of gastrointestinal tract in those patients undergoing anticoagulation treatment often occurred at the esophagus, duodenum, and small intestine, while colon was rarely affected site. Clinical symptoms of colonic intramural hematomas may include abdominal pain, lower gastrointestinal bleeding, and occasionally bowel obstruction. PATIENT CONCERNS: We herein report 2 cases of colonic intramural hematomas. Case 1 presented with abdominal pain and decreased defecation. Colonoscopy and contrast-enhanced computed tomography (CT) revealed intramural hematoma proximal to the neoplasm at ascending colon. Case 2 was a patient under regular anticoagulation therapy after coronary arterial stent implantation. His chief complaints were intermittent abdominal pain and distension. Colonoscopy and contrast-enhanced CT demonstrated intramural hematoma at sigmoid colon. DIAGNOSIS: Case 1 was diagnosed synchronous colonic intramural hematoma and colon cancer at ascending colon via surgery. Case 2 was diagnosed intramural hematoma of sigmoid colon through colonoscopy and follow-up CT. INTERVENTIONS: Case 1 underwent right hemicolectomy. Case 2 received conservative treatment including anticoagulation discontinuation, total parenteral nutrition, and intravenous hydration. OUTCOMES: They both had a good recovery. CONCLUSION: Colonoscopy and CT are useful in diagnosing colonic intramural hematoma. The optimal treatment should be individualized according to different etiologies causing hematoma.


Assuntos
Doenças do Colo/diagnóstico por imagem , Doenças do Colo/terapia , Hematoma/diagnóstico por imagem , Hematoma/terapia , Dor Abdominal/etiologia , Adenocarcinoma/complicações , Adenocarcinoma/diagnóstico por imagem , Adenocarcinoma/cirurgia , Idoso , Anticoagulantes/efeitos adversos , Colectomia , Doenças do Colo/etiologia , Neoplasias do Colo/complicações , Neoplasias do Colo/diagnóstico por imagem , Neoplasias do Colo/cirurgia , Colonoscopia , Constipação Intestinal/etiologia , Hidratação , Hematoma/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Nutrição Parenteral , Tomografia Computadorizada por Raios X
3.
Isr Med Assoc J ; 22(3): 154-159, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32147979

RESUMO

BACKGROUND: Guidelines recommend initiation of parenteral biologic or oral target-specific disease-modifying anti-rheumatic drugs (bDMARDs/tsDMARDs) in rheumatoid arthritis (RA) patients who do not adequately respond to conventional DMARDs. OBJECTIVES: To compare the preferred route of administration of bDMARDs or tsDMARDs in RA patients who were previously treated with at least one type. METHODS: A cross-sectional survey was conducted of consecutive RA patients previously prescribed bDMARDs or tsDMARDs. We analyzed the factors associated with patients' preferred route of administration. RESULTS: The cohort included 95 patients, mostly female (72.6%), seropositive (81.05%), mean age 63.4 ± 11.9 years. The oral route was preferred by 39 patients (41%) and 56 (59%) preferred the parenteral route. Most patients (65.9%) preferred to continue with their current route (P < 0.001). Switching from a current route was less common with patients who were currently using the oral route (13.3% vs. 38.2%, P = 0.04). Many patients (53.8%) who preferred the oral route had never experienced it before, while this was rare (3.6%) regarding the parenteral route (P = 0.0001). Employment status was associated with preference of the subcutaneous route over the intravenous route of bDMARDs (P = 0.01). Of the 21 patients who had previously experienced both parenteral and oral treatment, 16 (76.2%) preferred the oral route. CONCLUSIONS: RA patients preferred to continue treatment with an administration route they have already experienced. However, when choosing an unexperienced route, significantly more patients preferred the oral route. Our results strengthen the understanding of patient preferences, which could improve drug adherence, compliance, and disease outcome.


Assuntos
Antirreumáticos/administração & dosagem , Artrite Reumatoide/tratamento farmacológico , Produtos Biológicos/administração & dosagem , Nutrição Parenteral/estatística & dados numéricos , Preferência do Paciente/estatística & dados numéricos , Administração Oral , Adulto , Idoso , Idoso de 80 Anos ou mais , Antirreumáticos/uso terapêutico , Produtos Biológicos/uso terapêutico , Estudos de Coortes , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários
4.
Artigo em Alemão | MEDLINE | ID: mdl-32069478

RESUMO

The German Society for Nutritional Medicine has recently updated its guideline on clinical nutrition in critically ill patients thereby cooperating with seven other national medical societies. This article provides readers with a concise overview on selected key aspects of this guideline relevant for clinical practice. We will discuss some issues in detail such as the determination of energy expenditure and of calorie and protein intake, the choice of the route of administration (enteral or parenteral), and the handling of micronutrients.


