ABSTRACT
Introducción: En la fase aguda del ictus el 30% de los pacientes presentan disfagia, y de ellos, el 50% experimentarán broncoaspiración. Nuestro objetivo fue evaluar los resultados de mortalidad y broncoaspiración del test del agua comparado con el test 2 volúmenes/3 texturas controlado con pulsioximetría (2v/3t-P) en una unidad de ictus. Pacientes y métodos: Durante 5 años se analizaron de forma prospectiva y consecutiva todos los pacientes con infarto cerebral en la Unidad de Ictus. Del año 2008 al 2010 se utilizó el test del agua (grupo 0 o G0), y del 2011 al 2012, el test 2v/3t-P (grupo 1 o G1). Se recogieron las siguientes variables: demográficas, factores de riesgo vascular, gravedad neurológica con la escala NIHSS, subtipo etiológico según criterios TOAST, subtipo clínico según la clasificación Oxfordshire, prevalencia de disfagia, broncoaspiración y exitus. Resultados: Se analizaron 418 pacientes con infarto cerebral agudo (G0 = 275, G1 = 143). Se detectaron diferencias significativas entre ambos grupos en el porcentaje de pacientes con TACI (17% en G0 vs. 29% en G1, p = 0,005) y en la mediana de NIHSS (4 puntos en G0 vs. 7 puntos en G1, p = 0,003). Con el test 2v/3t-P se detectó un aumento no significativo en el porcentaje de disfagia (22% en G0 vs. 25% en G1, p = 0,4), una menor tasa de mortalidad (1,7% en G0 vs. 0,7% en G1, p = 0,3) y una reducción significativa de broncoaspiración (6,2% en G0 vs. 2,1% en G1, p = 0,05). Conclusiones: El nuevo test 2v/3t-P, comparado con el test del agua, mejoró significativamente los resultados de broncoaspiración en los pacientes con infarto cerebral agudo
Introduction: During acute stroke, 30% of all patients present dysphagia and 50% of that subgroup will experience bronchoaspiration. Our aim was to compare mortality and bronchoaspiration rates associated with the water test compared to those associated with a 2 volume/3 texture test controlled with pulse oximetry (2v/3t-P test) in our stroke unit. Patients and methods. Over a 5-year period, we performed a prospective analysis of all consecutive acute ischaemic stroke patients hospitalised in the Stroke Unit. Dysphagia was evaluated using the water test between 2008 and 2010 (group 0 or G0), and the 2v/3t-P test (group 1 or G1) between 2011 and 2012. We analysed demographic data, vascular risk factors, neurological deficit on the NIHSS, aetiological subtype according to TOAST criteria, clinical subtype according to the Oxfordshire classification, prevalence of dysphagia, percentage of patients with bronchoaspiration, and mortality. Results: We examined 418 patients with acute stroke (G0 = 275, G1 = 143). There were significant differences between the 2 groups regarding the percentage of patients with TACI (17% in G0 vs. 29% in G1, P = .005) and median NIHSS score (4 points in G0 vs. 7 points in G1, P = .003). Since adopting the new swallowing test, we detected a non-significant increase in the percentage of dysphagia (22% in G0 vs. 25% in G1, P = .4), lower mortality (1.7% in G0 vs. 0.7% in G1, P = .3) and a significant decrease in the bronchoaspiration rate (6.2% in G0 vs. 2.1% in G1, P = .05). Conclusions: Compared to the water test used for dysphagia screening, the new 2v/3t-P test lowered bronchoaspiration rates in acute stroke patients
Subject(s)
Humans , Male , Female , Cerebral Infarction/diagnosis , Cerebral Infarction/etiology , Deglutition Disorders/complications , Deglutition Disorders/diagnosis , Biopsy, Needle/statistics & numerical data , Risk Factors , Stroke/complications , Stroke/diagnosis , Prospective Studies , Deglutition , Indicators of Morbidity and Mortality , Multivariate AnalysisABSTRACT
INTRODUCTION: During acute stroke, 30% of all patients present dysphagia and 50% of that subgroup will experience bronchoaspiration. Our aim was to compare mortality and bronchoaspiration rates associated with the water test compared to those associated with a 2 volume/3 texture test controlled with pulse oximetry (2v/3t-P test) in our stroke unit. PATIENTS AND METHODS: Over a 5-year period, we performed a prospective analysis of all consecutive acute ischaemic stroke patients hospitalised in the Stroke Unit. Dysphagia was evaluated using the water test between 2008 and 2010 (group 0 or G0), and the 2v/3t-P test (group 1 or G1) between 2011 and 2012. We analysed demographic data, vascular risk factors, neurological deficit on the NIHSS, aetiological subtype according to TOAST criteria, clinical subtype according to the Oxfordshire classification, prevalence of dysphagia, percentage of patients with bronchoaspiration, and mortality. RESULTS: We examined 418 patients with acute stroke (G0=275, G1=143). There were significant differences between the 2 groups regarding the percentage of patients with TACI (17% in G0 vs. 29% in G1, P=.005) and median NIHSS score (4 points in G0 vs. 7 points in G1, P=.003). Since adopting the new swallowing test, we detected a non-significant increase in the percentage of dysphagia (22% in G0 vs. 25% in G1, P=.4), lower mortality (1.7% in G0 vs. 0.7% in G1, P=.3) and a significant decrease in the bronchoaspiration rate (6.2% in G0 vs. 2.1% in G1, P=.05). CONCLUSIONS: Compared to the water test used for dysphagia screening, the new 2v/3t-P test lowered bronchoaspiration rates in acute stroke patients.
