oalib
Search Results: 1 - 10 of 100 matches for " "
All listed articles are free for downloading (OA Articles)
Page 1 /100
Display every page Item
Guidelines for specialized nutritional and metabolic support in the critically-ill patient: Update. Consensus SEMICYUC-SENPE: Introduction and methodology Recomendaciones para el soporte nutricional y metabólico especializado del paciente crítico: Actualización. Consenso SEMICYUC-SENPE: Introducción y metodología  [cached]
A. Mesejo,C. Vaquerizo Alonso,J. Acosta Escribano,C. Ortiz Leiba
Nutrición Hospitalaria , 2011,
Abstract: The Recommendations for Specialized Nutritional Support in Critically-Ill patients were drafted by the Metabolism and Nutrition Working Group of the Spanish Society of Intensive Care Medicine and Coronary Units (SEMICYUC) in 2005. Given the time elapsed since then, these recommendations have been reviewed and updated as a Consensus Document in collaboration with the Spanish Society of Parenteral and Enteral Nutrition (SENPE). The primary aim of these Recommendations was to evaluate the best available scientific evidence for the indications of specialized nutritional and metabolic support in critically-ill patients. The Recommendations have been formulated by an expert panel with broad experience in nutritional and metabolic support in critically-ill patients and were drafted between October 2009 and March 2011. The studies analyzed encompassed metaanalyses, randomized clinical trials, observational studies, systematic reviews and updates relating to critically-ill adults in MEDLINE from 1966 to 2010, EMBASE reviews from 1991 to 2010 and the Cochrane Database of Systematic Reviews up to 2010. The methodological criteria selected were those established in the Scottish Intercollegiate Guidelines Network and the Agency for Health Care policy and Research, as well as those of the Jadad Quality Scale. Adjustment for the level of evidence and grade of recommendation was performed following the proposal of the GRADE group (Grading of Recommendations Assessment, Development and Evaluation Working Group). Sixteen pathological scenarios were selected and each of them was developed by groups of three experts. A feedback system was established with the five members of the Editorial Committee and with the entire Working Group. All discrepancies were discussed and consensus was reached over several meetings, with special emphasis placed on reviewing the levels of evidence and grades of recommendation. The Editorial Committee made the final adjustments before the document was approved by all the members of the Working Group. Finally, the document was submitted to the Scientific Committees of the two Societies participating in the Consensus for final approval. The present Recommendations aim to serve as a guide for clinicians involved in the management and treatment of critically-ill patients and for any specialists interested in the nutritional treatment of hospitalized patients. El Grupo de trabajo de Metabolismo y Nutrición de la Sociedad Espa ola de Medicina Intensiva, Crítica y Unidades Coronarias (SEMICYUC) elaboró en 2005 unas recomendaciones para el soporte nutri
Guidelines for specialized nutritional and metabolic support in the critically-ill patient: Update. Consensus SEMICYUC-SENPE: Respiratory failure Recomendaciones para el soporte nutricional y metabólico especializado del paciente crítico: Actualización. Consenso SEMICYUC-SENPE: Insuficiencia respiratoria  [cached]
T. Grau Carmona,J. López Martínez,B. Vila García
Nutrición Hospitalaria , 2011,
Abstract: Severe acute respiratory failure requiring mechanical ventilation is one of the most frequent reasons for admission to the intensive care unit. Among the most frequent causes for admission are exacerbation of chronic obstructive pulmonary disease and acute respiratory failure with acute lung injury (ALI) or with criteria of acute respiratory distress syndrome (ARDS). These patients have a high risk of malnutrition due to the underlying disease, their altered catabolism and the use of mechanical ventilation. Consequently, nutritional evaluation and the use of specialized nutritional support are required. This support should alleviate the catabolic effects of the disease, avoid calorie overload and, in selected patients, to use omega-3 fatty acid and antioxidant-enriched diets, which could improve outcome. La insuficiencia respiratoria aguda grave que precisa ventilacion mecanica es una de las causas mas frecuentes de ingreso de los pacientes en UCI. Entre las etiologias mas frecuentes se encuentran la reagudizacion de la enfermedad pulmonar obstructiva cronica y la insuficiencia respiratoria aguda con lesion pulmonar aguda o con criterios de sindrome de distres respiratorio agudo. Estos pacientes presentan un riesgo elevado de desnutricion por su enfermedad de base, por la situacion catabolica en la que se encuentran y por el empleo de la ventilacion mecanica. Ello justifica que estos pacientes deban ser valorados desde el punto de vista nutricional y que el uso de soporte nutricional especializado sea necesario. El soporte nutricional especializado debe paliar los efectos catabolicos de la enfermedad, evitar la sobrecarga de calorias y utilizar, en casos seleccionados, dietas especificas enriquecidas con acidos grasos ω-3 y antioxidantes que podrian mejorar el pronostico.
