Tercer injerto hepático: ¿hasta dónde deberíamos llegar? / Three-times liver transplanted: How far shall we arrive?

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Recomendaciones para el tratamiento nutrometabólico especializado del paciente crítico: enfermedad pulmonar aguda. Grupo de Trabajo de Metabolismo y Nutrición de la Sociedad Española de Medicina Intensiva, Crítica y Unidades Coronarias (SEMICYUC) / Recommendations for specialized nutritional-metabolic treatment of the critical patient: Acute lung disease. Metabolism and Nutrition Working Group of the Spanish Society of Intensive and Critical Care Medicine and Coronary Units (SEMICYUC)

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Empleo de ECMO en UCI. Recomendaciones de la Sociedad Española de Medicina Intensiva Crítica y Unidades Coronarias / The use of ECMO in ICU. Recommendations of the Spanish Society of Critical Care Medicine and Coronary Units

El empleo de sistemas de oxigenación con membrana extracorpórea se ha incrementado significativamente en los últimos años; ante esta realidad, la Sociedad Española de Medicina Intensiva Crítica y Unidades Coronarias (SEMICYUC) ha decidido elaborar una serie de recomendaciones que sirvan de marco para el empleo de esta técnica en las Unidades de Cuidados intensivos. Los tres ámbitos de empleo de oxigenación con membrana extracorpórea más frecuentes en nuestro medio son: como soporte cardiocirculatorio, como soporte respiratorio y para el mantenimiento de los órganos abdominales en donantes. La SEMICYUC nombró una serie de expertos pertenecientes a los tres grupos de trabajo implicados (Cuidados Intensivos Cardiológicos y RCP, Insuficiencia Respiratoria Aguda y Grupo de trabajo de Trasplantes de SEMICYUC) que tras la revisión de la literatura existente hasta marzo de 2018, elaboraron una serie de recomendaciones. Estas recomendaciones fueron expuestas en la web de la SEMICYUC para recibir las sugerencias de los intensivistas y finalmente fueron aprobadas por el Comité Científico de la Sociedad. Las recomendaciones, en base al conocimiento actual, versan sobre qué pacientes pueden ser candidatos a la técnica, cuándo iniciarla y las condiciones de infraestructura necesarias de los centros hospitalarios o en su caso, las condiciones para el traslado a centros con experiencia. Aunque desde un punto de vista fisiopatólogico, existen claros argumentos para el empleo de oxigenación con membrana extracorpórea, la evidencia científica actual es débil por lo que es necesario estudios que definen con más precisión qué pacientes se benefician más de la técnica y en qué momento deben iniciarse

The use of extracorporeal membrane oxygenation systems has increased significantly in recent years; given this reality, the Spanish Society of Critical Intensive Care Medicine and Coronary Units (SEMICYUC) has decided to draw up a series of recommendations that serve as a framework for the use of this technique in intensive care units. The three most frequent areas of extracorporeal membrane oxygenation systems use in our setting are: as a cardiocirculatory support, as a respiratory support and for the maintenance of the abdominal organs in donors. The SEMICYUC appointed a series of experts belonging to the three working groups involved (Cardiological Intensive Care and CPR, Acute Respiratory Failure and Transplant work group) that, after reviewing the existing literature until March 2018, developed a series of recommendations. These recommendations were posted on the SEMICYUC website to receive suggestions from the intensivists and finally approved by the Scientific Committee of the Society. The recommendations, based on current knowledge, are about which patients may be candidates for the technique, when to start it and the necessary infrastructure conditions of the hospital centers or, the conditions for transfer to centers with experience. Although from a physiopathological point of view, there are clear arguments for the use of extracorporeal membrane oxygenation systems, the current scientific evidence is weak, so studies are needed that define more precisely which patients benefit most from the technique and when they should start

The use of ECMO in ICU. Recommendations of the Spanish Society of Critical Care Medicine and Coronary Units. / Empleo de ECMO en UCI. Recomendaciones de la Sociedad Española de Medicina Intensiva Crítica y Unidades Coronarias.