Subject(s)
Deglutition Disorders/diagnosis , Mass Screening , Stroke/complications , Aged , Deglutition Disorders/etiology , Female , Hospitalization , Humans , Male , Prevalence , Prospective Studies , Risk FactorsABSTRACT
No disponible
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Humans , Nutrition Assessment , Nutritional Status , Nutrition Disorders/diagnosis , Mass Screening/methods , Malnutrition/epidemiology , Reference Standards , Clinical Protocols , Process Assessment, Health Care/standardsABSTRACT
No disponible
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Humans , Nutrition Assessment , Nutritional Status , Malnutrition/diagnosis , Mass Screening/methods , Nutrition SurveysABSTRACT
No disponible
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Humans , Nutritional Support/methods , Nutrition Therapy/methods , Nutrition Disorders/diet therapy , Malnutrition/diet therapy , Patient Care Planning/organization & administration , Nutritional RequirementsABSTRACT
No disponible
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Humans , Pharmaceutical Solutions/pharmacology , Drug Compounding/methods , Food, Formulated/standards , Parenteral Nutrition Solutions/pharmacology , Reference Standards , Food Labeling/standardsABSTRACT
No disponible
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Humans , Drug Dispensaries , Pharmaceutical Services , Pharmaceutical Services/standards , Good Dispensing Practices , Reference StandardsABSTRACT
No disponible
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Humans , Pharmacy Service, Hospital/organization & administration , Nutritional Support/methods , Medication Therapy Management/organization & administration , Patient Safety , /organization & administration , Reference Standards , Catheter-Related Infections/prevention & control , Parenteral Nutrition/standardsABSTRACT
No disponible
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Humans , Monitoring, Physiologic/standards , Nutrition Therapy/standards , Medication Therapy Management/standards , Parenteral Nutrition/standards , Nutritional Support/standards , Pharmaceutical ServicesABSTRACT
No disponible
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Humans , Nutritional Support/statistics & numerical data , Pharmaceutical Services , Process Assessment, Health Care , Reference StandardsABSTRACT
No disponible
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Humans , Pharmaceutical Services , Medication Therapy Management/standards , Nutritional Support/standards , Reference StandardsABSTRACT
No disponible
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Humans , Nutritional Support/ethics , Pharmacy Service, Hospital/ethics , Decision Making/ethics , Risk Management/ethicsABSTRACT
No disponible
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Humans , Biomedical Research/trends , Pharmacy Service, Hospital/trends , Access to Information , Health Services ResearchABSTRACT
No disponible
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Humans , Education, Pharmacy, Continuing/organization & administration , Pharmacy Service, Hospital , Professional Training , Professional CompetenceABSTRACT
During the II BAXTER-SENPE workshop, a multidisciplinary nutrition expert committee discusses on indications, advantages and drawbacks of Peripheral Parenteral Nutrition (PPN), being defined as PN compounded by the three essential elements, vitamins, and minerals. Its composition implies a CH: lipids ratio of 60:40, a limited lipid daily intake (1.3 g/kg of body weight/day) and no more than 30% of total calories), and a nitrogen load not higher than 10 g of nitrogen in a maximum volume of 2500 mL. PPN can be administered by the peripheral route since its osmolarity is lower than 800 mOsm/L and pH is 6.0-7.4; in this way, possible adverse affects of central venous accesses are prevented. Currently, PPN by represent up to 50% of all PNs prescribed at a hospital Studies on efficacy, safety and pharmacoeconomic show that PPN is very useful therapeutic resource in certain clinical situations, both medical and surgical, to prevent metabolic-nutritional worsening of the patient, thus having an impact on significant reduction of complications, the number of interventions, and hospital stay.
