RESUMO
The author, from his privileged position of nearly forty years dedicated to artificial nutrition, makes an excellent review of the origins, development and evolution of artificial nutrition in Spain. All the people involved, the birth of scientific societies, journals and Clinical Units, both in Spain and abroad, are perfectly described in this conference dictated at the XIX National Congress of the Spanish Society of Parenteral and Enteral Nutrition, held in Murcia in May 2003.
Assuntos
Apoio Nutricional/tendências , Previsões , Humanos , EspanhaRESUMO
El autor, desde su posición privilegiada de casi cuarenta años dedicados a la nutrición artificial, hace una magnífica revisión de los orígenes, el desarrollo y la evolución de la nutrición artificial en España. Todos los personajes involucrados, el nacimiento de sociedades científicas, revistas y unidades de nutrición, tanto en España como en el extranjero son magistralmente descritos en esta conferencia dictada durante el XIX Congreso Nacional de la Sociedad Española de Nutrición Parenteral y Enteral, que tuvo lugar en Murcia en Mayo de 2003 (AU)
The author, from his privileged position of nearly forty years dedicated to artificial nutrition, makes an excellent review of the origins, development and evolution of artificial nutrition in Spain. All the people involved, the birth of scientific societies, journals and Clinical Units, both in Spain and abroad, are perfectly described in this conference dictated at the XIX National Congress of the Spanish Society of Parenteral and Enteral Nutrition, held in Murcia in May 2003 (AU)
Assuntos
Humanos , Espanha , Apoio Nutricional , PrevisõesRESUMO
Patients with multiple injuries and burns are the paradigm of critically-ill patients. Their cases are acute, severe and, fortunately, reversible in a large number of situations. The severe aggressions leading to this kind of condition is the rigger for a maelstrom of inflammatory mediators, metabolic and neuro-endocrinal response, leading to an acceleration in the combustion of the injured organ. This "internal combustion" process takes nourishment from organic reserves, using them up and thus producing dysfunctions in various organs. This is where nutritional support has a role, always remedying the metabolic response to inflammation and attempting to modify it. For this reason, nutritional support plays an undisputed part in the treatment of such patients. This nutritional support, so necessary in situations with a high degree of stress, must be individually tailored in terms of quantity and quality to the process and to the patient in question. Thus, adapting the support to requirements appears as a priority of nutritional assessment. While it is important to provide nourishment to needy patients, it is just as important if not more so to avoid over-nourishment. Indirect calorimetry continues to be the most accurate indicator for determining the needs of each patient and, in view of the lack of knowledge of this technique mainly as a result of economic factors, many different methods and formulas have been proposed to attempt to carry out these adjustments. The characteristics and distribution of the macronutrients will be connected with the pathologies to be treated. And finally, the route for providing this nourishment seems ever more clearly to be as prompt first-line administration through the digestive tube. There are situations in which parenteral support will complement or replace the enteral route when the latter is insufficient or unavailable; in certain circumstances, the parenteral route even seems to be superior to enteral support, as in the case of pure head injury. As these patients are particularly prone to suffer from infections, another aspect of increasing interest in the nutritional support of these patients is the use of immunity-modulating diets, where a better response can be expected. The components of the immunity-modulating diets have been shown to be able to modify the immune response in different ways, sometimes favouring the replication of lymphocytes and at other times stimulating the production of certain types of cytokines and attenuating the release of others, in short balancing the inflammatory response.
Assuntos
Queimaduras/terapia , Traumatismo Múltiplo/terapia , Apoio Nutricional , HumanosRESUMO
The application of artificial nutritional treatment in critical patients, nowadays is a completely accepted fact. To a large degree this is due to the advances made in the understanding of the metabolic response shown by patients against a severe and persistent aggression. One of the entities which presents the highest mortality in critical patients, is the Acute Respiratory Distress Syndrome (ARDS), which one understands as the pulmonary response to different types of aggression. To understand the metabolic implications in the face of the development of this syndrome, would permit a better understanding of the need to treat these patients and to establish the nutritional standards which are most adequate to each different metabolic alteration. It would not only be important to understand the most effective method for calculating the caloric needs of these patients, but we shall also have to deepen our understanding of possible harmful effects of the different substrates, which undoubtedly could condition morbidity. This is why in this review we focus on the intimate pulmonary mechanism, both in healthy conditions as in those of disease, in order to extrapolate conclusions which are potentially applicable to patients suffering from an acute pulmonary lesion, as those suffering from ARDS: A main role shall be played the assessment of the administration of macronutrients in the form carbohydrates, lipids, and amino acid particles, due to the implications which each of these may have on the lesioned lung and its ventilatory capacity.