Assuntos
Cuidados Críticos , Nutrição Enteral , Estado Terminal , Ingestão de Energia , Humanos , Necessidades Nutricionais , Nutrição Parenteral , Guias de Prática Clínica como Assunto
6.
Medicine (Baltimore) ; 99(3): e18778, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32011471

RESUMO

BACKGROUND: Whether combined parenteral nutrition (PN) and enteral nutrition (EN) is superior to EN alone remains controversial. OBJECTIVES: This study aimed to evaluate the efficacy and safety of combined PN and EN versus EN alone for critically ill patients based on published randomized controlled trials (RCTs). DATA SOURCES: Studies designed as RCTs evaluating the treatment effectiveness of combined PN and EN versus EN alone for critically ill patients were identified from PubMed, Embase, and the Cochrane Library from inception to April 2019. METHODS: The pooled relative risks and weighted mean differences with corresponding 95% confidence intervals were calculated using the random-effects model. Twelve RCTs recruiting a total of 5609 adults and 1440 children were selected for the final meta-analysis. RESULTS: The summary relative risks indicated that combined PN and EN was not associated with the risk of all-cause mortality, respiratory infection, urinary tract infection, and nutrition-related complications. Moreover, combined PN and EN was associated with longer hospital stay and higher albumin and prealbumin levels compared with EN alone. No significant differences were, however, found between combined PN and EN and EN alone in terms of ventilatory support, intensive care unit stay, and transferrin and C-reactive protein levels. CONCLUSIONS: This study showed that combined PN and EN significantly increased hospital stay duration and albumin and prealbumin levels compared with EN alone for critically ill patients. Large-scale RCTs should be conducted to compare the treatment effectiveness of combined PN and EN versus EN alone for critically ill patients due to a specific cause.


Assuntos
Estado Terminal/terapia , Nutrição Enteral , Nutrição Parenteral , Nutrição Enteral/métodos , Humanos , Nutrição Parenteral/métodos , Ensaios Clínicos Controlados Aleatórios como Assunto
7.
Einstein (Sao Paulo) ; 18: AE4530, 2020.
Artigo em Inglês, Português | MEDLINE | ID: mdl-32049129

RESUMO

The nutritional status of patients submitted to hematopoietic stem cell transplant is considered an independent risk factor, which may influence on quality of life and tolerance to the proposed treatment. The impairment of nutritional status during hematopoietic stem cell transplant occurs mainly due to the adverse effects resulting from conditioning to which the patient is subjected. Therefore, adequate nutritional evaluation and follow-up during hematopoietic stem cell transplant are essential. To emphasize the importance of nutritional status and body composition during treatment, as well as the main characteristics related to the nutritional assessment of the patient, the Brazilian Consensus on Nutrition in Hematopoietic Stem Cell Transplant: Adults was prepared, aiming to standardize and update Nutritional Therapy in this area. Dietitians, nutrition physicians and hematologists from 15 Brazilian centers thar are references in hematopoietic stem cell transplant took part.


Assuntos
Transplante de Células-Tronco Hematopoéticas/normas , Terapia Nutricional/normas , Estado Nutricional , Adulto , Antropometria , Brasil , Transplante de Células-Tronco Hematopoéticas/efeitos adversos , Humanos , Avaliação Nutricional , Terapia Nutricional/métodos , Nutrição Parenteral/métodos , Nutrição Parenteral/normas , Condicionamento Pré-Transplante
8.
Crit Care ; 24(1): 35, 2020 Feb 04.
Artigo em Inglês | MEDLINE | ID: mdl-32019607

RESUMO

Nutrition therapy during critical illness has been a focus of recent research, with a rapid increase in publications accompanied by two updated international clinical guidelines. However, the translation of evidence into practice is challenging due to the continually evolving, often conflicting trial findings and guideline recommendations. This narrative review aims to provide a comprehensive synthesis and interpretation of the adult critical care nutrition literature, with a particular focus on continuing practice gaps and areas with new data, to assist clinicians in making practical, yet evidence-based decisions regarding nutrition management during the different stages of critical illness.