Subject(s)
Parenteral Nutrition/methods , Catheterization, Peripheral , HumansABSTRACT
En la II Mesa de Trabajo BAXTER-SENPE un grupo multidisciplinario de expertos en nutrición debate sobre las indicaciones, ventajas e inconvenientes de la Nutrición Parenteral Periférica (NPP), definiéndose ésta como una NP compuesta por los tres principios inmediatos, vitaminas y minerales. Su composición implica una razón H d C: Lípidos de 60:40, un límite en el aporte diario lipídico (1,3 g/kg de peso/día y no más del 30 % de las calorías totales) y una carga nitrogenada que no supere los 10 gramos de nitrógeno en un volumen máximo de 2500 ml. La NPP permite su administración por vía periférica debido a presentar una osmolaridad menor de 800 mOsml y un pH entre 6,0 y 7,4; de esta forma evita los posibles efectos deletéreos del acceso venoso central. A día de hoy la NPP puede llegar a suponer el 50 % de las NPs prescritas en un centro hospitalario. Los estudios de eficacia, seguridad y farmacoeconomía demuestran que la NPP es un recurso terapéutico muy útil en determinadas situaciones clínicas tanto médicas como quirúrgicas para evitar el deterioro metabólico-nutricional del paciente lo que repercute en una reducción significativa de las complicaciones, disminuye significativamente el número de exploraciones y acorta la estancia hospitalaria
During the II BAXTER-SENPE workshop, a multidisciplinary nutrition expert committee discusses on indications, advantages and drawbacks of Peripheral Parenteral Nutrition (PPN), being defined as PN compounded by the three essential elements, vitamins, and minerals. Its composition implies a CH: lipids ratio of 60:40, a limited lipid daily intake (1.3 g/kg of body weight/day) and no more than 30% of total calories), and a nitrogen load not higher than 10 g of nitrogen in a maximum volume of 2500 mL. PPN can be administered by the peripheral route since its osmolarity is lower than 800 mOsm/L and pH is 6.0- 7.4; in this way, possible adverse affects of central venous accesses are prevented. Currently, PPN by represent up to 50% of all PNs prescribed at a hospital. Studies on efficacy, safety and pharmacoeconomic show that PPN is very useful therapeutic resource in certain clinical situations, both medical and surgical, to prevent metabolic-nutritional worsening of the patient, thus having an impact on significant reduction of complications, the number of interventions, and hospital stay
Subject(s)
Humans , Parenteral Nutrition/methods , Catheterization, Peripheral/methods , Economics, Pharmaceutical , Cost Efficiency AnalysisABSTRACT
Daytime CPAP titration studies with full polysomnography have been successfully performed in patients with severe sleep apnea-hypopnea syndrome (SAHS). The implementation of daytime studies in unselected SAHS patients could help to reduce the waiting lists for CPAP titrations. The main purpose of this study was to compare the effectiveness of conventional versus manual or automatic daytime CPAP titration in unselected patients with SAHS. Ninety-three consecutive patients with SAHS in whom CPAP was indicated were assigned to conventional titration or to manual or automatic (AutoSet) daytime CPAP titration, after sleep deprivation. The number of valid studies, sleep architecture, final pressure selected and mean pressure in the different sleep stages were compared. Changes in sleepiness (Epworth sleepiness score) and hours of CPAP use were assessed after 3 months of treatment. Four patients did not sleep (3 AutoSet, 1 conventional daytime groups). Sleep latency was shorter during automatic daytime titration whereas REM latency was shorter in daytime studies; the percentage of sleep stages was similar during all types of titration. CPAP requirements were significantly higher during REM sleep in conventional and manual daytime titrations while mean pressure was unchanged throughout sleep stages during AutoSet titration. CPAP pressure selected with conventional or daytime manual titration (7.5(2.2) cm H2O and 7.4(1.5) cm H2O, ns) were significantly lower (P< 0.001) than with AutoSet (9.4(1.6) cm H20. All groups showed similar decrease of sleepiness and hours of use of CPAP at 3 months of follow-up. Automatic and manual daytime PSG studies after sleep deprivation are useful for CPAP titration in unselected patients with SAHS. Pressure selected with AutoSet is significantly higher than with conventional daytime or nighttime titration, although not significant in terms of treatment compliance and symptom improvement.
