ABSTRACT
NutriCOVer es un programa de investigación impulsado por Nutricia a nivel global para apoyar iniciativas de investigación clínica en 16 países de todo el mundo. El programa tiene como objetivo adaptar el cuidado nutricional a las necesidades de los pacientes con COVID-19 dados de alta de la unidad de cuidados intensivos. En España se están desarrollando tres proyectos de investigación, siendo un país de referencia dentro del programa NutriCOVer. Estos estudios analizan la evolución de los pacientes tras una COVID-19 grave desde el punto de vista nutricional, evaluando aspectos relevantes como la prevalencia y evolución de la desnutrición y la sarcopenia (estudio NUTRICOVID), la prevalencia y el impacto de la disfagia (estudio COVID-19-DN-OD) y los cambios de la composición corporal medida por ecografía nutricional y bioimpedanciometría (estudio NUTRIECOMUSCLE). En este artículo, los investigadores que lideran estos tres proyectos discuten todos los pasos que han seguido para el desarrollo de los estudios en el contexto de una pandemia mundial: desde la idea inicial, el diseño y el reclutamiento de pacientes hasta los problemas de ejecución que se han encontrado en el día a día o la política de publicación de los resultados. Además, ofrecen algunas impresiones sobre los resultados iniciales y las implicaciones que pueden tener estos estudios para cambiar la práctica clínica habitual (AU)
NutriCOVer is a global research program sponsored by Nutricia to support initiatives in clinical investigation in 16 countries worldwide. The program's objective is to adapt nutritional care to the needs of patients with COVID-19 who have been discharged from the intensive care unit. In Spain a reference country for the NutriCOVer program three research projects are being carried out. These studies analyze the clinical course of COVID-19 patients from a nutritional point of view, evaluating relevant aspects such as the prevalence and evolution of malnutrition and sarcopenia (the NUTRICOVID study), the prevalence and impact of dysphagia (the COVID-19-DN-OD study), or changes in corporal composition measured through nutritional ultrasound and bioimpedance analysis (the NUTRIECOMUSCLE study). In this article, the principal investigators of the three projects discuss the steps taken to develop these studies in the context of a worldwide pandemic: from initial concept, study design, and patient recruitment to problems in the execution of the project in day-to-day practice and publication policies. Also, they offer some insights on the initial results and the implications which these studies may have for current clinical practice (AU)
Subject(s)
Humans , Coronavirus Infections/therapy , Pneumonia, Viral/therapy , Pandemics , Malnutrition/diet therapy , Nutritional Status , Intensive Care Units , Sarcopenia/therapy , Deglutition Disorders/therapyABSTRACT
AIMS: The aim of this study is to evaluate the prevalence of the clinical and videofluoroscopic (VDF) symptoms of oropharyngeal dysphagia in patients with multiple sclerosis, and to describe its therapeutic management. PATIENTS AND METHODS: We studied 23 patients suffering from multiple sclerosis to evaluate the characteristics of the disease, the VDF exploration of swallowing and therapeutic strategies. The VDF exploration enables us to define the VDF symptoms that assess the safety and efficiency of swallowing for the oral and pharyngeal phases. The therapeutic strategies include: changes in the characteristics of the diet, changes of posture and active manoeuvres. RESULTS: The patients studied presented a mean EDSS score 7.4 (4-9). There were alterations in swallowing efficiency and/or safety in more than 80% of the patients. In 52% there was some change in the swallowing safety. 40% of them were silent aspirators. All these patients were fed orally without any complications, in 78% the volume of the bolus has been modified and changes have taken place in the consistency (thickening for liquids); in 43%, moreover, postural strategies were employed and active manoeuvres (supraglottic swallow) were introduced in 13% in order to improve swallowing safety. CONCLUSIONS: There is a high prevalence of clinical and VDF symptoms of oropharyngeal dysphagia in patients with advanced multiple sclerosis. VDF enables us to diagnose the pathophysiological mechanism of aspiration and the existence of silent aspirators, and helps us to introduce specific therapeutic interventions for each patient, thereby achieving safe and efficient swallowing, while prolonging oral feeding.