Assuntos
Estado Terminal , Apoio Nutricional , Adulto , Cuidados Críticos/normas , Estado Terminal/terapia , Nutrição Enteral/normas , Humanos , Estado Nutricional , Apoio Nutricional/normas , Nutrição Parenteral/normas
9.
J Zoo Wildl Med ; 50(4): 853-860, 2020 Jan 09.
Artigo em Inglês | MEDLINE | ID: mdl-31926515

RESUMO

Parenteral nutrition (PN) is one method of providing nutrient support to hospitalized, nondomestic ruminants that have a decreased appetite in hospital or have high metabolic demands caused by illness. There are a limited number of published reports of the use of PN in nondomestic ruminants. A retrospective evaluation of PN use in adult (>6 mo of age) hospitalized ruminants at the San Diego Zoo Safari Park was conducted from 2014 to 2018 (n = 24). Discharge rate for animals that received PN was 34%. Poor survival was likely caused by case selection of animals that had severe disease or malnutrition necessitating the need for PN. Common metabolic changes among the study animals included the following: hypokalemia, hyperglycemia, and hyperphosphatemia or hypophosphatemia. Bivariable analysis revealed no clinically significant factors that influenced odds of survival. There was little evidence of adverse effects with the administration of PN during the study period. Parenteral nutrition requires specialized equipment and technical skills, but is a viable means of nutrient support for hospitalized nondomestic ruminants.


Assuntos
Nutrição Parenteral/veterinária , Ruminantes , Doenças dos Animais/mortalidade , Doenças dos Animais/terapia , Animais , Animais de Zoológico , Feminino , Masculino , Estudos Retrospectivos , Fatores de Risco , Especificidade da Espécie
10.
Medicine (Baltimore) ; 99(2): e18539, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31914027

RESUMO

The purpose of this study was to determine the factors associated with parenteral nutrition-associated liver disease (PNALD) in infants who underwent surgery for necrotizing enterocolitis (NEC) and followed up the postoperative outcomes for long term parenteral nutrition (PN).This study included a retrospective review of 87 infants with NEC and managed surgically from July 2007 to May 2017 at the Children's Hospital, Chongqing Medical University. Clinical data and procedure information were collected and analyzed.Among the infants included, 16.1% of patients developed PNALD. Multivariable logistic regression analysis revealed progressive clinical deterioration (OR, 5.47; 95% CI, 1.10-26.96; P = .037) was independent risk factor for PNALD whereas congenital heart disease (OR, 0.068; 95% CI, 0.008-0.55; P = .012) presentation served as a protective factor.The current data suggested the distinct disease process for cardiac patients with NEC, which might help in the prevention and treatment of PNALD for patients with NEC.


Assuntos
Enterocolite Necrosante/complicações , Enterocolite Necrosante/cirurgia , Hepatopatias/etiologia , Nutrição Parenteral/efeitos adversos , Enterocolite Necrosante/dietoterapia , Enterocolite Necrosante/mortalidade , Feminino , Idade Gestacional , Cardiopatias Congênitas/epidemiologia , Cardiopatias Congênitas/mortalidade , Humanos , Doença Iatrogênica/epidemiologia , Doença Iatrogênica/prevenção & controle , Incidência , Lactente , Recém-Nascido , Hepatopatias/diagnóstico , Hepatopatias/epidemiologia , Masculino , Estudos Retrospectivos , Fatores de Risco
11.
Dev Med Child Neurol ; 62(1): 48-56, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31313290

RESUMO

AIM: To give evidence-based recommendations on the application of ketogenic diet parenteral nutrition (KD-PN) in emergency situations. METHOD: An international group of experts (n=14) researched the literature and distributed a survey among 150 expert centers. International accepted guidelines (European Society for Clinical Nutrition and Metabolism/European Society for Paediatric Gastroenterology Hepatology and Nutrition and the American Society for Parenteral and Enteral Nutrition) and handbooks for parenteral nutrition were considered general standards of care. RESULTS: In the literature, we identified 35 reports of patients treated by KD-PN. International guidelines and handbooks provided some conflicting information. Twenty-four expert teams from nine countries responded to the survey, reflecting the limited clinical experience. INTERPRETATION: This paper highlights 23 consensus-based recommendations for safe and effective KD-PN (e.g. diet initiation, calculation, application, monitoring, and evaluation) based on the best evidence available and expert opinions. WHAT THIS PAPER ADDS: In acute settings, ketogenic diet therapy (KDT) can be administered parenterally. Parenteral administration of KDT should be started only at the intensive care unit. Initiate ketogenic parenteral nutrition stepwise to the highest ratio possible with the lowest level of complications. Evaluate the risk-benefit ratio of parenteral administration continuously. Restart enteral feeding as soon as appropriate.