The use of extracorporeal membrane oxygenation systems has increased significantly in recent years; given this reality, the Spanish Society of Critical Intensive Care Medicine and Coronary Units (SEMICYUC) has decided to draw up a series of recommendations that serve as a framework for the use of this technique in intensive care units. The three most frequent areas of extracorporeal membrane oxygenation systems use in our setting are: as a cardiocirculatory support, as a respiratory support and for the maintenance of the abdominal organs in donors. The SEMICYUC appointed a series of experts belonging to the three working groups involved (Cardiological Intensive Care and CPR, Acute Respiratory Failure and Transplant work group) that, after reviewing the existing literature until March 2018, developed a series of recommendations. These recommendations were posted on the SEMICYUC website to receive suggestions from the intensivists and finally approved by the Scientific Committee of the Society. The recommendations, based on current knowledge, are about which patients may be candidates for the technique, when to start it and the necessary infrastructure conditions of the hospital centers or, the conditions for transfer to centers with experience. Although from a physiopathological point of view, there are clear arguments for the use of extracorporeal membrane oxygenation systems, the current scientific evidence is weak, so studies are needed that define more precisely which patients benefit most from the technique and when they should start.

¿Cuánto peso hoy doctor? Exceso de celo o exceso de confianza / How much weight today doctor? Overconfidence or zeal excess

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Trehalose-based Janus cyclooligosaccharides: the "Click" synthesis and DNA-directed assembly into pH-sensitive transfectious nanoparticles.

The convergent preparation of Janus molecular nanoparticles by thiourea-"clicking" of α,α'-trehalose halves has been implemented; the strategy allows access to macrocyclic derivatives with seggregated cationic and lipophilic domains that in the presence of DNA undergo pH-dependent self-assembly into lamellar superstructures, as established by electrochemical, structural (SAXS), microscopical (TEM) and computational techniques, that mediate transfection in vitro and in vivo.

Guidelines for specialized nutritional and metabolic support in the critically-ill patient. Update. Consensus SEMICYUC-SENPE: Hyperglycemia and diabetes mellitus / Recomendaciones para el soporte nutricional y metabólico especializado del paciente crítico. Actualización. Consenso SEMICYUC-SENPE: Hiperglucemia y diabetes mellitus

Hyperglycemia is one of the main metabolic disturbances in critically-ill patients and is associated within creased morbidity and mortality. Consequently, blood glucose levels must be safely and effectively controlled, that is, maintained within a normal range, avoiding hypoglycemia on the one hand and elevated glucose concentrations on the other. To accomplish this aim, insulin is often required, avoiding protocols designed to achieve tight glycemic control.To prevent hyperglycemia and its associated complications, energy intake should be adjusted to patients’ requirements, avoiding over nutrition and excessive glucose intake. Protein intake should be adjusted to the degree of metabolic stress. Whenever patients require artificial feeding, the enteral route , if not contraindicated, should be used since parenteral nutrition is associated with a higher frequency of hyperglycemia and greater insulin requirements. Enteral nutrition should be administered early, preferably within the first 24 hours of admission to the intensive care unit, after hemodynamic stabilization. Specific diets for hyperglycemia, containing low glycemic index carbohydrates and fibre and enriched with monounsaturated fatty acids, can achieve good glycemic control with lower insulin requirements (AU)

La hiperglucemia es una de las alteraciones metabólicas predominantes en los pacientes críticos y se asocia con un aumento de la morbimortalidad. por ello, es necesario realizar un control efectivo y a su vez seguro de la glucemia, esto es, mantener la normoglucemia en un rango que evite el riesgo de desarrollar hipoglucemia, por un lado, y las cifras elevadas de glucemia, por otro. Para conseguirlo, en la mayoría de los casos es necesario el tratamiento con insulina evitando protocolos dirigidos a conseguir cifras estrictas de glucemias. Con el fin de prevenir la hiperglucemia y sus complicaciones asociadas, el aporte energético debe adecuarse al os requerimientos de los pacientes, evitando la sobre nutrición y el aporte excesivo de glucosa. El aporte proteicos e ajustará al nivel de estrés metabólico. Siempre que el enfermo requiera nutrición artificial y no esté contraindicada debe emplearse la vía enteral, ya que la nutrición parenteral se asocia a mayor frecuencia de hiperglucemia y mayores necesidades de insulina. La administración de la nutrición enteral debe ser precoz, preferiblemente dentro de las primeras 24 h de ingreso en UCI, tras la estabilización hemodinámica. Las dietas específicas para hiperglucemia que contienen hidratos de carbono de bajo índice glucémico, fibra y ricas en ácidos grasos monoinsaturados podrían conseguir un mejor control glucémico con menores necesidades de insulina (AU)

Recomendaciones para el soporte nutricional y metabólico especializado del paciente crítico. Actualización. Consenso SEMICYUC-SENPE: Insuficiencia respiratoria / Guidelines for specialized nutritional and metabolic support in the critically-ill patient. Update. Consensus of the Spanish Society of Intensive Care Medicine and Coronary Units-Spanish Society of Parenteral and Enteral Nutrition (SEMICYUC-SENPE): Respiratory failure

