Nutrición hospitalaria : organo oficial de la Sociedad Española de Nutrición Parenteral y Enteral
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Observational Study
[Study of two variants of nutritional risk score “NUTRIC” in ventilated critical patients].
The NUTRIC score was proposed to assess the risk of adverse events potentially modifiable through nutritional intervention in critically ill patients. This score uses interleukin-6 (IL-6), a biomarker not always available. ⋯ The two studied variants of the NUTRIC score behaved similarly to the original NUTRIC score. The addition of the CRP improves the score performance and may be an alternative to IL-6, if it is not available.
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Neurocritical patients have a metabolic condition that makes them particularly sensitive to protein-caloric malnutrition in a short period of time. Due to this, it is essential nutritional support treatment. But the neurocritical patient has physiological connotations that makes it difficult to be able to establish an early nutrition: persistent gastroparesis for days and exacerbated metabolic response with hyperglycemia is a challenge to the therapist. This review intends to respond to nutritional difficulties in neurocritical patients and also review pharmaco-nutritients that may be helpful for the subsequent clinical course.
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Randomized Controlled Trial
[The metoclopramide effect on enteral nutrition tolerance and mechanical ventilation associated pneumonia in neuro critically ill patients].
The use of procinéticos in the critical patient with nutrition enteral, they have as aim reduce the increase of the gastric residue (RG). We evaluate his efficiency in the improvement of the intake enteral and on the reduction in the incident gastrointestinal complications (CGI) and pneumonia, in critical patients, with neurological injury Aims: To evaluate the effects in the administration metoclopramide (MCG), during the first five days with enteral nutrition, versus control (GC), on the volume of administered diet, gastrointestinal complications and the incidence of mechanical ventilation associated pneumonia (NAVM), in neuro-critically patients (NC) of traumatic and vascular aetiology. Prospective, closed-label, randomized study performed in an intensive Care Unit. Methords: 150 adult neuro-critical patients (NC) were admitted of consecutive form and 109 were randomly and two groups 58 MCG y 51 GC. The primary outcomes was the nutritional: the volume of administered diet (VAD); mean efficacious volume (MEV) measured in three consecutive periods of time; the gastrointestinal complications (GIC), and the rate of partial and definitive suspension of the diet. Infecction: incidence of ventilator associated pneumonia NAVM; and of secondary outcomes were: the duration of mechanical ventilation, length of ICU and hospital stay, and incidence the serious sequelae, and 30 days mortality. ⋯ The metoclopramida in the NC, it is not effective in the decrease of the CGI, in the doses and time of treatment reflected in the study.
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Prolonged Total Parental Nutrition (TPN) is associated with life-threatening complications in the pediatric population, being cholestasis one of the most important ones. The source of fatty acids, the amount of phytosterols and the dose of lipids in the nutritional support, have been linked to the development of this complication. ⋯ Our study suggests that the use of OmegavenR in pediatric patients with TPN and DB ≥ 2 mg/dL, seem to reverse or improve cholestasis while in patients with abnormal liver tests we still don't have clear effect.
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Observational Study
[Analysis of the nutritional parameters and adjustment of the requirements of the initial parenteral nutrition in post surgical critically ill patients].
To analyze nutritional parameters in critical post-surgical patients under stressful conditions, their evolution, and to assess the degree of adjustment of initial parenteral nutrition (PN) to the requirements set for in the recently published recommendations. ⋯ Nutritional support is essential, particularly in those patients with a significant level of hyponutrition before surgical intervention, low weighed patients, or in those submitted to gastrointestinal surgery. In our study, baseline PN prescriptions were adjusted to recent recommendations in more than half of the patients; however, in patients with low weight or low BMI we observed higher caloric-protein excess in the prescribed PN since the intake has not been reduced by individualizing it to the body weight. Standardization of PN formulations is a tool of quality and safety, although in these patients it should be individually assessed. More studies are needed to validate the clinical benefits of individualized nutritional intake in post-surgical critically ill patients.