Assuntos
Doença Aguda/terapia , Cuidados Críticos/normas , Dieta Cetogênica/normas , Nutrição Parenteral/normas , Guias de Prática Clínica como Assunto/normas , Criança , Humanos
12.
J Surg Res ; 245: 217-224, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31421366

RESUMO

BACKGROUND: Gastroschisis is an increasingly common congenital abdominal wall defect. Due to advances in neonatal critical care and early surgical management, mortality from gastroschisis and associated complications has decreased to less than 10% in most series. However, it has been recognized that the outcome of gastroschisis has a spectrum and that the disorder affects a heterogeneous cohort of neonates. The goal of this study is to predict morbidity and mortality in neonates with gastroschisis using clinically relevant variables. METHODS: A multicenter, retrospective observational study of neonates born with gastroschisis was conducted. Neonatal characteristics and outcomes were collected and compared. Prediction of morbidity and mortality was performed using multivariate clinical models. RESULTS: Five hundred and sixty-six neonates with gastroschisis were identified. Overall survival was 95%. Median hospital length of stay was 37 d. Sepsis was diagnosed in 107 neonates. Days on parenteral nutrition and mechanical ventilation were considerable with a median of 27 and 5 d, respectively. Complex gastroschisis (atresia, perforation, volvulus), preterm delivery (<37 wk), and very low birth weight (<1500 g) were associated with worse clinical outcomes including increased sepsis, short bowel syndrome, parenteral nutrition days, and length of stay. The composite metric of birth weight, Apgar score at 5 min, and complex gastroschisis was able to successfully predict mortality (area under the curve, 0.81). CONCLUSIONS: Clinical variables can be used in gastroschisis to distinguish those who will survive from nonsurvivors. Although these findings need to be validated in other large multicenter data sets, this prognostic score may aid practitioners in the identification and management of at-risk neonates.


Assuntos
Gastrosquise/mortalidade , Sepse/epidemiologia , Síndrome do Intestino Curto/epidemiologia , Índice de Apgar , Estudos de Viabilidade , Feminino , Gastrosquise/complicações , Gastrosquise/terapia , Idade Gestacional , Humanos , Recém-Nascido de Baixo Peso , Recém-Nascido , Recém-Nascido Prematuro , Tempo de Internação/estatística & dados numéricos , Masculino , Nutrição Parenteral/estatística & dados numéricos , Prognóstico , Respiração Artificial/estatística & dados numéricos , Estudos Retrospectivos , Medição de Risco/métodos , Fatores de Risco , Sepse/etiologia , Síndrome do Intestino Curto/etiologia , Taxa de Sobrevida
14.
Rev. méd. Urug ; 35(4): 316-324, dic. 2019. tab, fig
Artigo em Espanhol | LILACS | ID: biblio-1026161

RESUMO

Cuando la falla intestinal ocurre luego de una resección intestinal masiva se denomina síndrome de intestino corto. Es una entidad rara, con un espectro clínico que va desde una disfunción leve y reversible hasta una condición grave e incapacitante. Presenta una elevada morbimortalidad, altos costos de atención médica e importante impacto en la calidad de vida. El 50% de los pacientes con síndrome de intestino corto no se adaptan espontáneamente ni mejoran la absorción por el intestino remanente, por lo que deben recurrir de por vida a la nutrición parenteral. La terapia nutricional especializada y el tratamiento hormonal focalizado en el intestino son pilares en la rehabilitación promoviendo la adaptación intestinal, logrando independencia de la nutrición parenteral y evitando el trasplante intestinal. Actualmente, teduglutide es el tratamiento de referencia en estos pacientes, pero hasta el momento inaccesible en Uruguay por su elevado costo. Presentamos el único caso en nuestro país de un paciente de 23 años portador de falla intestinal crónica por síndrome de intestino corto que depende de la nutrición parenteral desde hace 17 años y presenta complicaciones graves asociadas a esta técnica.


