COVID-19 infection in patients with intestinal failure: UK experience.

BACKGROUND: The direct effect of the coronavirus disease 2019 (COVID-19) pandemic on patients with intestinal failure (IF) has not been described. METHODS: We conducted a nationwide study of UK IF centers to evaluate the infection rates, presentations, and outcomes in patients with types 2 and 3 IF. RESULTS: A total of 45 patients with IF contracted COVID-19 between March and August 2020; this included 26 of 2191 (1.2%) home parenteral nutrition (HPN)-dependent adults and 19 of 298 (6.4%) adults hospitalized with type 2 IF. The proportion of patients receiving nursing care for HPN administration was higher in those with community-acquired COVID-19 (66.7%) than the proportion in the entire HPN cohort (26.1%; P < .01). Two HPN-dependent and 1 hospitalized patient with type 2 IF died as a direct consequence of the virus (6.7% of 45 patients with types 2 or 3 infected). CONCLUSION: This is the first study to describe the outcomes of COVID-19 in a large cohort of patients requiring long-term PN. Methods to reduce hospital and community nosocomial spread would likely be beneficial.

Prebiotics and probiotics in irritable bowel syndrome and inflammatory bowel disease in children.

Underlying pathophysiological mechanisms of irritable bowel syndrome (IBS), a common disorder characterized by abdominal pain associated to a change in stool consistency or frequency, include low-grade inflammation and intestinal microbiota changes. Few and disappointing data are available for prebiotics. A few controlled trials (RCTs) of probiotics are instead available with favourable effects, although most are limited by suboptimal design and small sample size. A recent report from the Rome foundation group included 32 RCTs of probiotics, most of which showed an overall modest improvement in symptoms, with the patients most benefitting from probiotics being those with predominant diarrhoea and those having a post-infectious IBS. A review focusing only on children with functional gastrointestinal disorders concluded that probiotics are more effective than placebo in the treatment of patients with abdominal pain-related functional gastrointestinal disorders, although no effect on constipation was evident. The role for probiotics in inflammatory bowel disease (IBD) appears logical: the endogenous intestinal microbiota plays a central role in their development, and various probiotics have been found effective in animal models of IBD. However, research in humans has been overall quite limited, and it would seem that after a phase of intense research in the first decade of this century, the pace has slowed down, with fewer clinical trials been published in the past 2-3 years. To summarize current evidence: no probiotic has proven successful in Crohn's disease. In ulcerative colitis, on the other hand, data are more promising, and a very recent meta-analysis, that included 23 randomized controlled trials, concluded that there is evidence of efficacy for the probiotic mixture VSL#3 in helping inducing and maintaining remission, as well as in maintaining remission in patients with pouchitis. It is fair to state that for both IBD and IBS, more well-designed, rigorous, randomized clinical trials must be performed.

Oxigenoterapia de alto flujo en cánulas nasales: empleo en una planta de hospitalización / High-flow nasal cannula oxygen therapy: employment in ward

Objetivo: La oxigenoterapia de alto flujo (OAF) es un soporte respiratorio normalmente empleado en las unidades de cuidados intensivos. En nuestro hospital lo llevamos utilizando en planta (lactantes y escolares) desde abril de 2009. El objetivo de este estudio es comprobar los resultados clínicos y su seguridad, así como valorar la aceptación de su uso por parte de enfermería. Pacientes y métodos: Se ha revisado el empleo de OAF en la insuficiencia respiratoria aguda (IRA) durante 2011, estableciendo tres grupos: G1, bronquiolitis; G2, menores de 2 años con episodios previos, y G3, mayores de 2 años con episodios previos. Prospectivamente, hemos valorado la gravedad de la IRA y comparado más tarde su mejoría, considerando el paso de grave a moderado a las 6 y 12 horas de su inicio. Asimismo, se ha realizado una encuesta al personal de enfermería sobre su percepción de la OAF (montaje y mantenimiento, interferencia con medicaciones, alimentación, efectos secundarios, tolerancia...). Resultados: Han recibido OAF 33 pacientes. En conjunto, mejoran todos (p <0,001), sin diferencias significativas entre ellos. Separadamente, hay mejoría en los tres grupos: G1 (p <0,001), G2 (p= 0,003) y G3 (p= 0,006). La percepción del personal de enfermería es que se trata de un sistema de fácil aplicación, y de forma generalizada se tiene una impresión positiva de este soporte respiratorio. Conclusiones: La OAF supone un soporte respiratorio de evidente beneficio clínico, de fácil aplicación y bien asumido por la enfermería. Creemos que es aplicable en una planta de hospitalización, pero sin olvidarnos de que se aplica a pacientes graves que requieren la máxima vigilancia y que no todos responderán favorablemente (AU)

Objective: The high-flow nasal cannula (HFNC) oxygen therapy is a respiratory support usually used in intensive care units. In our hospital we used it in the pediatric ward (infants and children) since April 2009. Our aim is to test the clinical out­comes, security, and assess the acceptance of its use by the nursing service. Patients and methods: We reviewed the use of HFNC in acute respiratory failure (ARF) during 2011, establishing three groups: G1, bronchiolitis; G2, children under 2 years with previous episodes, and G3, children over 2 years with previous episodes. Prospectively, we assessed the severity of the ARF, comparing the improvement of the patients, considering the transition of severe distress to moderate distress at 6 respectively 12 hours of the clinical onset. We also realized a survey to all the paediatric ward nurses about their perception of the HFNC (installation and maintenance, interference with medications, diet, side effects, tolerance...). Results: In our study, 33 patients received HNCF. We saw an improvement in all three groups (p <0.001), without significant differences between them. Taking separately, we found an improvement in each one of them, G1 (p <0.001), G2 (p= 0.003) and G3 (p= 0.006). The perception of nursing about the HFNC is that it's easy to apply, so generally, they had a positive impression about this respiratory support. Conclusions: The HFNC it's a respiratory support with obvious clinical benefits, easy to use, well accepted by nurses and, as we think, applicable in a hospital ward. Anyway, we mustn't forget that are critically patients requiring maximum vigilance and that not all of them respond favorably (AU)