Recomendaciones para el tratamiento nutrometabólico especializado del paciente crítico: patología abdominal no quirúrgica. Grupo de Trabajo de Metabolismo y Nutrición de la Sociedad Española de Medicina Intensiva, Crítica y Unidades Coronarias (SEMICYUC) / Recommendations for specialized nutritional-metabolic treatment of the critical patient: Nonsurgical abdominal disease. Metabolism and Nutrition Working Group of the Spanish Society of Intensive and Critical Care Medicine and Coronary Units (SEMICYUC)

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Guidelines for specialized nutritional and metabolic support in the critically-ill patient. Update. Consensus SEMICYUC-SENPE: Macronutrient and micronutrient requirements / Recomendaciones para el soporte nutricional y metabólico especializado del paciente crítico. Actualización. Consenso SEMICYUC-SENPE: Requerimientos de macronutrientes y micronutrientes

Energy requirements are altered in critically-ill patients and are influenced by the clinical situation, treatment, and phase of the process. Therefore, the most appropriate method to calculate calorie intake is indirect calorimetry. In the absence of this technique, fixed calorie intake (between 25 and 35 kcal/kg/day) or predictive equations such as the Penn State formula can be used to obtain a more accurate evaluation of metabolic rate. Carbohydrate administration should be limited to a maximum of 4 g/kg/day and a minimum of 2 g/kg/day. Plasma glycemia should be controlled to avoid hyperglycemia. Fat intake should be between 1 and 1.5g/kg/day. The recommended protein intake is 1-1.5g/kg/day but can vary according to the patient’s clinical status. Particular attention should be paid to micronutrient intake. Consensus is lacking on micronutrient requirements. Some vitamins (A, B, C, E) are highly important in critically-ill patients, especially those undergoing continuous renal replacement techniques, patients with severe burns and alcoholics, although the specific requirements in each of these types of patient have not yet been established. Energy and protein intake in critically-ill patients is complex, since both clinical factors and the stage of the process must be taken into account. The first step is to calculate each patient’s energy requirements and then proceed to distribute calorie intake among its three components: proteins, carbohydrates and fat. Micronutrient requirements must also be considered (AU)

Los pacientes críticos presentan modificaciones importantes en sus requerimientos energéticos, en las que intervienen la situación clínica, el tratamiento aplicado y el momento evolutivo. Por ello, el método más adecuado para el cálculo del aporte calórico es la calorimetría indirecta. En su ausencia puede recurrirse al aporte de una cantidad calórica fija (comprendida entre 25-35kcal/kg/día) o al empleo de ecuaciones predictivas, entre las cuales la fórmula de penn State proporciona una evaluación más precisa de la tasa metabólica. La administración de carbohidratos debe tener un límite máximo de 4 g/kg/día y mínimo de 2 g/kg/día. Deben controlarse los valores de glucemia plasmática con el fin de evitar la hiperglucemia. Respecto al aporte de grasa, debe estar entre 1-1,5 g/kg/día. El aporte proteico recomendado se encuentra entre 1-1,5 g/kg/día, aunque puede variar en función de las características de la propia situación clínica. Debe prestarse una atención especial al aporte de micronutrientes. No hay un acuerdo unánime sobre los requerimientos de éstos. Algunas de las vitaminas (A, B,C, E) son de gran importancia para los pacientes en situación crítica, con especial atención en pacientes sometidos a técnicas continuas de reemplazo renal, grandes quemados y alcohólicos, aunque los requerimientos específicos para cada uno de ellos no han sido establecidos. El aporte de los requerimientos energéticos y proteicos a los pacientes críticos es complejo, dado que debe tener en cuenta tanto las circunstancias clínicas como su momento evolutivo. La primera fase del proceso es la del cálculo de las necesidades energéticas de cada paciente para, en una fase posterior, proceder a la distribución del aporte caló-rico entre los 3 componentes de éste: proteínas, hidratos de carbono y grasas, así como considerar la necesidad de aportar micronutrientes (AU)

