Leon Sanz M.,Hospital Universitario Doce Of Octubre |
Leon Sanz M.,Complutense University of Madrid
Nutricion Hospitalaria | Year: 2011
A primary goal of nutritional support is to provide the energy requirements needed to sustain metabolic processes, maintain body temperature and tissue repair. The beginnings of artificial nutrition were characterized by high calorie nutritional formulae. The assimilation of physiological concepts, accumulating research data and clinical experience led to a progressive reduction of this intake. During the decade of the 90s of the past century, the concept of permissive underfeeding was proposed. Since then, there has been a controversy between supporters of an initial reduction of energy intake for the critical patient and advocates of a full administration of the estimated calorie needs since the very first days of admission to the Intensive Care Unit. This controversy has extended into clinical practice guidelines, showing a clear disagreement between recent recommendations of ASPEN and ESPEN. In the future we will see the publication of new studies that might better define the evidence on which to base the recommendations of caloric intake. There is also a clear need to deepen the knowledge about the optimal caloric intake in the non-critically ill patient requiring artificial nutrition. It is of great importance that these new concepts, which will arise undoubtedly, are incorporated quickly in the design of nutritional formulas produced by the pharmaceutical industry. Finally, it is important to encourage active participation in continuous educational activities in the field of Nutrition for achieving a rapid incorporation in daily practice of these new concepts of optimal caloric intake.
Hoeper M.M.,Hannover Medical School |
Barst R.J.,Columbia University |
Bourge R.C.,University of Alabama at Birmingham |
Feldman J.,Arizona Pulmonary Specialists |
And 15 more authors.
Circulation | Year: 2013
Background-: By its inhibitory effect on platelet-derived growth factor signaling, imatinib could be efficacious in treating patients with pulmonary arterial hypertension (PAH). Methods and Results-: Imatinib in Pulmonary Arterial Hypertension, a Randomized, Efficacy Study (IMPRES), a randomized, double-blind, placebo-controlled 24-week trial, evaluated imatinib in patients with pulmonary vascular resistance ≥800 dyne·s·cm-5 symptomatic on ≥2 PAH therapies. The primary outcome was change in 6-minute walk distance. Secondary outcomes included changes in hemodynamics, functional class, serum levels of N-terminal brain natriuretic peptide, and time to clinical worsening. After completion of the core study, patients could enter an open-label long-term extension study. Of 202 patients enrolled, 41% patients received 3 PAH therapies, with the remainder on 2 therapies. After 24 weeks, the mean placebo-corrected treatment effect on 6-minute walk distance was 32 m (95% confidence interval, 12-52; P=0.002), an effect maintained in the extension study in patients remaining on imatinib. Pulmonary vascular resistance decreased by 379 dyne·s·cm-5 (95% confidence interval,-502 to-255; P<0.001, between-group difference). Functional class, time to clinical worsening, and mortality did not differ between treatments. Serious adverse events and discontinuations were more frequent with imatinib than placebo (44% versus 30% and 33% versus 18%, respectively). Subdural hematoma occurred in 8 patients (2 in the core study, 6 in the extension) receiving imatinib and anticoagulation. Conclusions-: Imatinib improved exercise capacity and hemodynamics in patients with advanced PAH, but serious adverse events and study drug discontinuations were common. Further studies are needed to investigate the long-term safety and efficacy of imatinib in patients with PAH. Clinical Trial Registration-: URL: http://www.clinicaltrials.gov. Unique identifier: NCT00902174 (core study); NCT01392495 (extension). © 2013 American Heart Association, Inc.
Grau-Carmona T.,Hospital Universitario Doce Of Octubre |
Bonet-Saris A.,Intensive Care Unit |
Garcia-De-Lorenzo A.,Hospital Universitario La Paz |
Sanchez-Alvarez C.,Hospital General Universitario Reina Sofia |
And 5 more authors.
Critical Care Medicine | Year: 2015
Objective: n-3 polyunsaturated fatty acids (contained in fish oil) have been shown to beneficially influence infection rate and clinical outcomes in surgical patients probably due to their immunomodulatory action. In contrast, study results of fish oil administration in critically ill patients are controversial. The aim of this study was to investigate the effects of n-3 polyunsaturated fatty acids on the prevalence of nosocomial infections and clinical outcomes in medical and surgical critically ill patients. Design: Prospective, multicenter, randomized, comparative, double- blind study. Setting: Seventeen Spanish ICUs during 4 years. Subjects: A total of 159 medical and surgical intensive care patients with Acute Physiology and Chronic Health Evaluation II score more than or equal to 13, expected to require total parenteral nutrition for at least 5 days. Interventions: Patients received total parenteral nutrition prepared either with a lipid emulsion containing 10% fish oil or a fish oil-free lipid emulsion. The prevalence of nosocomial infections was detected during 28 days of ICU stay. Patients were followed 6 months after discharge from the ICU for length of hospital stay, hospital mortality, and 6-month mortality. Measurements and Main Results: The number of patients with nosocomial infections was significantly reduced in the fish oil-receiving group (21.0% vs 37.2%, p = 0.035) and the predicted time free of infection was prolonged (21 ± 2 vs 16 ± 2 d, p = 0.03). No significant differences were detected for ICU, hospital, and 6-month mortality. Conclusions: The results show that administration of n-3 polyunsaturated fatty acids reduces the risk of nosocomial infections and increases the predicted time free of infections in critically ill medical and surgical patients. The administration of n-3 polyunsaturated fatty acids was safe and well tolerated.