La insuficiencia respiratoria aguda grave que precisa ventilación mecánica es una de las causas más frecuentes de ingreso de los pacientes en UCI. Entre las etiologías más frecuentes se encuentran la reagudización de la enfermedad pulmonar obstructiva crónica y la insuficiencia respiratoria aguda con lesión pulmonar aguda o con criterios de síndrome de distrés respiratorio agudo. Estos pacientes presentan un riesgo elevado de desnutrición por su enfermedad de base, por la situación catabólica en la que se encuentran y por el empleo de la ventilación mecánica. Ello justifica que estos pacientes deban ser valorados desde el punto de vista nutricional y que el uso de soporte nutricional especializado sea necesario. El soporte nutricional especializado debe paliar los efectos catabólicos de la enfermedad, evitar la sobrecarga de calorías y utilizar, en casos seleccionados, dietas específicas enriquecidas con ácidos grasos w-3 y antioxidantes que podrían mejorar el pronóstico (AU)

Severe acute respiratory failure requiring mechanical ventilation is one of the most frequent reasons for admission to the intensive care unit. Among the most frequent causes for admission are exacerbation of chronic obstructive pulmonary disease and acute respiratory failure with acute lung injury (ALI) or with criteria of acute respiratory distress syndrome (ARDS). These patient s have a high risk of malnutrition due to the under lying disease, their altered catabolism and the use of mechanical ventilation. Consequently, nutritional evaluation and the use of specialized nutritional support are required. This support should alleviate the catabolic effects of the disease, avoid calorie overload and, in selected patients, to use omega-3 fatty acid- and antioxidant-enriched diets, which could improve outcome (AU)

Recomendaciones para el soporte nutricional y metabólico especializado del paciente crítico. Actualización. Consenso SEMICYUC-SENPE: Hiperglucemia y diabetes mellitus / Guidelines for specialized nutritional and metabolic support in the critically-ill patient. Update. Consensus of the Spanish Society of Intensive Care Medicine and Coronary Units-Spanish Society of Parenteral and Enteral Nutrition (SEMICYUC-SENPE): Hyperglycemia and diabetes mellitus

La hiperglucemia es una de las alteraciones metabólicas predominantes en los pacientes críticos y se asocia con un aumento de la morbimortalidad. Por ello, es necesario realizar un control efectivo y a su vez seguro de la glucemia, esto es, mantener la normoglucemia en un rango que evite el riesgo de desarrollar hipoglucemia, por un lado, y las cifras elevadas de glucemia, por otro. Para conseguirlo, en la mayoría de los casos es necesario el tratamiento con insulina evitando protocolos dirigidos a conseguir cifras estrictas de glucemias. Con el fin de prevenir la hiperglucemia y sus complicaciones asociadas, el aporte energético debe adecuarse a los requerimientos de los pacientes, evitando la sobrenutrición y el aporte excesivo de glucosa. El aporte proteico se ajustará al nivel de estrés metabólico. Siempre que el enfermo requiera nutrición artificial y no esté contraindicada debe emplearse la vía enteral, ya que la nutrición parenteral se asocia a mayor frecuencia de hiperglucemia y mayores necesidades de insulina. La administración de la nutrición enteral debe ser precoz, preferiblemente dentro de las primeras 24 h de ingreso en UCI, tras la estabilización hemodinámica. Las dietas específicas para hiperglucemia que contienen hidratos de carbono de bajo índice glucémico, fibra y ricas en ácidos grasos monoinsaturados podrían conseguir un mejor control glucémico con menores necesidades de insulina (AU)

Hyperglycemia is one of the main metabolic disturbances in critically-ill patients and is associated with increased morbidity and mortality. Consequently, blood glucose levels must be safely and effectively controlled, that is, maintained within a normal range, avoiding hypoglycemia on the one hand and elevated glucose concentrations on the other. To accomplish this aim, insulin is often required, avoiding protocols designed to achieve tight glycemic control. To prevent hyperglycemia and its associated complications, energy intake should be adjusted to patients’ requirements, avoiding over nutrition and excessive glucose intake. Protein intake should be adjusted to the degree of metabolic stress. Whenever patients require artificial feeding, the enteral route , if not contraindicated, should be used since parenteral nutrition is associated with a higher frequency of hyperglycemia and greater insulin requirements. Enteral nutrition should be administered early, preferably within the first 24 hours of admission to the intensive care unit, after hemodynamic stabilization. Specific diets for hyperglycemia, containing low glycemic index carbohydrates and fibre and enriched with monounsaturated fatty acids, can achieve good glycemic control with lower insulin requirements (AU)