Guidelines for specialized nutritional and metabolic support in the critically-ill patient. Update. Consensus SEMICYUC-SENPE: Liver failure and liver transplantation / Recomendaciones para el soporte nutricional y metabólico especializado del paciente crítico. Actualización. Consenso SEMICYUC-SENPE: Insuficiencia hepática y trasplante hepático

Patients with liver failure have a high prevalence ofmalnutrition, which is related to metabolic abnormalitiesdue to the liver disease, reduced nutrient intake andaltera tions in digestive function, among other factors.In general, in patients with liver failure, metabolic andnutritional support should aim to provide adequate nutrientintake and, at the same time, to contribute to patients’recovery through control or reversal of metabolic altera -tions. In critically-ill patients with liver failure, currentknowledge indicates that the organ failure is not the mainfactor to be considered when choosing the nutritionalregi men. As in other critically-ill patients, the enteralroute should be used whenever possible.The composition of the nutritional formula should beadapted to the patient’s metabolic stress.Despite the physiopathological basis classicallydescribed by some authors who consider amino acidimbalance to be a triggering factor and key element inmaintaining encephalopathy, there are insufficient datato recommend “specific” solutions (branched-chainamino acid-enriched with low aromatic amino acids) aspart of nutritional support in patients with acute liverfailure.In patients undergoing liver transplantation, nutrientintake should be started early in the postoperative periodthrough transpyloric access. Prevention of the hepatic alterations associated withnutritional support should also be considered in distinctclinical scenarios (AU)

Los pacientes con insuficiencia hepática presentan unaelevada prevalencia de malnutrición. Ésta se encuentrarelacionada, entre otros factores, con las alteraciones delmetabolismo derivadas de la enfermedad hepática, la disminución en la ingesta de nutrientes y las alteraciones enla función digestiva.De modo general, en los pacientes con insuficienciahepática, el soporte metabólico-nutricional debe tenercomo objetivo el aporte adecuado de los requerimientoscontribuyendo, al mismo tiempo, a la recuperación de lospacientes mediante el control o la reversión de las alteraciones metabólicas apreciadas. En los pacientes críticosque presentan insuficiencia hepática, los conocimientosactuales indican que ésta no parece ser un factor fundamental a la hora de considerar la pauta nutricional. Comoen otros pacientes críticos, la vía de aporte de nutrientesdebe ser la enteral, siempre que ello sea posible.La composición de la fórmula nutricional debe estaradaptada a la situación de estrés metabólico. A pesar de labase fisiopatológica, clásicamente descrita por algunosautores, que considera al disbalance de aminoácidos unfactor desencadenante y mantenedor de la encefalopatía,no hay datos suficientes para recomendar el empleo desoluciones “específicas” (enriquecidas en aminoácidosramificados y pobres en aminoácidos aromáticos) comoparte del soporte nutricional en los pacientes con insuficiencia hepática aguda.En los pacientes sometidos a trasplante hepático, elaporte de nutrientes debería iniciarse de manera precozen el postoperatorio mediante una vía de acceso transpilórica. La prevención de las alteraciones hepáticas asociadas al soporte nutricional debe ser también consideradaen diferentes situaciones clínicas (AU)

Recomendaciones para el soporte nutricional y metabólico especializado del paciente crítico. Actualización. Consenso SEMICYUC-SENPE: Requerimientos de macronutrientes y micronutrientes / Guidelines for specialized nutritional and metabolic support in the critically-ill patient. Update. Consensus of the Spanish Society of Intensive Care Medicine and Coronary Units-Spanish Society of Parenteral and Enteral Nutrition (SEMICYUC-SENPE): Macro- and micronutrient requirements

