Complicações metabólicas relacionadas à terapia de nutrição parenteral em pacientes hospitalizados / Metabolic complications related to parenteral nutrition therapy in hospitalized patients

Investigar as complicações metabólicas relacionadas à administração da terapia nutricional parenteral (TNP) e sua relação com o desfecho clínico de pacientes hospitalizados. Métodos: Estudo longitudinal retrospectivo realizado com pacientes internados em hospital público referência no atendimento de urgências e emergências da cidade de Goiânia no período de setembro de 2020 a fevereiro de 2021. A coleta de dados foi realizada por meio de consulta aos prontuários eletrônicos. As informações foram coletadas após o primeiro dia de uso da NP até o desfecho clínico -alta, óbito ou descontinuidade da NP. Resultados: A amostra foi constituída por 28 pacientes em uso de nutrição parenteral no hospital durante a etapa de coleta dedados. Desses pacientes a maioria era do sexo masculino, com média de idade de 46,78 anos. As indicações mais frequentes para o uso da terapia nutricional parenteral foram: repouso,abdome agudo e pós-operatório. As complicações mais prevalentes foram a hipocalemia, hipomagnesemia, uremia e a hiponatremia e o desfecho clínico mais frequente foi o óbito. Encontrou-se relação entre desfecho clínico e presença de hipernatremia (p=0,010), ocorrendo a alta hospitalar exclusivamente naqueles pacientes que não apresentaram hipernatremia. E ainda houve relação marginal (p=0,053) entre desfecho clínico e local da internação, sendo que foi mais frequente o óbito naqueles admitidos na unidade de terapia intensiva. Conclusão: Não houve associação entre a TNP e as complicações metabólicas. Todavia, observou-se relação entre hipernatremia e mortalidade, sendo esta mais prevalente em pacientes internados nas unidades de terapia intensiva (UTIs). Nessa amostra, a complicação metabólica mais observada foi a hipocalemia

To investigate the metabolic complication related to administration of the Parenteral Nutrition Therapy (PNT) and their relation to the clinical outcome of hospitalized patients. Methods: retrospective longitudinal study carried with interned patients at a public hospital of standart in the urgency and emergency care from the Goiânia city during the period from september2020 to february 2021. The data capture was realized through consultation to the electronic record. The information was collected after the first day use of NP to clinical outcome -discharge, death or discontinuation of NP. Results: The sample was composed by 28 patients in use of parenteral nutrition at hospital during the data capture. The majority of these patients were male, with mean age of 46-78 anos. The indications more frequent to the use of parenteral nutrition therapy were: rest, acute abdomen and pos-operative. The complications more prevalent were hypokalemia, hypomagnesemia, uremia and hyponatremia. And the clinical outcome more frequent was death. A relationship between clinical outcome and hypernatremia presence (p=0,010) was found, occurring the hospitalar discharge exclusively in those patients which did not submit to hypernatremia. And there was still a marginal relationship (p=0,053) between clinical outcome and hospitalization, which was more frequent the death in those admitted in intensive care units. Conclusion: There was no association between the PNT and the metabolic complications. However, there was an observed relationship between hypernatremia and mortality, while more prevalent in patients staying in the intensive care unit (ICU). In this sample, the metabolic complication most observed was hypokalemia

Terapia antimicrobiana endovenosa ambulatoria: Alternativa a la hospitalización en un servicio de urgencia pediátrico / Outpatient parenteral antimicrobial therapy: An alternative to hospitalization in a pediatric emergency departament

Outpatient parenteral antimicrobial therapy (OPAT) was first introduced in 1973 as an alternative treatment. Since then, there have been numerous international case based studies including both children and adults with significant bacterial infections using this strategy. The protocol requires a careful screening and evaluation process of the patient. There must be no other motive for hospitalization other than the need for parenteral antibiotics. Objective: To describe the results of OPAT during a period of 26 months in emergency department of a Chilean pediatric public hospital. Results: During the study period 228,144 patients received medical care in the Emergency Department (ED) and 380 patients were admitted to the OPAT program after clinical evaluation and based on the socioeconomic and cultural conditions of their parents. The major indications of OPAT were skin and soft tissues infections (50 percent) and pneumonia (28 percent) respectively. (ß-lactamic antibiotics the were most commonly prescribed. Thirty eight patients (10 percent) required hospitalization, mostly because of clinical deterioration. There were no deaths. Conclusión: In our public hospital OPAT for treatment of significant bacterial infections constitutes an efficient and safe alternative to hospitalization allowing the child to remain in his home.

La terapia antimicrobiana endovenosa ambulatoria (TAEA) surgió como una alternativa de tratamiento en 1973, publicándose numerosas experiencias internacionales en niños y adultos para diversas infecciones bacterianas de importancia mayor. Requiere seleccionar a cada paciente considerando que no hay otro motivo de hospitalización, salvo la administración del fármaco. Objetivo: Sistematizar la experiencia de TAEA efectuada durante 26 meses en el servicio de urgencia (SU) de un hospital pediátrico público de Chile. Resultados: De un total de 228.144 pacientes consultantes al SU en el período elegido, un total de 380 pacientes ingresaron al programa de TAEA luego de una evaluación clínica y de las condiciones socioeconómicas y culturales de sus apoderados. La principal indicación de TAEA fueron las infecciones de piel y tejidos blandos (50 por ciento), seguida de neumonía (28 por ciento), utilizándose en su mayoría ß-lactámicos solos o asociados. Diez por ciento de los pacientes requirió hospitalización, en su mayoría por deterioro de su condición clínica. Ninguno falleció. Conclusión: En nuestro medio, la TAEA es una alternativa eficiente y segura a la hospitalización, que permite tratar pacientes pediátricos con infecciones bacterianas mayores en su entorno familiar.