Subject(s)
Deglutition Disorders , Esophageal Sphincter, Upper/physiology , Multiple Sclerosis/complications , Oropharynx/physiology , Administration, Oral , Adult , Deglutition Disorders/epidemiology , Deglutition Disorders/etiology , Deglutition Disorders/physiopathology , Deglutition Disorders/therapy , Diet Therapy , Female , Fluoroscopy/methods , Humans , Inhalation , Male , Middle Aged , Oropharynx/anatomy & histology , Posture , Risk Factors , Videotape RecordingABSTRACT
Objetivo. El objetivo de este trabajo es evaluar la prevalencia de los síntomas clínicos y videofluoroscópicos (VDF) de disfagia orofaríngea en pacientes con esclerosis múltiple, y describir su manejo terapéutico. Pacientes y métodos. Se han estudiado 23 pacientes afectados de esclerosis múltiple, y se han evaluado las características de la enfermedad, la exploración VDF de la deglución y las estrategias terapéuticas. Con la exploración VDF se definen los síntomas VDF, que evalúan la seguridad y la eficacia de la deglución para las fases oral y faríngea. Las estrategias terapéuticas incluyen: cambios en las características de la dieta, cambios posturales y maniobras activas. Resultados. Los pacientes estudiados presentan una puntuación media en el EDSS de 7,4 (4-9). Se obtiene una alteración en la eficacia y/o la seguridad de la deglución en más del 80 por ciento de los pacientes. En el 52 por ciento existe una alteración en la seguridad de la deglución. El 40 por ciento es aspirador silente. Todos estos pacientes mantienen la alimentación por vía oral sin complicaciones. En el 78 por ciento se ha modificado el volumen del bolo y se han efectuado cambios en la consistencia (espesante para los líquidos); en el 43 por ciento, además, se han utilizado estrategias posturales, y en el 13 por ciento se han introducido maniobras activas (deglución supraglótica) para mejorar la seguridad de la deglución. Conclusión. Existe una elevada prevalencia de los síntomas clínicos y VDF de la disfagia orofaríngea en los pacientes con esclerosis múltiple avanzada. La VDF permite diagnosticar el mecanismo fisiopatológico de la aspiración y la existencia de aspiradores silentes, y nos ayuda a introducir intervenciones terapéuticas específicas para cada paciente, y conseguir así una deglución segura y eficaz, con lo que se prolonga la alimentación por vía oral (AU)
Aims. The aim of this study is to evaluate the prevalence of the clinical and videofluoroscopic (VDF) symptoms of oropharyngeal dysphagia in patients with multiple sclerosis, and to describe its therapeutic management. Patients and methods. We studied 23 patients suffering from multiple sclerosis to evaluate the characteristics of the disease, the VDF exploration of swallowing and therapeutic strategies. The VDF exploration enables us to define the VDF symptoms that assess the safety and efficiency of swallowing for the oral and pharyngeal phases. The therapeutic strategies include: changes in the characteristics of the diet, changes of posture and active manoeuvres. Results. The patients studied presented a mean EDSS score 7.4 (4-9). There were alterations in swallowing efficiency and/or safety in more than 80% of the patients. In 52% there was some change in the swallowing safety. 40% of them were silent aspirators. All these patients were fed orally without any complications, in 78% the volume of the bolus has been modified and changes have taken place in the consistency (thickening for liquids); in 43%, moreover, postural strategies were employed and active manoeuvres (supraglottic swallow) were introduced in 13% in order to improve swallowing safety. Conclusions. There is a high prevalence of clinical and VDF symptoms of oropharyngeal dysphagia in patients with advanced multiple sclerosis. VDF enables us to diagnose the pathophysiological mechanism of aspiration and the existence of silent aspirators, and helps us to introduce specific therapeutic interventions for each patient, thereby achieving safe and efficient swallowing, while prolonging oral feeding (AU)
Subject(s)
Male , Middle Aged , Female , Adult , Humans , Deglutition Disorders , Deglutition Disorders , Multiple Sclerosis , Oropharynx , Posture , Videotape Recording , Inhalation , Diet Therapy , Risk Factors , Fluoroscopy , Administration, Oral , Barrett EsophagusABSTRACT
BACKGROUND: Acute respiratory failure (ARF) is one of the systemic complications of acute pancreatitis (AP). The severity of AP may be objectified by the Ranson index and the radiologic alterations showed by abdominal computerized tomography (CT). The aim of the present was to study the relation between both problems. METHODS: Two hundred ninety-five cases of AP attended between November 1983 and August 1987 were revised. Ranson criteria were used to qualify the 295 AP and the abdominal CT in 85 cases. ARF was defined as PaO2 less than 60 mmHg breathing air at room temperature. The severity of ARF was classified by the respiratory index (RI: PaO2/FIO2) with ARF being considered as severe when less than 200. In 100 cases of AP the thoracic radiologic alterations were objectified and evaluated in order to know their relation with ARF. RESULTS: ARF was the most frequent complication (28%) of AP, being severe in 8%. Pleural effusion was the radiologic alteration most frequently observed (23 patients). In 28% there was no correlation between the radiology and the presence of ARF. The correction of ARF was achieved in 85% of the patients with a mask of O2 less than 40%. Mean ARF was 227. A correlation was found between ARF and the severity of the episode of AP and the changes observed in the abdominal CT. CONCLUSIONS: Acute respiratory failure is the most frequent complication of acute pancreatitis and correlates with the severity of the episode of the latter; classification of the episode of acute respiratory failure by respiratory index is of use.
