Nutrición hospitalaria : organo oficial de la Sociedad Española de Nutrición Parenteral y Enteral
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Comparative Study
[INFORNUT process: validation of the filter phase-FILNUT--and comparison with other methods for the detection of early hospital hyponutrition].
According to several series, hospital hyponutrition involves 30-50% of hospitalized patients. The high prevalence justifies the need for early detection from admission. There several classical screening tools that show important limitations in their systematic application in daily clinical practice. ⋯ Hyponutrition prevalence in our study (60%) is similar to that found by other authors. Hyponutrition is associated to increased mortality, hospital stay, and re-admission rate. There are no tools that have proven to be effective to show early hyponutrition at the hospital setting without important applicability limitations. FILNUT, as the first phase of the filter process of INFORNUT represents a valid tool: it has sensitivity and specificity for nutritional screening at admission. The main advantages of the process would be early detection of patients with risk for hyponutrition, having a teaching and sensitization function to health care staff implicating them in nutritional assessment of their patients, and doing a hyponutrition diagnosis and nutritional support need in the discharge report that would be registered by the Clinical Documentation Department. Therefore, INFORNUT would be a universal screening method with a good cost-effectiveness ratio.
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Neuromuscular pathology in the critically ill patient develops within two settings: primary neurological diseases that require admission in the Intensive Care Medicine Unit for close monitoring or mechanical ventilation, and peripheral nervous system manifestations secondary to critical systemic diseases. The most frequent conditions in the first group are Guillain-Barré syndrome and Myasthenia Gravis, and in the second group, polyneuropathy and myopathy of the critically ill patient. The most commonly shared clinical pattern is the development of severe weakness and quadriplegia which most typical manifestation is the need for assisted ventilation and/or weaning difficulty/impossibility. ⋯ Myopathy of the critically ill patient involves the muscle and provokes a generalized weakness with quadriplegia, very similar to that from polyneuropathy, which prevents or delays weaning from mechanical ventilation, and which may lead to CPK and myoglobin increase in more advanced stages, together with changes in neurophysiological examination. The findings of neurophysiological examination are difficult to differentiate from those encountered in polyneuropathy, although normal sensitive action potentials and reduction of motor action potentials with direct muscle stimulation may help in the differentiation. The functional prognosis of primary muscle impairments tends to be quite good, but both polyneuropathy and myopathy resolve very slowly along weeks or months, with the possibility of an important residual deficit within two years in the most severe cases.
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To communicate the information available by the NADYA-SENPE Working Group from patients on Home Enteral Nutrition (HEN) in our country during the year 2003. ⋯ We found a persistence of these treatment in our country. Neurological and neoplasic diseases were the more frequent diagnosis in patients analysed. The high prevalence of cancer patients could be the main cause of oral access for enteral nutrition. Change of enteral tube was the more frequent complication observed during this treatment.
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Comparative Study
[Estimation of height from leg lenght measured with tape measure].
Equations to predict height from several body segments have been developed. However, those that use the knee height are limited by the need of an instrument with high cost (anthropometer). Thus, the aim of this study was to develop a prediction equation from the leg length by using a tape measure. ⋯ Linear regression analysis was done to estimate the height in each gender and the results were tested on an independent sample. The generated equations achieved a very good correlation with the real height and the standard error was calculated. Thus, in those subjects in whom assessment of the real height is not possible by conventional means, it is possible to use height prediction equations from simple techniques and equipment accessible to the whole health care staff.
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Comparative Study
[Degree of nutritional training of intensive care physicians. A survey in public hospitals of Asunción].
Nutritional support in the critically ill patient is an important mainstay within the specialty of intensive care medicine. Patients at the Intensive Care Unit (ICU) are usually hypercatabolic and require an adequate nutritional support. Usually, the intensive care physician prescribes nutrition type, its amount, and follow-up of patients; however, the qualification of these physicians regarding clinical nutrition is unknown. ⋯ nutritional training in intensive care medicine is incomplete and the degree of knowledge on nutrition in the critically ill patient is insufficient, being lower in physicians with a limited practice in the ICU. These results suggest the urgent need for training on clinical nutrition of intensive care physicians for the care of the critically ill patient being complete.