Guidelines for specialized nutritional and metabolic support in the critically-ill patient. Update. Consensus SEMICYUC-SENPE: Respiratory failure / Recomendaciones para el soporte nutricional y metabólico especializado del paciente crítico. Actualización. Consenso SEMICYUC-SENPE: Insuficiencia respiratoria

Severe acute respiratory failure requiring mechanical ventilation is one of the most frequent reasons for admission to the intensive care unit. Among the most frequent causes for admission are exacerbation of chronic obstructive pulmonary disease and acute respiratory failure with acute lung injury (ALI) or with criteria of acute respiratory distress syndrome (ARDS). These patients have a high risk of malnutrition due to the underlying disease, their altered catabolism and the use of mechanical ventilation. Consequently, nutritional evaluation and the use of specialized nutritional support are required. This support should alleviate the catabolic effects of the disease, avoid calorie overload and, in selected patients, to use omega-3 fatty acid and antioxidant-enriched diets, which could improve outcome (AU)

La insuficiencia respiratoria aguda grave que precisa ventilación mecánica es una de las causas mas frecuentes de ingreso de los pacientes en UCI. Entre las etiologías mas frecuentes se encuentran la reagudización de la enfermedad pulmonar obstructiva crónica y la insuficiencia respiratoria aguda con lesion pulmonar aguda o con criterios de síndrome de distrés respiratorio agudo. Estos pacientes presentan un riesgo elevado de desnutrición por su enfermedad de base, por la situación catabólica en la que se encuentran y por el empleo de la ventilación mecánica. Ello justifica que estos pacientes deban ser valorados desde el punto de vista nutricional y que el uso de soporte nutricional especializado sea necesario. El soporte nutricional especializado debe paliar los efectos catabólicos de la enfermedad, evitar la sobrecarga de calorías y utilizar, en casos seleccionados, dietas especificas enriquecidas con ácidos grasos ω-3 y antioxidantes que podrían mejorar el pronostico (AU)

[Guidelines for specialized nutritional and metabolic support in the critically-ill patient. Update. Consensus of the Spanish Society of Intensive Care Medicine and Coronary Units-Spanish Society of Parenteral and Enteral Nutrition (SEMICYUC-SENPE): respiratory failure]. / Recomendaciones para el soporte nutricional y metabólico especializado del paciente crítico. Actualización. Consenso SEMICYUC-SENPE: insuficiencia respiratoria.

Severe acute respiratory failure requiring mechanical ventilation is one of the most frequent reasons for admission to the intensive care unit. Among the most frequent causes for admission are exacerbation of chronic obstructive pulmonary disease and acute respiratory failure with acute lung injury (ALI) or with criteria of acute respiratory distress syndrome (ARDS). These patients have a high risk of malnutrition due to the underlying disease, their altered catabolism and the use of mechanical ventilation. Consequently, nutritional evaluation and the use of specialized nutritional support are required. This support should alleviate the catabolic effects of the disease, avoid calorie overload and, in selected patients, to use omega-3 fatty acid- and antioxidant-enriched diets, which could improve outcome.

[Guidelines for specialized nutritional and metabolic support in the critically-ill patient. Update. Consensus of the Spanish Society of Intensive Care Medicine and Coronary Units-Spanish Society of Parenteral and Enteral Nutrition (SEMICYUC-SENPE): hyperglycemia and diabetes mellitus]. / Recomendaciones para el soporte nutricional y metabólico especializado del paciente crítico. Actualización. Consenso SEMICYUC-SENPE: hiperglucemia y diabetes mellitus.

Hyperglycemia is one of the main metabolic disturbances in critically-ill patients and is associated with increased morbidity and mortality. Consequently, blood glucose levels must be safely and effectively controlled, that is, maintained within a normal range, avoiding hypoglycemia on the one hand and elevated glucose concentrations on the other. To accomplish this aim, insulin is often required, avoiding protocols designed to achieve tight glycemic control. To prevent hyperglycemia and its associated complications, energy intake should be adjusted to patients' requirements, avoiding overnutrition and excessive glucose intake. Protein intake should be adjusted to the degree of metabolic stress. Whenever patients require artificial feeding, the enteral route, if not contraindicated, should be used since parenteral nutrition is associated with a higher frequency of hyperglycemia and greater insulin requirements. Enteral nutrition should be administered early, preferably within the first 24 hours of admission to the intensive care unit, after hemodynamic stabilization. Specific diets for hyperglycemia, containing low glycemic index carbohydrates and fibre and enriched with monounsaturated fatty acids, can achieve good glycemic control with lower insulin requirements.