Los pacientes críticos presentan modificaciones importantes en sus requerimientos energéticos, en las que intervienen la situación clínica, el tratamiento aplicado y el momento evolutivo. Por ello, el método más adecuado para el cálculo del aporte calórico es la calorimetría indirecta. En su ausencia puede recurrirse al aporte de una cantidad calórica fija (comprendida entre 25-35 kcal/ kg/ día) o al empleo de ecuaciones predictivas, entre las cuales la fórmula de Penn State proporciona una evaluación más precisa de la tasa metabólica. La administración de carbohidratos debe tener un límite máximo de 4 g/kg/día y mínimo de 2 g/kg/día. Deben controlarse los valores de glucemia plasmática con el in de evitar la hiperglucemia. Respecto al aporte de grasa, debe estar entre 1-1,5 g/ kg/ día. El aporte proteico recomendado se encuentra entre 1-1,5 g/kg/día, aunque puede variar en función de las características de la propia situación clínica. Debe prestarse una atención especial al aporte de micronutrientes. No hay un acuerdo unánime sobre los requerimientos de éstos. Algunas de las vitaminas (A, B, C, E) son de gran importancia para los pacientes en situación crítica, con especial atención en pacientes sometidos a técnicas continuas de reemplazo renal, grandes quemados y alcohólicos, aunque los requerimientos específicos para cada uno de ellos no han sido establecidos. El aporte de los requerimientos energéticos y proteicos a los pacientes críticos es complejo, dado que debe tener en cuenta tanto las circunstancias clínicas como su momento evolutivo. La primera fase del proceso es la del cálculo de las necesidades energéticas de cada paciente para, en una fase posterior, proceder a la distribución del aporte calórico entre los 3 componentes de éste: proteínas, hidratos de car- bono y grasas, así como considerar la necesidad de aportar micronutrientes (AU)

Energy requirements are altered in critically-ill patients and are influenced by the clinical situation, treatment, and phase of the process. Therefore, the most appropriate method to calculate calorie intake is indirect calorimetry. In the absence of this technique, fixed calorie intake (between 25 and 35 kcal/kg/day) or predictive equations such as the Penn State formula can be used to obtain a more accurate evaluation of metabolic rate. Carbohydrate administration should be limited to a maximum of 4 g/kg/day and a minimum of 2 g/ kg/ day. Plasma glycemia should be controlled to avoid hyperglycemia. Fat intake should be between 1 and 1.5 g/ kg/ day. The recommended protein intake is 1-1.5 g/ kg/ day but can vary according to the patient’s clinical status. Particular attention should be paid to micronutrient intake. Consensus is lacking on micronutrient requirements. Some vitamins (A, B, C, E) are highly important in critically-ill patients, especially those undergoing continuous renal replacement techniques, patients with severe burns and alcoholics, although the specific requirements in each of these types of patient have not yet been established. Energy and protein intake in critically-ill patients is complex, since both clinical factors and the stage of the process must be taken into account. The first step is to calculate each patient’s energy requirements and then proceed to distribute calorie intake among its three components: proteins, carbohydrates and fat. Micronutrient requirements must also be considered (AU)

Recomendaciones para el soporte nutricional y metabólico especializado del paciente crítico. Actualización. Consenso SEMICYUC-SENPE: Insuiciencia hepática y trasplante hepático / Guidelines for specialized nutritional and metabolic support in the critically-ill patient. Update. Consensus of the Spanish Society of Intensive Care Medicine and Coronary Units-Spanish Society of Parenteral and Enteral Nutrition (SEMICYUC-SENPE): Liver failure and transplantation

Los pacientes con insuficiencia hepática presentan una elevada prevalencia de malnutrición. Ésta se encuentra relacionada, entre otros factores, con las alteraciones del metabolismo derivadas de la enfermedad hepática, la disminución en la ingesta de nutrientes y las alteraciones en la función digestiva. De modo general, en los pacientes con insuficiencia hepática, el soporte metabólico-nutricional debe tener como objetivo el aporte adecuado de los requerimientos contribuyendo, al mismo tiempo, a la recuperación de los pacientes mediante el control o la reversión de las alteraciones metabólicas apreciadas. En los pacientes críticos que presentan insuficiencia hepática, los conocimientos actuales indican que ésta no parece ser un factor fundamental a la hora de considerar la pauta nutricional. Como en otros pacientes críticos, la vía de aporte de nutrientes debe ser la enteral, siempre que ello sea posible. La composición de la fórmula nutricional debe estar adaptada a la situación de estrés metabólico. A pesar de la base isiopatológica, clásicamente descrita por algunos autores, que considera al disbalance de aminoácidos un factor desencadenante y mantenedor de la encefalopatía, no hay datos suficientes para recomendar el empleo de soluciones “específicas” (enriquecidas en aminoácidos ramificados y pobres en aminoácidos aromáticos) como parte del soporte nutricional en los pacientes con insuficiencia hepática aguda. En los pacientes sometidos a trasplante hepático, el aporte de nutrientes debería iniciarse de manera precoz en el postoperatorio mediante una vía de acceso transpilórica. La prevención de las alteraciones hepáticas asociadas al soporte nutricional debe ser también considerada en diferentes situaciones clínicas (AU)

