[The evaluation of enteral nutritional support in the critical patient]. / Valoración del soporte nutricional enteral en el paciente crítico.

UNLABELLED: A prospective study of 40 patients for a period of 9 months was conducted, in order to evaluate the tolerance, clinical evolution and nutritional parameters in critical patients on enteral nutrition. In all cases, nutrients were administered enterally, by nasogastric tube and the administration method selected was continuous perfusion in most cases. 78.5 +/- 17% of estimated Kcal. were administered. During the study, the following aspects were studied: fasting time, type of diet, time during which enteral nutrition (EN) was maintained and reason for suspension, degree of derivation using nasogastric tube (NGT), number of bowel movements per day, antibiotic therapy ad gastric protection drugs as well as drugs administered for supporting mechanical ventilation and the evolution of the patient. Evolutional controls of the nutritional state were also conducted. Tolerance was seen to be good, especially in patients on continuous perfusion. With regard to the evolution of nutritional parameters, we observed maintenance of proteic levels with a slight recovery of retinol-binding protein (RBP) and no statistically significant differences between patients who died and those with a favourable development. The level of oligoelements was maintained, although below normal levels. CONCLUSIONS: EN is the ideal selection for the nutritional support of critical patients with functionally usefull gastrointestinal tracts. A good digestive tolerance was observed, and proteic levels maintained were similar to the initial ones, although with this type of diet, we recommend an additional intake of iron.

[Impact of surgical aggression and postoperative septic problems on fibronectin levels]. / Repercusión de la agresión quirúrgica y de problemas septicos postoperatorios en los niveles de fibronectina.

The following study has been carried out in order to assess the repercussion of surgery on fibronectin (F) levels and its course, whether or not septic complications are presented. The F, albumin (ALB), prealbumin (PREALB), retinol binding protein (RBP) and alpha-1-glycoprotein (GLYCO) levels were controlled in 37 patients (29 undergoing scheduled digestive tract surgery and 8 undergoing heart surgery), through preoperative and postoperative tests every three days. A group of 40 healthy controls was taken as reference. Group I contained 19 patients free of septic complications, statistically significant changes were observed in PREALB and RBP levels but not in F, although a decrease was observed which return to normal by the third test. Group II contained 18 patients which were subdivided into: a) 12 patients suffering from brief septic complication without known focus of infection and, b) 6 patients suffering from more severe septic complication with known focus of infection. The IIA subgroup showed a significant decrease in all protein levels, returning to normal levels by the sixth or seventh day. Subgroup IIB showed lower F levels, which did not return to normal before the ninth day. CONCLUSION. Preoperative controls were similar in I and IIa, while IIB showed significantly lower values. Although F decreased in the first preoperative control, it was not statistically significant. Patients not suffering from complications showed F recuperation within the first week, which was not the case of septic patients. Due to the wide number of functions of F and of the factors that influence it, we believe it should not be interpreted on a single basis a nutritional parameters.

Caloric supply in parenteral nutrition in the stress phase.

Due to the metabolic alterations following surgery, glucose is not completely oxidized but is converted into glycogen and lipids. Therefore we analysed 2 groups of 15 patients following surgery. They received parenteral nutrition with identical nitrogen (N = 0.28 g/kg/d) and lipid (1.5 g/kg/d) intake, whereby only the composition of carbohydrates was varied. Group I received exclusively glucose = 0.22 g/kg/h, and group II the combination fructose-glucose-xylitol in a proportion of 2:1:1 at the same infusion rate. The study lasted approximately 10 days. We found decreased exogenous insulin requirements and an increase in the NEFA levels with a maximum on the 3rd and 4th day in group II. There were no significant differences in the levels of either albumin, prealbumin or retinol-binding protein, nor were any hepatic or renal alterations related to the xylitol infusion observed. Xylituria was 6.13 +/- 3% of the amount infused. In our opinion, the partial substitution of glucose in group II led to a better utilisation of the infused energy supply, and to less insulin stimulation, which facilitated the mobilization of endogenous energy sources such as fatty acids, although we did not succeed in increasing the protein synthesis.