Short bowel syndrome consists of intestinal failure after a massive intestinal resection. It is an unusual condition, ranging from a mild and reversible malfunction to a severe condition causing inability. Short bowel syndrome has high morbimortality, high medical costs and a significant impact on quality of life. 50% of patients with short bowel syndrome do not spontaneously adapt and neither does absorption improve by the remaining intestine, thus they depend on parenteral nutrition for the rest of their lives. Specialized nutritional therapy and focalized hormone therapy in the intestine are pillars in rehabilitation. They promote intestine adaptation and achieve independence from parenteral nutrition and avoid intestinal transplant. Today, Teduglutide is the reference treatment for these patients, although it is still not available in Uruguay due to its high cost. The study presents a 23 year old patient carrier of chronic intestinal failure due to short bowel syndrome who has depended on parenteral nutrition for 17 years and presents severe complications associated to this technique.


Quando a falência intestinal ocorre depois de uma ressecção intestinal massiva é chamada Síndrome de intestino curto. É uma entidade rara, com um espectro clínico que pode manifestar-se por uma disfunção leve e reversível até um quadro grave e incapacitante. Apresenta alta morbimortalidade, altos custos de atenção médica e grande impacto sobre a qualidade de vida do paciente. 50% dos pacientes com síndrome de intestino curto não se adaptam espontaneamente nem conseguem uma melhoria da absorção pelo intestino restante sendo obrigados a utilizar nutrição parenteral de forma permanente. A terapia nutricional especializada e o tratamento hormonal focado no intestino são as bases da reabilitação promovendo a adaptação intestinal, diminuindo a dependência da nutrição parenteral e evitando o transplante intestinal. Atualmente o Teduglutide é o tratamento de referência para estes pacientes, porém devido ao seu elevado custo não é acessível aos pacientes no Uruguai. Apresentamos o único caso no país, de um paciente de 23 anos portador de falência intestinal crônica por síndrome de intestino curto que depende de nutrição parenteral há 17 anos e apresenta complicações graves associadas a esta técnica.


Assuntos
Adulto , Síndrome do Intestino Curto/complicações , Nutrição Parenteral
15.
Cochrane Database Syst Rev ; 2019(10)2019 10 31.
Artigo em Inglês | MEDLINE | ID: mdl-31684690

