[Parenteral periferic nutrition: non surgical indications]. / Indicaciones no quirúrgicas de la nutrición parenteral periférica.

INTRODUCTION: Peripheral Parenteral Nutrition, defined as a mixture of micronutrients, vitamins and minerals with lower osmolarity of 800 mOsm/L, it avoids the risk of the central catheter. It has traditionally been used in postoperative patients, but really medical conditions can also benefit from it either as complementary, or as the only one source of nutrients, since a high number of patients require less caloric intake than previously believed. OBJECTIVE: Evaluation of the use of peripheral parenteral nutrition in non postoperative hospitalized patients, reasons for its prescription and duration. MATERIAL AND METHODS: 368 patients who required peripheral parenteral nutrition were studied by the Nutrition Support Unit for 54 months, in a Tertiary Hospital of 1,560 beds, from all, specialties excluding postoperative patients. The study include the mechanisms that led to its use in all its forms: the only one nutritional support or complementing insufficient Enteral Nutrition or Oral Diet. RESULTS: Oncology and Critical Care were the most prescribed pathologies, followed by Pancreatitis, Inflammatory Bowel Disease and HIV and a miscellany of clinical pathologies. Gastrointestinal pathology (pain, diarrhea or vomiting) was the most frequent cause, both in critically ill as in non-critical patients. CONCLUSIONS: Although enteral route is preferred and raised primarily in most patients studied, there are many causes that might impair or nullify it. Peripheral parenteral nutrition is an alternative when caloric intake is impossible or insufficient or refused by the patient, as it minimizes the complications of the central catheter.

Indicaciones no quirúrgicas de la nutrición parenteral periférica / Parenteral periferic nutrition: non surgical indications

Introducción: La Nutrición Parenteral Periférica, definida como la mezcla de macronutrientes, vitaminas y minerales con osmolaridad menor de 800 mOsm/L, permite evitar los riesgos del catéter central. Clásicamente ha sido utilizada en postoperados, pero actualmente la patología médica también puede beneficiarse de ella, bien como única fuente de nutrientes, ya que un alto porcentaje de pacientes precisan menor aporte calórico de lo que se creía, o como complementaria. Objetivo: Evaluación de la utilización de la Nutrición Parenteral Periférica en pacientes hospitalizados no postoperados, razones de su prescripción y su duración. Material y método: Se estudiaron 368 pacientes de todas las especialidades sin incluir postoperados con Nutrición Parenteral Periférica prescrita por la Unidad de Nutrición en un Hospital Terciario de 1.560 camas durante 54 meses, estudiándose los mecanismos que llevaron a su utilización en todas sus variantes: soporte único nutricional o complementando a Nutrición Enteral o Dieta Oral insuficiente. Resultados: Las patologías en las que se ha prescrito más frecuentemente han sido la Oncológica y Críticos, siguiendo en número la Pancreatitis, Enfermedad Inflamatoria Intestinal y VIH y una miscelánea de cuadros clínicos. La causa más frecuente ha sido la patología digestiva (dolor, diarrea o vómitos) tanto en pacientes críticos como en no críticos. Conclusiones: Aunque la vía enteral es de elección y así se ha planteado primariamente en la mayoría de los pacientes del estudio, existen múltiples causas que la impiden total o parcialmente. La Nutrición Parenteral Periférica es una alternativa cuando la ingesta es imposible o insuficiente o existe negativa por parte del enfermo, ya que minimiza las complicaciones al no precisar vía central (AU)

Introduction: Peripheral Parenteral Nutrition, defined as a mixture of micronutrients, vitamins and minerals with lower osmolarity of 800 mOsm/L, it avoids the risk of the central catheter. It has traditionally been used in postoperative patients, but really medical conditions can also benefit from it either as complementary, or as the only one source of nutrients, since a high number of patients require less caloric intake than previously believed. Objective: Evaluation of the use of peripheral parenteral nutrition in non postoperative hospitalized patients, reasons for its prescription and duration. Material and methods: 368 patients who required peripheral parenteral nutrition were studied by the Nutrition Support Unit for 54 months, in a Tertiary Hospital of 1,560 beds, from all, specialties excluding postoperative patients. The study include the mechanisms that led to its use in all its forms: the only one nutritional support or complementing insufficient Enteral Nutrition or Oral Diet. Results: Oncology and Critical Care were the most prescribed pathologies, followed by Pancreatitis, Inflammatory Bowel Disease and HIV and a miscellany of clinical pathologies. Gastrointestinal pathology (pain, diarrhea or vomiting) was the most frequent cause, both in critically ill as in non-critical patients. Conclusions: Although enteral route is preferred and raised primarily in most patients studied, there are many causes that might impair or nullify it. Peripheral parenteral nutrition is an alternative when caloric intake is impossible or insufficient or refused by the patient, as it minimizes the complications of the central catheter (AU)

Identificación de pacientes de riesgo nutricional por 3 métodos de cribado distintos / No disponible

