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ABSTRACT: Description of the nutritional support in an intensive care unit. REFERENCE POPULATION: Patients hospitalized in our ICU over a period of 48 months (October 1994-September 1998).
The study was carried out by means of a review of the two data bases generated, one by using the clinical history management program, and the other by using the artificial nutrition program.
Nutritional support is used in 31% of the non-coronary patients, predominantly medical (61%), and followed by surgical (29%) and trauma (9%) cases. These patients presented an APACHE (17.7 +/- 15), a hospitalization (15.8 +/- 14.9) and a mortality (26%) that was greater than that in non-coronary patients who did not require the nutritional support. The delay in starting the nutritional support is 2.8 +/- 1.9 days. In decreasing order, the nutritional support is most used in medical (42%), trauma (37%) and surgical (18%) patients. The access route is similar, enteral in 55% of the cases, with a predominance of medical patients, and parenteral in 45% of the cases, with a predominance of surgical patients. In 100 patients with a nutritional support in excess of 10 days, it was found that 87% at some time were given this enterally. In this group we studied the gastrointestinal complications, finding these in 61% of these patients, with the most frequent complication being an increase in the gastric residue (44%). Diarrhea was found in 14% and broncho-aspiration in 3.4%. The enteral route as the initial access failed in 25% of these cases, thus requiring parenteral nutrition.
In our unit we used nutritional support in 31% of the non coronary patients, and these presented a greater severity, longer hospitalization, and higher mortality than those patients who did not require this. The beginning of the nutritional support is relatively early. The gastrointestinal complications derived from enteral nutrition are very common, with a predominance of gastric retention. In 25% of the critical patients who begin enteral nutrition, this fails, and thus they require parenteral nutrition.
Nutricion hospitalaria: organo oficial de la Sociedad Espanola de Nutricion Parenteral y Enteral 14(6):217-22. · 1.12 Impact Factor
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ABSTRACT: To verify the hypothesis that a high nitrogen intake leads to better nutritional results in critical patients. REFERENCE POPULATION: Patients hospitalized in the critical care unit between 1995 and 1998 with nutritional support for 14 days, excluding patients with liver and/or kidney failure.
The calculation of the requirements was made using a computerized program for determining the eliminated nitrogen, depending on the degree of stress. At the end of the second year the formulae for calculating the requirements were changed, thus we had two groups of patients with a different protein intake. The nutritional biochemical parameters are usually analyzed on days 1, 4, and 14, as were the characteristics of the nutrition used during the first and second week of treatment in both periods.
32 patients were included in the first period, and 50 in the second. It was seen that there were no significant differences between them. The characteristics of the administered nutrition showed a greater caloric supply in the first week of the first period (35.14 +/- 4.4 vs. 30.04 +/- 6.1 cal/kg), with there not being any difference in the protein intake (0.26 +/- 0.04 vs. 0.24 +/- 0.09 grams of nitrogen/kg) and a greater protein intake in the second week of the second period (0.34 +/- 0.06 vs. 0.28 +/- 0.04 grams of nitrogen/kg), with there not being any differences in the caloric intake (34.08 +/- 5.6 vs. 34.13 +/- 3.1 cal/kg). The analyzed parameters did not present any significant differences between the periods. The evolution of these was similar for each period, although in the second period the transferrin improved with respect to the first period, and the decrease in the height creatinine index was stopped in the second week. The nitrogen balance could not be improved.
The increase in the protein intake above certain limits only very slightly improves some of the nutritional biochemical parameters, without improving the nitrogen balance as a result of an increased elimination thereof.
Nutricion hospitalaria: organo oficial de la Sociedad Espanola de Nutricion Parenteral y Enteral 14(5):203-9. · 1.12 Impact Factor
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ABSTRACT: To compare the method for calculating the energy requirements in critical patients as calculated by our computer software with those measured using calorimetry and using the recommendations of experts in nutritional support. REFERENCE POPULATION: 18 critical patients with mechanical ventilation and admitted to our ICU during 1998.
Indirect calorimetry was carried out over a 24 hour period in critical patients with mechanical ventilation and their requirements were calculated using computer software. Ten of the measurements were placed on Internet web pages in order to receive the comments and recommendations of nutritional support experts. Those responses which fell into the range between 80% and 120% of the calorimetric measurement were considered correct.
Calorimetric determinations were effected on 31 occasions in 18 patients, with an average APACHE score of 19 +/- 3. The energy requirements measured by calorimetry were 34 +/- 3 kcal/kg/day with 0.34 +/- 16 g/kg/day of nitrogen in urine, whereas the recommendations of the computer programme were 31 +/- 1 kcal/kg/day and 0.28 +/- 0.04 g/kg/day of nitrogen in urine, i.e. 92 +/- 8% of the former values. The responses by the experts to 10 of these measurements came very close to those of the programme, with 33 +/- 6 kcal/kg/day and 0.29 +/- 0.06 gr/kg/day of nitrogen, with a percentage of correct responses of around 68%.
The method for calculating the energy requirements used by our computer software constitutes around 92% of the calorimetric measurements in critical patients with mechanical ventilation and the responses are very similar to the average of the responses given by experts in nutritional support.
Nutricion hospitalaria: organo oficial de la Sociedad Espanola de Nutricion Parenteral y Enteral 15(3):97-104. · 1.12 Impact Factor
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ABSTRACT: A study is made of the evolution of the nutritional biochemical parameters, albumin, prealbumin, cholesterol, creatinine index/height and transferrin, as well as the nutrition route, SAPS, APACHE II, chronic age score, and maximum degree of metabolic stress reached, involving all patients requiring artificial nutrition during at least 14 days, admitted to our intensive medicine unit during an 18 months period, with the aim of finding differences between survivors and those who died. The following conclusions were reached: 1) In patients with severe metabolic stress, like those of the present study, artificial nutrition manages to maintain the nutritional parameters within the limits of moderate malnutrition, improving the nitrogenation balance, without achieving its balance not reducing the consumption of lean body mass, represented by the progressive and significant reduction of the ICALT. 2) In our series, the nutritional parameters behave in a notably different manner with regard to the evolution. In survivors, improvements are seen in albumin, cholesterol, and prealbumin, without variations in transferrin, these changes not being seen in those who died, the latter also showing a significant drop in transferrin, and 3) The greater age and poorer prior health status, despite a lower APS, of those who died appears to be the determining factors for the mortality, and probably also for the different evolution of the nutritional parameters for the usual nutritional standards, maybe due to a lower response capacity to stress.
Nutricion hospitalaria: organo oficial de la Sociedad Espanola de Nutricion Parenteral y Enteral 12(5):257-62. · 1.12 Impact Factor
