ABSTRACT
OBJECTIVE: To assess the nutritional response of a group of critically ill patients, as well as the differences in the response to nutritional support between medical and surgical patients. METHODS: One-year long retrospective study including critically ill patients on artificial nutrition for 7 days. Throughout the first week, three nutritional biochemical controls were done that included albumin, prealbumin, transferrin, cholesterol, and electrolytes. Other data gathered were: nutritional risk index, age, gender, weight, height, APACHE, delay of onset of nutritional support, access route, predicted and real caloric intake, medical or surgical patient, hospital stay, duration of the central venous catheter, urinary tube, and/or mechanical ventilation, incidence and density of incidence of nosocomial infections. RESULTS: Sixty-three patients were studied, 30 (47%) medical and 33 (53%) surgical/trauma patients, with a usage of EN higher among medical patients (16/30, 53% vs. 5/33, 15%), PN higher among surgical patients (25/33, 76%), and mixed nutrition similar in both groups (5 medical and 3 surgical patients) (p = 0.001). There were no differences between medical and surgical patients regarding: both predicted and real caloric and nitrogenous intake, APACHE, delay of onset of nutrition, phosphorus, magnesium or glucose levels, mortality and incidence of nosocomial infections. There were no differences either in hospital stay or use of mechanical ventilation, although these tended to be lower in surgical patients. The baseline biochemical parameters did not show differences between both groups, although they were worse among surgical patients. These patients presented during the study period steady albumin levels with improvement in the remaining parameters, whereas medical patients showed a decrease in albumin and transferrin levels, steady prealbumin levels, and slightly improvement in cholesterol levels. CONCLUSIONS: We have observed higher usage of PN among surgical patients, which showed worse baseline nutritional biochemical parameters and responded better to nutritional support and having a trend towards shorter hospital stay and lower mechanical ventilation use than medical patients. We have not observed differences regarding the mortality or nosocomial infection.
Subject(s)
Critical Illness , Nutritional Support/methods , APACHE , Aged , Critical Care , Female , Humans , Male , Middle Aged , Nitrogen/metabolism , Patients , Retrospective Studies , Risk Factors , Surgical Procedures, OperativeABSTRACT
Introducción: El uso del helicóptero para la atención sanitaria urgente en Aragón data del año 2000. Desde entonces 1.055 pacientes han sido atendidos por el equipo medicalizado del 112-SOS Aragón. Métodos: Se realiza un estudio descriptivo retrospectivo simple de los 999 últimos pacientes atendidos por el helicóptero sanitario desde el 10 de mayo de 2001 hasta el 12 de septiembre de 2005. Resultados: De los 999 pacientes analizados el 81,1% fueron atendidos en el lugar del suceso (servicio primario) y el 18,9% fue un traslado interhospitalario (servicio secundario). Las patologías más frecuentes estuvieron relacionadas con el accidente traumático (40,9% accidentes de tráfico y 12,7% accidente laboral) y con la emergencia cardiovascular en 12% de los pacientes. Estas dos patologías ocuparon casi el 70% de los pacientes atendidos. De los menores de 45 años, el 47% sufren accidentes de tráfico y de los mayores de 45, un 26% padecen eventos cardiovasculares (p < 0,001). Existen otras patologías atendidas como son accidentes deportivos (7,6%), domésticos (2,3%), emergencias neonatales (2,4%), respiratorias (2%), autólisis, agresiones o incendios, aunque con menor prevalencia. Conclusiones: El helicóptero 112 SOS Aragón representa un importante recurso dentro del sistema de emergencias sanitarias de la Comunidad Autónoma de Aragón. El estudio ha permitido determinar el perfil del paciente grave que recibe atención sanitaria urgente desde este servicio. El paciente crítico (traumatizado grave, neonato y cardiaco) es el que principalmente se beneficia del helitransporte sanitario, sobre todo, cuando se encuentran en áreas rurales distantes de un hospital de referencia (AU)
I ntroduction: The use of the helicopter for the sanitary urgent attention in Aragon dates from year 2000. Since then 1055 patients has been attended by the medical equipment of 112-SOS Aragon. Methods: there is realized a descriptive retrospective simple study of the last 999 patients attended by the sanitary helicopter from the 10 of May of 2001 to the 12 of September of 2005. Result: Of all 999 analyzed patients, 81,1% were taken care of in the place of the event (primary service) and 18,9% were a interhospital movement (secondary service). The most frequent pathologies related to the traumatic accident (40,9% traffic accidents and 12,7% labour accident) and the cardiovascular emergency with 12% of the patients. These two pathologies almost occupied 70% of treated patients. Of the minors of 45 years, 47% suffers traffic accidents and of the greater ones of 45 years, 26% suffers cardiovascular processes (p < 0.001). Other taken care of pathologies exists as they are sports accidents (7,6%), domestic accidents (2,3%), neonative emergencies (2,4%), respiratory (2%), autolisis, aggressions, fires with smaller prevalence. Conclusions: The helicopter 112 SOS Aragon represents an important resource within the system of sanitary emergencies of the Autonomous Community of Aragon. The study has allowed determine the profile of the serious patient who received urgent sanitary attention from this service. The critical patient (traumatized serious, neonates and cardiac) is the one that mainly benefits from transports by helicopter, mainly, when they are in distant rural areas of a hospital of reference (AU)