Subject(s)
Polysomnography/methods , Positive-Pressure Respiration/methods , Sleep Apnea Syndromes/therapy , Adult , Aged , Air Pressure , Circadian Rhythm , Female , Follow-Up Studies , Humans , Male , Middle Aged , Sleep Apnea Syndromes/psychology , Sleep Deprivation , Sleep Stages , Treatment OutcomeABSTRACT
AIMS: The purpose of this study was to establish the relevance of several clinical factors associated with parenteral nutrition (PN) hypertriglyceridemia and to construct a predictive model for this complication. METHOD: This multicenter study included all patients with initial serum triglyceridemia <3 mmol and receiving a minimum of 7 days' PN therapy. The study ended for each patient when hypertriglyceridemia developed or PN was terminated. Two multivariate models were constructed, one to study the clinical factors and the second to predict plasma triglyceridemia. A total of 22 clinical factors studied as independent variables were included in the multiple-step regression models only when they showed a P-value over 0.1. Statistical significance was determined by the confidence interval of the odds ratio (OR) and the partial regression coefficient (b). RESULTS: The study included 260 patients from 14 hospitals. Lipid administration was 0.83+/-0.37 g/kg/day. Among the total, 68 patients (26.2%) showed hypertriglyceridemia. Variables included in both models were serum glucose (OR, 2.63; b, 0.06), renal failure (OR, 10.56; b, 1.70), corticoid administration >0.5 mg/kg (OR, 7.98; b, 0.97), pancreatitis (OR, 4.38; b, 0.64), sepsis (OR, 4.48; b, 0.24), lipids infused (OR, 3.03; b, 0.24) and heparin administration >3 mg/kg/day (OR, 0.11; b, -1.21). CONCLUSION: Although the rate of lipid infusion was low, certain clinical factors modified triglyceridemia. Nevertheless, relatively fast plasma clearance of lipids infused indicates that a reduction in lipid supply could be a quick, effective measure for controlling hypertriglyceridemia. Thus, careful monitoring of patients with clinical factors predicting risk in the model studied, with adjustment of lipid perfusion rates accordingly, is suggested to avoid hypertriglyceridemia.
Subject(s)
Hypertriglyceridemia/blood , Hypertriglyceridemia/epidemiology , Parenteral Nutrition/adverse effects , Adult , Cohort Studies , Female , Humans , Lipids/administration & dosage , Male , Models, Statistical , Multivariate Analysis , Odds Ratio , Predictive Value of Tests , Prospective Studies , Regression Analysis , Risk Factors , Triglycerides/bloodABSTRACT
Weight loss is associated with clinical improvement in sleep apnoea/ hypopnoea syndrome (SAHS). The aim of this study was to ascertain whether the therapeutic efficacy of dietary weight loss is maintained in the long-term. From a total of 216 overweight SAHS patients treated by only a weight reduction programme, 24 cured by this method (apnoea/hypopnoea index (AHI) at diagnosis 443+/-27.8, after weight loss 3+/-3.1) were re-evaluated after a mean (+/-SD) period of 94.3+/-27.4 months post-cure. No correlation was found between changes in AHI and body mass index experienced by each patient in the two phases of the study (diagnosis to cure and cure to long-term follow-up), r=0.29, p=0.156, demonstrating a marked intra-individual variability. Six of the 13 patients who maintained their weight presented recurrence of SAHS (AHI 40.5+/-24.1) as did eight of the 11 who had regained weight (AHI 44.3+/-23.). Weight maintenance was more frequent among patients who had continued to attend periodic appointments, 10/11 versus 3/13 (p<0.001). In conclusion, weight-loss efficacy is maintained in the long-term in some sleep apnoea/hypopnoea syndrome patients. This study indicates the need for periodic follow-up of these patients as a reinforcement for weight maintenance and for early detection of the reappearance of sleep apnoea/hypopnoea syndrome.