RESUMO

BACKGROUND: Early enteral nutrition support (within 48 hours of admission or injury) is frequently recommended for the management of patients in intensive care units (ICU). Early enteral nutrition is recommended in many clinical practice guidelines, although there appears to be a lack of evidence for its use and benefit. OBJECTIVES: To evaluate the efficacy and safety of early enteral nutrition (initiated within 48 hours of initial injury or ICU admission) versus delayed enteral nutrition (initiated later than 48 hours after initial injury or ICU admission), with or without supplemental parenteral nutrition, in critically ill adults. SEARCH METHODS: We searched CENTRAL (2019, Issue 4), MEDLINE Ovid (1946 to April 2019), Embase Ovid SP (1974 to April 2019), CINAHL EBSCO (1982 to April 2019), and ISI Web of Science (1945 to April 2019). We also searched Turning Research Into Practice (TRIP), trial registers (ClinicalTrials.gov, ISRCTN registry), and scientific conference reports, including the American Society for Parenteral and Enteral Nutrition and the European Society for Clinical Nutrition and Metabolism. We applied no restrictions by language or publication status. SELECTION CRITERIA: We included all randomized controlled trials (RCTs) that compared early versus delayed enteral nutrition, with or without supplemental parenteral nutrition, in adults who were in the ICU for longer than 72 hours. This included individuals admitted for medical, surgical, and trauma diagnoses, and who required any type of enteral nutrition. DATA COLLECTION AND ANALYSIS: Two review authors extracted study data and assessed the risk of bias in the included studies. We expressed results as risk ratios (RR) for dichotomous data, and as mean differences (MD) for continuous data, both with 95% confidence intervals (CI). We assessed the certainty of the evidence using GRADE. MAIN RESULTS: We included seven RCTs with a total of 345 participants. Outcome data were limited, and we judged many trials to have an unclear risk of bias in several domains. Early versus delayed enteral nutrition Six trials (318 participants) assessed early versus delayed enteral nutrition in general, medical, and trauma ICUs in the USA, Australia, Greece, India, and Russia. Primary outcomes Five studies (259 participants) measured mortality. It is uncertain whether early enteral nutrition affects the risk of mortality within 30 days (RR 1.00, 95% CI 0.16 to 6.38; 1 study, 38 participants; very low-quality evidence). Four studies (221 participants) reported mortality without describing the timeframe; we did not pool these results. None of the studies reported a clear difference in mortality between groups. Three studies (156 participants) reported infectious complications. We were unable to pool the results due to unreported data and substantial clinical heterogeneity. The results were inconsistent across studies. One trial measured feed intolerance or gastrointestinal complications; it is uncertain whether early enteral nutrition affects this outcome (RR 0.84, 95% CI 0.35 to 2.01; 59 participants; very low-quality evidence). Secondary outcomes One trial assessed hospital length of stay and reported a longer stay in the early enteral group (median 15 days (interquartile range (IQR) 9.5 to 20) versus 12 days (IQR 7.5 to15); P = 0.05; 59 participants; very low-quality evidence). Three studies (125 participants) reported the duration of mechanical ventilation. We did not pool the results due to clinical and statistical heterogeneity. The results were inconsistent across studies. It is uncertain whether early enteral nutrition affects the risk of pneumonia (RR 0.77, 95% CI 0.55 to 1.06; 4 studies, 192 participants; very low-quality evidence). Early enteral nutrition with supplemental parenteral nutrition versus delayed enteral nutrition with supplemental parenteral nutrition We identified one trial in a burn ICU in the USA (27 participants). Primary outcomes It is uncertain whether early enteral nutrition with supplemental parenteral nutrition affects the risk of mortality (RR 0.74, 95% CI 0.25 to 2.18; very low-quality evidence), or infectious complications (MD 0.00, 95% CI -1.94 to 1.94; very low-quality evidence). There were no data available for feed intolerance or gastrointestinal complications. Secondary outcomes It is uncertain whether early enteral nutrition with supplemental parenteral nutrition reduces the duration of mechanical ventilation (MD 9.00, 95% CI -10.99 to 28.99; very low-quality evidence). There were no data available for hospital length of stay or pneumonia. AUTHORS' CONCLUSIONS: Due to very low-quality evidence, we are uncertain whether early enteral nutrition, compared with delayed enteral nutrition, affects the risk of mortality within 30 days, feed intolerance or gastrointestinal complications, or pneumonia. Due to very low-quality evidence, we are uncertain if early enteral nutrition with supplemental parenteral nutrition compared with delayed enteral nutrition with supplemental parenteral nutrition reduces mortality, infectious complications, or duration of mechanical ventilation. There is currently insufficient evidence; there is a need for large, multicentred studies with rigorous methodology, which measure important clinical outcomes.


Assuntos
Estado Terminal/terapia , Nutrição Enteral/métodos , Nutrição Parenteral/métodos , Terapia Combinada/métodos , Humanos , Unidades de Terapia Intensiva , Desnutrição/prevenção & controle , Ensaios Clínicos Controlados Aleatórios como Assunto , Fatores de Tempo
16.
Pediatrics ; 144(6)2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31767714

RESUMO

Aluminum has no known biological function; however, it is a contaminant present in most foods and medications. Aluminum is excreted by the renal system, and patients with renal diseases should avoid aluminum-containing medications. Studies demonstrating long-term toxicity from the aluminum content in parenteral nutrition components led the US Food and Drug Administration to implement rules for these solutions. Large-volume ingredients were required to reduce the aluminum concentration, and small-volume components were required to be labeled with the aluminum concentration. Despite these rules, the total aluminum concentration from some components continues to be above the recommended final concentration. The concerns about toxicity from the aluminum present in infant formulas and antiperspirants have not been substantiated but require more research. Aluminum is one of the most effective adjuvants used in vaccines, and a large number of studies have documented minimal adverse effects from this use. Long-term, high-concentration exposure to aluminum has been linked in meta-analyses with the development of Alzheimer disease.