Identificar precozmente a los pacientes de Riesgo Nutricional es fundamental para actuar de forma inmediata sobre ellos y aplicar el aporte nutricional correcto a aquellos que lo necesiten. Para ello existen varios métodos de cribado o screening. Objetivos: 1.- Determinar el índice de riesgo nutricional por 3 métodos de gran sensibilidad.2.- Comprobar si existe concordancia en el resultado obtenido con cada uno de ellos. Material y métodos: Se estudian 184 pacientes mayores de edad (92<65 años y 92≥65años) ingresados en 6 hospitales públicos de Galicia, a quienes se aplican los protocolos de estudio para 3 métodos de cribado nutricional perfectamente validados que determinan pacientes de Riesgo Nutricional. Se valoran cambios recientes en el peso, albúmina sérica, concentración de linfocitos e ingesta y diagnóstico al ingreso y se determina el porcentaje de pacientes de riesgo con cada método. Contrastamos los porcentajes y comprobamos si existe concordancia entre los resultados. Resultados: El Índice de Riesgo Nutricional lo definen los pacientes con riesgo de desnutrición hallados por cada parámetro: Elmore -IR.= 20,1%; Ulíbarri – IR. = 51,1%, Cardona –IR. = 48,9%El Coeficiente de correlación de Spearman muestra una significación de 0,00, lo que suponeuna concordancia entre los pacientes de riesgo nutricional definidos por cada uno de losíndices. Conclusiones: 1.- El Índice de Riesgo determinado por cada parámetro está dentro del estándar habitual de desnutrición Hospitalaria. 2.-Los 3 Índices de Riesgo muestran una correlación significativa entre ellos, es decir, que detectan los mismos pacientes como pacientes d eriesgo (AU)

To identify precociously patients at nutritional risk is essential to act immediately to apply nutritional support is needed. There are several screening methods. Objectives: 1.- To determine nutritional risk by 3 methods of great sensitivity. 2.- To establish the concordance of results obtained between methods. Material and Methods: We studied 184 adult patients (92<65 years and 92≥65 years) admitted in 6 publics hospitals of Galicia, who were applied for study protocol for 3 validated nutritional screening methods that determine nutritional at risk patients; evaluation included recent weight changes, serum albumin, lymphocyte count, ingestion and diagnosis at admittance, and we determined the percentage of risk patients with each method. We contrasted percentages and studied concordance between results. Results: Nutritional Risk Index is defined by patients at risk founded by each parameter: Elmore- IR.= 20,1%; Ulíbarri – IR. = 51,1%, Cardona– IR. = 48,9%Spearman’s correlation coefficient shows significant relation of de 0,00, that implies a concordance between at risk patients defined bay each index. Conclusions: 1.- Risk index defined by each parameter is between usual hospital malnutrition standards. 2.- All 3 risk index show significant correlation; that means that they show significant correlation and detect same patients as at risk (AU)

[Nutrition and chronic renal failure]. / Nutrición e insuficiencia renal crónica.

The causes of malnutrition in chronic terminal kidney failure are reviewed in the situation both before and after dialysis, as are the malnutrition rates in both circumstances and their treatment. Malnutrition has a high prevalence in terminal kidney patients, partly as a result of the therapeutic restriction on calories and proteins, but also due to the metabolic reactions typical of the disease and to anorexia. In patients subjected to dialytical methods, certain other mechanisms are added. In addition to malnutrition, there are alterations in the metabolism of calcium, phosphorus and potassium, as well as lipids, thus limiting nutritional therapy's ability to restore the nutritional status to normal. An awareness of energy expenditure in chronic terminal kidney failure and the consequences of malnutrition have led to new challenges in nutritional therapy, both in the dose and quality of the proteins, with a debate raging over the advantages of ketoanalogues, and also in the methods for providing nutrients. The ideal nutritional method for repletion is oral administration, but this can be enhanced with artificial support such as oral supplements, parenteral nutrition during dialysis or such alternatives as enteral nutrition at home in the case of chronic kidney problems in children, using percutaneous endoscopic gastrostomy (PEG), in order to nourish the patients and minimize growth disorders.

[Quality of support by artificial nutrition: difficulties with AIDS patients]. / Calidad asistencial en nutrición artificial: dificultades en pacientes con SIDA.

The use of Enteral Nutrition (EN) in patients with AIDS with a severe nutritional deterioration, is the most common route, not only because of the risk/benefit relation, bur also because this is a physiological route that is easily managed and is profitable in terms of renutrition. However, and given the characteristics of the affected population, whose origin in a large percentage is the addiction to parenteral drugs, implanting this route in these patients is a challenge, as these patients refuse in more than 50% of the cases. Moreover, the risk group is not only a factor in the difficulty for applying the ideal across route, but also the combination of other elements like sex or the disease itself, force the clinical to use more aggressive methods (Parenteral Nutrition) or those that are less profitable nutritionally (Supplements). The negative aspects with regard to tube feeding of these patients are shown, in relation to the factors, and these are compared with the negative aspects of other diagnosis groups (rest of the Hospital).