Guidelines for specialized nutritional and metabolic support in the critically-ill patient: update. Consensus SEMICYUC-SENPE: respiratory failure.

Severe acute respiratory failure requiring mechanical ventilation is one of the most frequent reasons for admission to the intensive care unit. Among the most frequent causes for admission are exacerbation of chronic obstructive pulmonary disease and acute respiratory failure with acute lung injury (ALI) or with criteria of acute respiratory distress syndrome (ARDS). These patients have a high risk of malnutrition due to the underlying disease, their altered catabolism and the use of mechanical ventilation. Consequently, nutritional evaluation and the use of specialized nutritional support are required. This support should alleviate the catabolic effects of the disease, avoid calorie overload and, in selected patients, to use omega-3 fatty acid and antioxidant-enriched diets, which could improve outcome.

Guidelines for specialized nutritional and metabolic support in the critically-ill patient: update. Consensus SEMICYUC-SENPE: hyperglycemia and diabetes mellitus.

Hyperglycemia is one of the main metabolic disturbances in critically-ill patients and is associated with increased morbidity and mortality. Consequently, blood glucose levels must be safely and effectively controlled, that is, maintained within a normal range, avoiding hypoglycemia on the one hand and elevated glucose concentrations on the other. To accomplish this aim, insulin is often required, avoiding protocols designed to achieve tight glycemic control. To prevent hyperglycemia and its associated complications, energy intake should be adjusted to patients' requirements, avoiding overnutrition and excessive glucose intake. Protein intake should be adjusted to the degree of metabolic stress. Whenever patients require artificial feeding, the enteral route, if not contraindicated, should be used since parenteral nutrition is associated with a higher frequency of hyperglycemia and greater insulin requirements. Enteral nutrition should be administered early, preferably within the first 24 hours of admission to the intensive care unit, after hemodynamic stabilization. Specific diets for hyperglycemia, containing low glycemic index carbohydrates and fibre and enriched with monounsaturated fatty acids, can achieve good glycemic control with lower insulin requirements.

Evaluación de los resultados de cinco años de consulta de tabaquismo en el Hospital Puerta de Hierro / Evaluation of the results of five years of smoking cessation consultation in the Hospital Puerta de Hierro

Objetivo: Analizar los resultados obtenidos en cinco años deConsulta de Tabaquismo, valorando la abstinencia tabáquica al año de seguimiento de los fumadores que acudieron en fase de acción. Pacientes y métodos: Los fumadores proceden del Hospital Puerta de Hierro (trabajadores y pacientes) y del área sanitaria VI de Madrid. La consulta es individualizada y la metodología se ha ajustado a las recomendaciones del área de tabaquismo de la SEPAR, basadas en el tratamiento combinado de terapia farmacológica y apoyo psicológico verbal y reforzado con una guía práctica para dejar de fumar. La abstinencia anual se ha valorado en porcentajes absolutos y por el método de probabilidades de Kaplan-Meier, primero en todos los fumadores conjuntamente y segundo, en relación con la presencia o ausencia de: enfermedades relacionadas con el tabaquismo, diabetes y depresión. En este caso también se calculó el riesgo relativo de recaída (RR) y el intervalo de confianza del 95% (IC.95%). Se ha valorado en hombres y mujeres la ganancia de peso a los seis meses y al año de abstinencia. Resultados: El seguimiento se ha realizado en los 226 fumadores en fase de acción (46 % hombres, 54 % mujeres). Los tratamientos más utilizados fueron la terapia sustitutiva con nicotina (67%) y el bupropión (13%). Dejan de fumar un año el 31% (28,6% hombres y 32,2% mujeres). El 37% están abstinentes seis meses, el 48% tres meses, y el 72% un mes. La probabilidad de abstinencia por Kaplan-Meier es de 32%. El tratamiento que mejores resultados mostró fue la terapia sustitutiva con nicotina, tanto en forma de parches como asociada a chicles (35% de abstinencia anual). Los fumadores que tenían alguna patología asociada al tabaquismo eran 97. Su edad media, años de fumador e intentos previos de abandono eran significativamente mayores (*p<0,005) que de los 129 fumadores sin patología asociada. De los primeros dejan de fumar un año el 21% (probabilidad de abstinencia 23%) mientras que los que no tienen patología asociada dejan de fumar el 38% (probabilidad de abstinencia 38%). El riesgo de recaída es 1,6 veces superior en el grupo con patología asociada. Conclusiones: Nuestra consulta de tabaquismo consigue unas tasas de abandono de casi un tercio, que es bastante menor en los fumadores que tienen una patología asociada al tabaco. Estas tasas refuerzan la justificación de las consultas de tabaquismo como instrumento para facilitar la deshabituación tabáquica (AU)