Assuntos
Alumínio/efeitos adversos , Soluções/química , Adjuvantes Farmacêuticos/química , Alumínio/análise , Alumínio/farmacocinética , Doença de Alzheimer , Antiperspirantes/química , Criança , Soluções para Diálise/química , Contaminação de Medicamentos/legislação & jurisprudência , Rotulagem de Medicamentos/legislação & jurisprudência , Regulamentação Governamental , Humanos , Lactente , Fórmulas Infantis/química , Recém-Nascido , Recém-Nascido Prematuro , Rim/metabolismo , Nefropatias/metabolismo , Nutrição Parenteral , Soluções/normas , Estados Unidos , United States Food and Drug Administration , Vacinas/química
17.
Ned Tijdschr Geneeskd ; 1632019 10 01.
Artigo em Holandês | MEDLINE | ID: mdl-31580037

RESUMO

Iron deficiency anaemia is a common problem. The majority of patients are treated with oral iron supplements. The current recommended dosage for oral supplementation of 200 mg ferrous fumarate 3x per day however, is based on a single small study of poor quality. There is no consensus concerning parenteral dosing. In recent years, new insights have been gained regarding both the dosage of oral supplementation and the indication for parenteral supplementation. Oral therapy is preferred. In principle, 100 mg ferrous fumarate once a day is sufficient for the treatment of symptom-free patients with anaemia. In cases of severe anaemia, or in patients with symptoms, 200 mg/day should be prescribed. If side effects appear, it can be dosed every other day. Where oral therapy does not show effectiveness, the anaemia is severe, or rapid increase of haemoglobin is indicated, parenteral supplementation should be chosen. Parenteral supplementation is more effective than oral supplementation in specific conditions, such as dialysis-dependent renal insufficiency, heart failure or active IBD.


Assuntos
Anemia Ferropriva/terapia , Suplementos Nutricionais , Compostos Ferrosos/administração & dosagem , Nutrição Parenteral/métodos , Administração Oral , Esquema de Medicação , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Nutrição Parenteral/normas , Diálise Renal/métodos
18.
Artigo em Inglês | MEDLINE | ID: mdl-31594655

RESUMO

New diagnostic techniques have advanced our knowledge about the irritable bowel syndrome. The majority of patients that we believed to have a psychosomatic disorder have received other diagnoses explaining their symptoms. Endoscopy makes it possible to diagnose celiac disease before it leads to malnutrition and allows the detection of microscopic colitis as a cause of watery diarrhea. At the severe end of the symptom spectrum enteric dysmotility marks the border at which IBS ceases to be a functional disorder and becomes a genuine motility disorder. Joint hypermobility or Ehlers-Danlos syndrome is present in a substantial proportion of patients with enteric dysmotility. Chronic intestinal pseudo-obstruction is the end-stage of a large number of very rare disorders in which failed peristalsis is the common denominator. Nutritional needs and symptom control are essential in the management of pseudo-obstruction. Home parenteral nutrition is life saving in more than half of patients with chronic intestinal pseudo-obstruction.


Assuntos
Pseudo-Obstrução Intestinal/fisiopatologia , Síndrome do Intestino Irritável/fisiopatologia , Nutrição Parenteral/métodos , Humanos
19.
Rev Assoc Med Bras (1992) ; 65(9): 1151-1155, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31618329

RESUMO

This report describes the post-bariatric-surgery evolution of an obese patient who had low adherence to the diet and micronutrient supplementation. Four years after two bariatric surgeries, the patient was admitted due to transient loss of consciousness, slow thinking, anasarca, severe hypoalbuminemia, in addition to vitamin and mineral deficiencies. She had subcutaneous foot abscess but did not present fever. Received antibiotics, vitamins A, D, B12, thiamine, calcium, and parenteral nutrition. After hospitalization (twenty-eight days), there was a significant body weight reduction probably due to the disappearance of clinical anasarca. Parenteral nutrition was suspended after twenty-five days, and the oral diet was kept fractional. After hospitalization (weekly outpatient care), there was a gradual laboratory data improvement, which was now close to the reference values. Such outcome shows the need for specialized care in preventing and treating nutritional complications after bariatric surgeries as well as clinical manifestations of infection in previously undernourished patients.