Patients with liver failure have a high prevalence of malnutrition, which is related to metabolic abnormalities due to the liver disease, reduced nutrient intake and alterations in digestive function, among other factors. In general, in patients with liver failure, metabolic and nutritional support should aim to provide adequate nutrient intake and, at the same time, to contribute to patients’ recovery through control or reversal of metabolic alterations. In critically-ill patients with liver failure, current knowledge indicates that the organ failure is not the main factor to be considered when choosing the nutritional regimen. As in other critically-ill patients, the enteral route should be used whenever possible. The composition of the nutritional formula should be adapted to the patient’s metabolic stress. Despite the physiopathological basis classically described by some authors who consider amino acid imbalance to be a triggering factor and key element in maintaining encephalopathy, there are insuficient data to recommend “specific” solutions (branched-chain amino acid-enriched with low aromatic amino acids) aspart of nutritional support in patients with acute liver failure. In patients undergoing liver transplantation, nutrient intake should be started early in the postoperative period through transpyloric access. Prevention of the hepatic alterations associated with nutritional support should also be considered in distinct clinical scenarios (AU)

[Guidelines for specialized nutritional and metabolic support in the critically-ill patient. Update. Consensus of the Spanish Society of Intensive Care Medicine and Coronary Units-Spanish Society of Parenteral and Enteral Nutrition (SEMICYUC-SENPE): macro-and micronutrient requirements]. / Recomendaciones para el soporte nutricional y metabólico especializado del paciente crítico. Actualización. Consenso SEMICYUC-SENPE: requerimientos de macronutrientes y micronutrientes.

Energy requirements are altered in critically-ill patients and are influenced by the clinical situation, treatment, and phase of the process. Therefore, the most appropriate method to calculate calorie intake is indirect calorimetry. In the absence of this technique, fixed calorie intake (between 25 and 35 kcal/kg/day) or predictive equations such as the Penn State formula can be used to obtain a more accurate evaluation of metabolic rate. Carbohydrate administration should be limited to a maximum of 4 g/kg/day and a minimum of 2g/kg/day. Plasma glycemia should be controlled to avoid hyperglycemia. Fat intake should be between 1 and 1.5 g/kg/day. The recommended protein intake is 1-1.5 g/kg/day but can vary according to the patient's clinical status. Particular attention should be paid to micronutrient intake. Consensus is lacking on micronutrient requirements. Some vitamins (A, B, C, E) are highly important in critically-ill patients, especially those undergoing continuous renal replacement techniques, patients with severe burns and alcoholics, although the specific requirements in each of these types of patient have not yet been established. Energy and protein intake in critically-ill patients is complex, since both clinical factors and the stage of the process must be taken into account. The first step is to calculate each patient's energy requirements and then proceed to distribute calorie intake among its three components: proteins, carbohydrates and fat. Micronutrient requirements must also be considered.

[Guidelines for specialized nutritional and metabolic support in the critically-ill patient. Update. Consensus of the Spanish Society of Intensive Care Medicine and Coronary Units-Spanish Society of Parenteral and Enteral Nutrition (SEMICYUC-SENPE): liver failure and transplantation]. / Recomendaciones para el soporte nutricional y metabólico especializado del paciente crítico. Actualización. Consenso SEMICYUC-SENPE: insuficiencia hepática y trasplante hepático.