Objective: Analyze the results obtained in 5 years of Smoking CessationConsultation, evaluating abstinence at 1 year of follow-up of the smokers who came in the action phase. Patients and methods: Those smokers who came from the hospital Puerta de Hierro (workers and patients) and from the health-care area VI of Madrid were included. The consultation was individualized and the method was adjusted to the SEPAR recommendations of the smoking cessation area, based on combined treatment of drug therapy and all psychological support and reinforced with a practical guide to quit smoking. Yearly abstinence was evaluated in absolute percentages and with the Kaplan-Meier likelihood method, first in all of the smokers jointly and then in relationship with the presence or absence of: diseases related with smoking, diabetes and depression. In this case, the relative risk of relapse (RR) and 95% confidence interval (95% CI) were also calculated. Weight gain at 6 months and 1 year of abstinence was also evaluated in men and women. Results: The follow-up was made in 226 smokers in the action phase(46% in men,54% women). The treatments used most were nicotine replacement therapy (67%) and Bupropion (13%). After 1 year, 31% (28.6% in men and 32.2% women) quit smoking. At 6 months, 37% were abstinent, at 3 months 48% and at 1 month 72%. The Kaplan Meier likelihood of abstinence is 32%. The treatment that had the best results was nicotine replacement therapy, both with patches and gum (35% of annual abstinence). There were 97 smokers who had a disease associated to smoking. Their main age, years of smoking and previous attempts to quit were significantly greater (*p < 0,005) then those of the 129 smokers with no associated disease. In the first group 21% quit smoking at 1 year (abstinence likelihood 23%) while 38% of those who had no associated disease quit smoking (abstinence likelihood 38%). Risk of relapse was 1.6 times greater in the group with associated disease. Conclusions: Our tobacco cessation clinic achieves cessation rates of almost one third, which is much less in the smokers who have any disease associated to tobacco. These rates reinforce the justification of smoking cessation consultation as an instrument to facilitate smoking cessation (AU)

[Recommendations for nutritional assessment and specialized nutritional support of critically ill patients]. / Recomendaciones para la valoración nutricional y el soporte nutricional especializado de los pacientes críticos.

Due to the characteristics of critically ill patients, elaborating recommendations on nutritional support for these patients is difficult. Usually the time of onset of nutritional support or its features are not well established, so that its application is based on experts' opinion. In the present document, recommendations formulated by the Metabolism and Nutrition Working Group of the Spanish Society of Intensive and Critical Medicine and Coronary Units (SEMICYUC) are presented. Recommendations are based on the literature analysis and further discussion by the working group members in order to define, consensually, the more relevant issues of metabolic and nutritional support of patients in a critical condition. Several clinical situations have been considered which are developed in the following articles of this publication. The present recommendations aim at providing a guideline for the less experienced clinicians when considering the metabolic and nutritional issues of critically ill patients.

[Artificial nutrition in intestinal failure: short bowel syndrome. Inflammatory Bowel Disease]. / Nutrición artificial en la insuficiencia intestinal: síndrome de intestino corto. Enfermedad inflamatoria intestinal.

Large intestinal resection produces a sufficient number of impairments as to require specialized nutritional support. Basic treatment measures, especially during the acute phase after intestinal resection or in the presence of severe complications in patients with short bowel syndrome, include fluid and electrolytes reposition and nutritional support implementation in order to prevent hyponutrition. Enteral nutrition is the main stimulating factor for adaptation of the remaining bowel. However, its application has some difficulties during the acute phase, and thus patients must be frequently treated with parenteral nutrition. The presence of hyponutrition may be also important in patients with intestinal inflammatory disease. Nutritional support is indicated in these cases as the primary treatment modality for the disease, as hyponutrition treatment, or as perioperative treatment in patients needing surgery. In spite of the digestive pathology, there are data to recommend enteral nutrition as the initial method for nutrients provision in patients that need it.