[Optimisation of the prescription of medication for patients undergoing elective surgery]. / Optimización del circuito de prescripción de medicamentos en pacientes con cirugía electiva.

OBJECTIVE: To draw up a document in which patients can note down their residential treatment and determine its usefulness. The level of compliance and assessment of the document can be quantified by the healthcare personnel. METHOD: Initially the medical prescription process was analysed in the preoperative stage. Its usefulness was later evaluated, analysing the percentage of patients who could benefit from it, through a questionnaire for the healthcare personnel. RESULTS: A residential medication document was drawn up and included in the documentation process at the preoperative stage. From a sample of 350 patients, 76.0 % took medication at home and 81.2 % of those used the document. The health personnel rated its usefulness as 4.51 and the safety of it at 4.38 in a scale of 1 to 5. The time saved was valued at 4.37; 4 being a saving of between 0 and 5 minutes, and 5 being a saving of between 5 and 10 minutes. DISCUSSION: The home medication document could overcome the problem of knowing exactly the home medication itself, and this could be the first step in therapeutic conciliation. According to the assessment by the healthcare personnel, it improves the usefulness and the efficiency of the process. According to our data, the time saved by the medical staff and nursing personnel fluctuates between 93-310 and 122-339 hours per year, respectively. Computerised, up-to-date clinical records accessed by both primary and specialised care, could further optimise the prescription process of medication in the perioperative stages.

[Nitrogen losses and nitrogen balance in patients with malignant infarction of the median cerebral artery submitted to moderate hypothermia (32-33 degrees C)]. / Pérdidas de nitrógeno y balance nitrogenado en pacientes con infarto maligno de la arteria cerebral media y sometidos a hipotermia moderada (32-33 degrees C).

OBJECTIVES: Induction of moderate hypothermia in patients with median cerebral artery (MCA) infarction may produce metabolic and nutritional impairments. Currently, we do not know which is the best method to carry out nutritional assessment in this population group. The aim of the present study was to assess the usefulness of nitrogen balance in the follow-up of patients with MCA submitted to moderate hypothermia (32-33 degrees C) by means of intravascular cooling at the Neurocritical Patients Unit at a tertiary hospital. MATERIAL AND METHODS: We designed a retrospective study including patients with MCA infarction of whom we gathered bio-demographical, clinical, hypothermia, and nutritional variables. Similarly, we carried out a prospective follow-up of a patient with MCA infarction and induced hypothermia, gathering the same variables at different time points of his clinical course. RESULTS: Six patients with MCA infarction submitted to moderate hypothermia for a mean duration of 12 days (interval 9-15) were included in the retrospective series. We observed that nitrogen losses (mean 9.9 g) were lower than those previously thought for critical patients during the acute phase. During the prospective follow-up of the patient with malignant infarction of the MCA from day 1 to day 22 after the application of hypothermia, low levels of nitrogen losses were similarly observed during the phase of induced hypothermia, which increased later on when the patient recovered normothermia. The mean nitrogen expenditure during the period of hypothermia was 10.7 g and increased up to 27.3 g during the normothermia period (day 17). CONCLUSIONS: These results suggest that moderate hypothermia-induced metabolic suppression is clinically relevant and thus the determination of nitrogen balance does not seem to be a useful tool in the nutritional followup of this type of patients.

[The contamination of enteral nutrition in critical patients]. / Contaminación de nutriciones enterales en pacientes críticos.

Some previous studies have shown that administration of contaminated enteral diets may produce nosocomial infections in critical patients. There is a series of factors in these patients which may enhance the risk of clinical complications deriving from the administration of enteral nutrition (EN) contaminated by microorganisms (alteration of the immunological state, increased stomach pH, reduced intestinal motility, reduced mucosa production, etc.). This study examines EN contamination in critical patients admitted to the ICU of the Hospital Universitario de Traumatología y Rehabilitación de las C. S. Vall d'Hebron, suffering from cranial-encephalic traumatism and/or multiple traumatism. The data made it possible to create a working design which takes account of factors which may increase the risk of EN contamination. The work was done in three phases, involving different handling procedures (Phase 1, Phase 2 and Phase 3). The results of the three studies made it possible to describe a working method in which the following points are outstanding: handwashing with antiseptic soap prior to handling the EN, avoidance of reuse of containers (if necessary) for more than 24 hours, not to exceed 8 hours' perfusion of EN previously handled, and not to wash the container prior to adding new quantities of EN.