Patients with liver failure have a high prevalence of malnutrition, which is related to metabolic abnormalities due to the liver disease, reduced nutrient intake and alterations in digestive function, among other factors. In general, in patients with liver failure, metabolic and nutritional support should aim to provide adequate nutrient intake and, at the same time, to contribute to patients' recovery through control or reversal of metabolic alterations. In critically-ill patients with liver failure, current knowledge indicates that the organ failure is not the main factor to be considered when choosing the nutritional regimen. As in other critically-ill patients, the enteral route should be used whenever possible. The composition of the nutritional formula should be adapted to the patient's metabolic stress. Despite the physiopathological basis classically described by some authors who consider amino acid imbalance to be a triggering factor and key element in maintaining encephalopathy, there are insufficient data to recommend "specific" solutions (branched-chain amino acid-enriched with low aromatic amino acids) as part of nutritional support in patients with acute liver failure. In patients undergoing liver transplantation, nutrient intake should be started early in the postoperative period through transpyloric access. Prevention of the hepatic alterations associated with nutritional support should also be considered in distinct clinical scenarios.

Guidelines for specialized nutritional and metabolic support in the critically-ill patient: update. Consensus SEMICYUC-SENPE: macronutrient and micronutrient requirements.

Energy requirements are altered in critically-ill patients and are influenced by the clinical situation, treatment, and phase of the process. Therefore, the most appropriate method to calculate calorie intake is indirect calorimetry. In the absence of this technique, fixed calorie intake (between 25 and 35 kcal/kg/day) or predictive equations such as the Penn State formula can be used to obtain a more accurate evaluation of metabolic rate. Carbohydrate administration should be limited to a maximum of 4 g/kg/day and a minimum of 2 g/kg/day. Plasma glycemia should be controlled to avoid hyperglycemia. Fat intake should be between 1 and 1.5 g/kg/day. The recommended protein intake is 1-1.5 g/kg/day but can vary according to the patient's clinical status. Particular attention should be paid to micronutrient intake. Consensus is lacking on micronutrient requirements. Some vitamins (A, B, C, E) are highly important in critically-ill patients, especially those undergoing continuous renal replacement techniques, patients with severe burns and alcoholics, although the specific requirements in each of these types of patient have not yet been established. Energy and protein intake in critically-ill patients is complex, since both clinical factors and the stage of the process must be taken into account. The first step is to calculate each patient's energy requirements and then proceed to distribute calorie intake among its three components: proteins, carbohydrates and fat. Micronutrient requirements must also be considered.

Guidelines for specialized nutritional and metabolic support in the critically-ill patient: update. Consensus SEMICYUC-SENPE: liver failure and liver transplantation.

Patients with liver failure have a high prevalence of malnutrition, which is related to metabolic abnormalities due to the liver disease, reduced nutrient intake and alterations in digestive function, among other factors. In general, in patients with liver failure, metabolic and nutritional support should aim to provide adequate nutrient intake and, at the same time, to contribute to patients' recovery through control or reversal of metabolic alterations. In critically-ill patients with liver failure, current knowledge indicates that the organ failure is not the main factor to be considered when choosing the nutritional regimen. As in other critically-ill patients, the enteral route should be used whenever possible. The composition of the nutritional formula should be adapted to the patient's metabolic stress. Despite the physiopathological basis classically described by some authors who consider amino acid imbalance to be a triggering factor and key element in maintaining encephalopathy, there are insufficient data to recommend "specific" solutions (branched-chain amino acid-enriched with low aromatic amino acids) as part of nutritional support in patients with acute liver failure. In patients undergoing liver transplantation, nutrient intake should be started early in the postoperative period through transpyloric access. Prevention of the hepatic alterations associated with nutritional support should also be considered in distinct clinical scenarios.

[Recommendations for nutritional assessment and specialized nutritional support of critically ill patients]. / Recomendaciones para la valoración nutricional y el soporte nutricional especializado de los pacientes críticos.