Acosta-Escribano J.,Hospital General Universitario Of Alicante |
Fernandez-Vivas M.,Hospital Universitario Virgen Of La Arrixaca |
Grau Carmona T.,Hospital Universitario Doce Of Octubre |
Caturla-Such J.,Hospital General Universitario Of Alicante |
And 4 more authors.
Intensive Care Medicine | Year: 2010
Purpose: To evaluate the efficacy of transpyloric feeding (TPF) compared with gastric feeding (GF) with regard to the incidence of ventilator-associated pneumonia in severe traumatic brain injury patients (TBI). Design and setting: Prospective, open-label, randomized study in an intensive care unit of a university hospital. Patients: One hundred and four CHI adult patients admitted for TBI between April 2007 and December 2008. Patients were included within the first 24 h after ICU admission and were followed until discharge or 30 days after admission. Intervention: Patients were randomized to TPF or GF groups. They received the same diet, with 25 kcal kg-1 day-1 of calculated energy requirements and a nitrogen intake of 0.2 g N kg-1 day-1. Primary outcome was the incidence of early and ventilatory-associated pneumonia. Secondary outcomes were enteral nutrition-related gastrointestinal complications (GIC), days on mechanical ventilation, length of ICU stay and hospital stay, and sequential organ failure assessment score (SOFA). Results: The TPF group had a lower incidence of pneumonia, OR 0.3 (95% CI 0.1-0.7, P = 0.01). There were no significant differences in other nosocomial infections. The TPF group received higher amounts of diet compared to the GF group (92 vs. 84%, P < 0.01) and had lesser incidence of increased gastric residuals, OR 0.2 (95% CI 0.04-0.6, P = 0.003). Conclusions: Enteral nutrition delivered through the transpyloric route reduces the incidence of overall and late pneumonia and improves nutritional efficacy in severe TBI patients. © 2010 Copyright jointly held by Springer and ESICM.
Barros-Tizon J.C.,Complexo Hospitalario Universitario Of Vigo |
Torres M.L.,Complexo Hospitalario Universitario Of Vigo |
Blanco I.,Hospital Valle del Nalon |
Martinez M.T.,Hospital Universitario Doce Of Octubre
Therapeutic Advances in Respiratory Disease | Year: 2012
Objective: Severe exacerbations in alpha-1-antitrypsin (AAT)-deficient patients with chronic obstructive pulmonary disease (COPD) and/or emphysema are a major cause of hospitalization. A multicentre, observational, retrospective study was undertaken to evaluate the effect of continuous AAT augmentation therapy in reducing the incidence of exacerbations in these patients.Methods: Patients treated with Trypsone® or Prolastin® for at least 18 months were recruited if their medical records for 18 months before starting augmentation therapy were available. The number of mild and severe exacerbations in the two periods was compared and hospitalization-related costs were analysed.Results: A total of 127 patients were recruited; 75 of them experienced at least one exacerbation in the period prior to augmentation. In the treatment period, the mean number of exacerbations per patient was reduced in both the total population and the population with exacerbations (mean ± SD: 1.2 ± 1.6 versus 1.0 ± 2.2 and 2.0 ± 1.6 versus 1.4 ± 2.7, respectively; p < 0.01). The percentage of patients experiencing exacerbations was reduced in the total population (59.1% versus 44.1%; p < 0.05). In the patient subgroup of the total population who experienced a change in their number of exacerbations between the two periods, 43.7% had a reduction and 21.4% had an increase (p < 0.01). The number of severe exacerbations diminished in 42.9% of this subgroup and increased in 12.0% (p < 0.001). Most adverse events were nonserious or not related to treatment. Hospitalization costs savings per patient associated with treatment ranged from approximately €400 to €900 (p < 0.05).Conclusions: Augmentation therapy with AAT concentrates was associated with a reduction in the incidence and severity of exacerbations in AAT-deficient patients, which resulted in lower hospitalization expenditures. © The Author(s), 2012.