Assuntos
Cirurgia Bariátrica , Desnutrição Proteico-Calórica/complicações , Infecções Estreptocócicas/complicações , Adulto , Deficiência de Vitaminas/complicações , Deficiência de Vitaminas/terapia , Cirurgia Bariátrica/efeitos adversos , Feminino , Humanos , Nutrição Parenteral , Complicações Pós-Operatórias , Desnutrição Aguda Grave/complicações , Desnutrição Aguda Grave/etiologia , Desnutrição Aguda Grave/terapia , Cooperação e Adesão ao Tratamento
20.
Nutr. hosp ; 36(5): 1150-1156, sept.-oct. 2019. tab, graf, ilus
Artigo em Espanhol | IBECS | ID: ibc-184639

RESUMO

Objetivo: evaluar el impacto de la inmunonutrición oral preoperatoria y postoperatoria en la prevención de la desnutrición y las complicaciones posquirúrgicas en cáncer colorrectal. Pacientes y método: estudio retrospectivo descriptivo observacional con una única cohorte. Se incluyeron todos los pacientes sometidos a cirugía por cáncer colorrectal desde junio de 2014 a diciembre de 2015, sin ningún criterio de exclusión. En un pequeño número de casos (28 pacientes) no se suministró suplementación nutricional oral y se consideran pérdidas del estudio. Se realizó una evaluación del estado nutricional preoperatorio (NSR-2002). Se pautó inmunonutrición durante los cinco o diez días previos a la intervención en función del resultado. En el postoperatorio, se añadió inmunonutrición al tercer día postoperatorio hasta el séptimo o hasta el alta hospitalaria. Los pacientes con albúmina < 2,5 g/dl o íleo prolongado recibieron nutrición parenteral. El análisis de los datos se realizó con el paquete estadístico SPSS 21.0. Resultados: se incluyeron 220 pacientes con cáncer colorrectal, de los cuales 28 fueron pérdidas del estudio. La suplementación preoperatoria mejoró significativamente las cifras de prealbúmina y transferrina al ingreso. En el postoperatorio recibieron nutrición enteral 121 pacientes y 41 nutrición parenteral. Los pacientes que no tomaron suplementos nutricionales preoperatorios tuvieron más complicaciones (50% vs. 28,1%; p = 0,019) y la estancia media fue superior (14,64 ± 11,86 vs. 9,36 ± 5,5; p < 0,005). Los pacientes que no tomaron suplementos en el postoperatorio tuvieron más complicaciones (24% vs. 18,2%; p < 0,005), destacando más infección de herida (1,9% vs. 0,8%) y más dehiscencia anastomótica (1,9% vs. 0,8%). Tuvieron también una estancia media superior (9,15 ± 4,6 vs. 7,57 ± 2,5 días; p = 0,021). Conclusión: la administración de suplementos nutricionales orales previo a la intervención y en el postoperatorio en la cirugía del cáncer colorrectal se ha asociado a menos complicaciones y estancia media


Introduction: the aim of the study is to evaluate the effect of preoperative and postoperative oral nutritional therapy in the prevention of malnutrition and postsurgical complications in colorectal cancer Patients and methods: patients who underwent oncological colorectal surgery between June 2014 and December 2015 are included. An evaluation of preoperative nutritional status is performed. Patients received IMPACT(R) (2/day) for 5-10 days previous surgery. In the postoperative period, patients received IMPACT(R)/24h from 3rd to 7th postoperative day. Patients with low rates of albumin (< 2.5) or postoperative ileus received parenteral nutrition. Data were analyzed with the statistical package SPSS 21.0. Results: two hundred and twenty colorectal cancer patients were included. Twenty-eight patients did not take the preoperative oral supplements. Following the intake of nutritional supplements, an improvement of prealbumin and transferrin was noticed. One hundred and twenty-one patients received oral nutrition and 41 received parenteral nutrition in the postoperative period. There were more postoperative complications among patients without preoperative nutritional supplements (50% vs 28.1%; p = 0.019), and hospital stay was higher 14.64 ± 11.86 vs 9.36 ± 5.5; p < 0.005). There were more complications among patients without postoperative oral nutritional supplements (24% vs 18.2%; p < 0.005), with more wound infection (1.9% vs 0.8%) and leaks (1.9% vs 0.8%). They also had a higher average stay (9.15 4.6 vs 7.57 2.5 days; p = 0.021). Conclusion: in our study, patients that received oral nutritional supplements prior and following colorectal surgery had a lower rate of complications and a shorter hospital stay


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Estado Nutricional/imunologia , Cirurgia Colorretal , Desnutrição/prevenção & controle , Complicações Pós-Operatórias/prevenção & controle , Suplementos Nutricionais , Apoio Nutricional , Neoplasias Colorretais/cirurgia , Estudos Retrospectivos , Nutrição Parenteral/métodos , Soluções de Nutrição Parenteral , Desnutrição/imunologia
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