Due to the characteristics of critically ill patients, elaborating recommendations on nutritional support for these patients is difficult. Usually the time of onset of nutritional support or its features are not well established, so that its application is based on experts' opinion. In the present document, recommendations formulated by the Metabolism and Nutrition Working Group of the Spanish Society of Intensive and Critical Medicine and Coronary Units (SEMICYUC) are presented. Recommendations are based on the literature analysis and further discussion by the working group members in order to define, consensually, the more relevant issues of metabolic and nutritional support of patients in a critical condition. Several clinical situations have been considered which are developed in the following articles of this publication. The present recommendations aim at providing a guideline for the less experienced clinicians when considering the metabolic and nutritional issues of critically ill patients.

[Artificial nutrition in intestinal failure: short bowel syndrome. Inflammatory Bowel Disease]. / Nutrición artificial en la insuficiencia intestinal: síndrome de intestino corto. Enfermedad inflamatoria intestinal.

Large intestinal resection produces a sufficient number of impairments as to require specialized nutritional support. Basic treatment measures, especially during the acute phase after intestinal resection or in the presence of severe complications in patients with short bowel syndrome, include fluid and electrolytes reposition and nutritional support implementation in order to prevent hyponutrition. Enteral nutrition is the main stimulating factor for adaptation of the remaining bowel. However, its application has some difficulties during the acute phase, and thus patients must be frequently treated with parenteral nutrition. The presence of hyponutrition may be also important in patients with intestinal inflammatory disease. Nutritional support is indicated in these cases as the primary treatment modality for the disease, as hyponutrition treatment, or as perioperative treatment in patients needing surgery. In spite of the digestive pathology, there are data to recommend enteral nutrition as the initial method for nutrients provision in patients that need it.

[Nutritional support in polytraumatized patients]. / Nutrición artificial en el paciente politraumatizado.

Polytraumatism usually presents in previously healthy patients with a good nutritional status. However, metabolic changes derived from the traumatic injury put these patients in a nutritional risk situation. Specialized nutritional support should be started if it is foreseeable that nutritional requirements will not be met p.o. within the 5-10 days period from admission. Enteral nutrition should be the first route to consider for nutrients intake. However, the presence of head trauma leads to gastrointestinal motility impairments that hinder tolerance to enteral nutrition. Patients with abdominal trauma also present difficulties for the onset and tolerance of enteral diet. The insertion of transpyloric tubes or jejunostomy catheters allows early use of enteral nutrition in these patients.

Recomendaciones para la valoración nutricional y el soporte nutricional especializado de los pacientes críticos / Recommendations for nutritional assessment and specialized nutritional support of critically ill patients

Debido a las características de los pacientes críticos, la elaboración de recomendaciones sobre el soporte nutricional en estos pacientes es difícil. En muchas ocasiones no está claramente establecido el momento de inicio del soporte nutricional ni las características del mismo, por lo que su aplicación está basada en opiniones de expertos. En el presente documento se presentan las recomendaciones elaboradas por el Grupo de Trabajo de Metabolismo y Nutrición de la sociedad Española de Medicina Intensiva, Crítica y Unidades Coronarias (SEMICYUC). Las recomendaciones están basadas en el análisis de la literatura y en la posterior discusión entre los miembros del grupo de trabajo para definir, mediante consenso, los aspectos más relevantes del soporte metabólico y nutricional de los pacientes en situación crítica. Se han considerado diferentes situaciones clínicas, que se desarrollan en los artículos siguientes de esta publicación. Las presentes recomendaciones pretenden servir de guía para los clínicos con menor experiencia en la consideración de los aspectos metabólicos y nutricionales de los pacientes críticos (AU)

Due to the characteristics of critically ill patients, elaborating recommendations on nutritional support for these patients is difficult. Usually the time of onset of nutritional support or its features are not well established, so that its application is based on experts' opinion. In the present document, recommendations formulated by the Metabolism and Nutrition Working Group of the Spanish Society of Intensive and Critical Medicine and Coronary Units (SEMICYUC) are presented. Recommendations are based on the literature analysis and further discussion by the working group members in order to define, consensually, the more relevant issues of metabolic and nutritional support of patients in a critical condition. Several clinical situations have been considered which are developed in the following articles of this publication. The present recommendations aim at providing a guideline for the less experienced clinicians when considering the metabolic and nutritional issues of critically ill patients (AU)

Nutrición artificial en la insuficiencia intestinal: síndrome de intestino corto. Enfermedad inflamatoria intestinal / Artificial nutrition in intestinal failure: short bowel syndrome. Intestinal inflammatory disease

La resección intestinal amplia produce suficientes alteraciones como para requerir soporte nutricional especializado. Las medidas básicas de tratamiento, especialmente en la fase aguda tras la resección intestinal o en presencia de complicaciones graves sobre pacientes con intestino corto, incluyen la repleción de fluidos y electrolitos y la instauración de soporte nutricional con el fin de prevenir la malnutrición. La nutrición enteral es el principal factor estimulador de la adaptación del intestino remanente. No obstante, su aplicación presenta dificultades en las fases agudas, por lo que los pacientes deben ser tratados frecuentemente con nutrición parenteral. La presencia de desnutrición puede ser también de importancia en los pacientes con enfermedad inflamatoria intestinal. El soporte nutricional está indicado en estos casos como tratamiento primario de la enfermedad, como tratamiento de la desnutrición o como tratamiento perioperatorio en los pacientes que requieren cirugía. A pesar de la patología digestiva, existen datos para recomendar la nutrición enteral como método inicial para el aporte de nutrientes en los pacientes que lo precisen (AU)

Large intestinal resection produces a sufficient number of impairments as to require specialized nutritional support. Basic treatment measures, especially during the acute phase after intestinal resection or in the presence of severe complications in patients with short bowel syndrome, include fluid and electrolytes reposition and nutritional support implementation in order to prevent hyponutrition. Enteral nutrition is the main stimulating factor for adaptation of the remaining bowel. However, its application has some difficulties during the acute phase, and thus patients must be frequently treated with parenteral nutrition. The presence of hyponutrition may be also important in patients with intestinal inflammatory disease. Nutritional support is indicated in these cases as the primary treatment modality for the disease, as hyponutrition treatment, or as perioperative treatment in patients needing surgery. In spite of the digestive pathology, there are data to recommend enteral nutrition as the initial method for nutrients provision in patients that need it (AU)

Nutrición artificial en el paciente politraumatizado / Nutritional support in polytraumatized patients

El politraumatismo suele presentarse en pacientes previamente sanos y con buen estado nutricional. A pesar de ello, los cambios metabólicos originados por la agresión traumática colocan a estos pacientes en situación de riesgo nutricional. El soporte nutricional especializado debería iniciarse si es previsible que los requerimientos nutricionales no puedan ser cubiertos por vía oral en un periodo de 5-10 días tras el ingreso. La nutrición enteral deberá ser la primera vía a considerar para el aporte de nutrientes. No obstante, la presencia de trauma craneoencefálico produce alteraciones en la motilidad gastrointestinal que dificultan la tolerancia a la nutrición enteral. Los pacientes con trauma abdominal presentan también dificultades para el inicio y la tolerancia a la dieta enteral. La inserción de sondas transpilóricas o catéteres de yeyunostomía permite el empleo precoz de nutrición enteral en estos pacientes (AU)

Polytraumatism usually presents in previously healthy patients with a good nutritional status. However, metabolic changes derived from the traumatic injury put these patients in a nutritional risk situation. Specialized nutritional support should be started if it is foreseeable that nutritional requirements will not be met p.o. within the 5-10 days period from admission. Enteral nutrition should be the first route to consider for nutrients intake. However, the presence of head trauma leads to gastrointestinal motility impairments that hinder tolerance to enteral nutrition. Patients with abdominal trauma also present difficulties for the onset and tolerance of enteral diet. The insertion of transpyloric tubes or jejunostomy catheters allows early use of enteral nutrition in these patients (AU)