Guidelines for specialized nutritional and metabolic support in the critically-ill patient: Update. Consensus SEMICYUC-SENPE: Neurocritical patient Recomendaciones para el soporte nutricional y metabólico especializado del paciente crítico: Actualización. Consenso SEMICYUC-SENPE: Paciente neurocrítico  [cached]
J. Acosta Escribano,I. Herrero Meseguer,R. Conejero García-Quijada
Nutrición Hospitalaria , 2011,
Abstract: Neurocritical patients require specialized nutritional support due to their intense catabolism and prolonged fasting. The preferred route of nutrient administration is the gastrointestinal route, especially the gastric route. Alternatives are the transpyloric route or mixed enteralparenteral nutrition if an effective nutritional volume of more than 60% cannot be obtained. Total calore intake ranges from 20-30 kcal/kg/day, depending on the period of the clinical course, with protein intake higher than 20% of total calories (hyperproteic diet). Nutritional support should be initiated early. The incidence of gastrointestinal complications is generally higher to other critically-ill patients, the most frequent complication being an increase in gastric residual volume. As in other critically-ill patients, glycemia should be closely monitored and maintained below 150 mg/dL. El enfermo neurocrítico precisa un soporte nutricional especializado debido a su intenso catabolismo y a un prolongado período de ayuno. La vía de administración nutricional preferente es la gastrointestinal, particularmente la vía gástrica, siendo alternativas la vía transpilórica o la nutrición mixta enteral-parenteral en caso de no obtener un volumen nutricional eficaz superior al 60%. El aporte calórico total oscila entre 20-30 kcal/kg/día, según el período de evolución clínica en que se encuentre, con un aporte proteico superior al 20% de las calorías totales (hiperproteico). El inicio del aporte nutricional debe ser precoz. La incidencia de complicaciones gastrointestinales es superior al enfermo crítico en general, siendo el aumento del residuo gástrico el más frecuente. Debe establecerse un estrecho control de la glucemia, manteniéndose por debajo de 150 mg/dl como en el resto de los enfermos críticos.
Cuerpos extra os en el aparato digestivo  [cached]
Trini Fragoso Arbelo,Ernesto Luaces Fragoso,Tamara Díaz Lorenzo
Revista Cubana de Medicina General Integral , 2002,
Abstract: Se expone una revisión sobre ingestión de cuerpos extra os en el aparato digestivo, su epidemiología, etiopatogenia y manifestaciones clínicas, según el tipo y localización del cuerpo extra o en el tracto gastrointestinal, el diagnóstico, así como las posibles complicaciones y el tratamiento. Se hace énfasis en la frecuencia de estos accidentes. A review is made on the finding of foreign bodies in the digestive system, its epidemiology, etiopathogeny and clinical manifestations, according to the type and localization of the foreign body in the gastrointestinal tract, the diagnosis and the possible complications and treatment. Emphasis is made on the frequency of these accidents.
Desarrollo del Aparato Digestivo Digestive System Development
Ignacio Roa,Manuel Meruane
International Journal of Morphology , 2012,
Abstract: El aparato digestivo deriva del endodermo y el mesodermo, que forman su epitelio y la musculatura lisa respectivamente. Al igual que en el resto de los sistemas, existe un interacción epitelio-mesenquimática mediada por moléculas como Hedgehog, BMP y FoxF1 que determinan el crecimiento intestinal en sus ejes principales. Los genes Hox, junto con el resto de las moléculas, participan en la regionalización del sistema digestivo. En sus inicios lo denominaremos intestino primitivo, formado por un tubo endodérmico que deriva del saco vitelino; dividiéndose en intestino anterior, medio y posterior. En esta revisión veremos cómo estos 3 segmentos darán origen a las diferentes estructuras del sistema digestivo en los vertebrados. The digestive system is derived from the endoderm and mesoderm, which form its epithelium and smooth muscle, respectively. As in the other systems, there is an epithelial-mesenchymal interactions mediated by molecules such as Hedgehog, BMP and FoxF1, determining intestinal growth in the main axes. The Hox genes, together the rest of the molecules, involved in the regionalization of the digestive system. In the beginning we call it primitive gut, consisting of a tube derived of endodermal yolk sac, divided into foregut, midgut and hindgut. In this review we will see how these 3 segments give rise to different structures of the digestive system in vertebrates.
Guidelines for specialized nutritional and metabolic support in the critically-ill patient: Update. Consensus SEMICYUC-SENPE: Introduction and methodology
Mesejo,A.; Vaquerizo Alonso,C.; Acosta Escribano,J.; Ortiz Leiba,C.; Montejo González,J.C.;
Nutrición Hospitalaria , 2011,
Abstract: the recommendations for specialized nutritional support in critically-ill patients were drafted by the metabolism and nutrition working group of the spanish society of intensive care medicine and coronary units (semicyuc) in 2005. given the time elapsed since then, these recommendations have been reviewed and updated as a consensus document in collaboration with the spanish society of parenteral and enteral nutrition (senpe). the primary aim of these recommendations was to evaluate the best available scientific evidence for the indications of specialized nutritional and metabolic support in critically-ill patients. the recommendations have been formulated by an expert panel with broad experience in nutritional and metabolic support in critically-ill patients and were drafted between october 2009 and march 2011. the studies analyzed encompassed metaanalyses, randomized clinical trials, observational studies, systematic reviews and updates relating to critically-ill adults in medline from 1966 to 2010, embase reviews from 1991 to 2010 and the cochrane database of systematic reviews up to 2010. the methodological criteria selected were those established in the scottish intercollegiate guidelines network and the agency for health care policy and research, as well as those of the jadad quality scale. adjustment for the level of evidence and grade of recommendation was performed following the proposal of the grade group (grading of recommendations assessment, development and evaluation working group). sixteen pathological scenarios were selected and each of them was developed by groups of three experts. a feedback system was established with the five members of the editorial committee and with the entire working group. all discrepancies were discussed and consensus was reached over several meetings, with special emphasis placed on reviewing the levels of evidence and grades of recommendation. the editorial committee made the final adjustments before the document was appro
Conclusiones del III Foro de Debate SENPE. Soporte nutricional especializado: aspectos éticos Conclusions of the III SENPE Debate Forum on specialized nutritional support: ethical issues  [cached]
A. García de Lorenzo,J. Barbero,A. Casta?o,S. Celaya
Nutrición Hospitalaria , 2006,
Abstract: Conclusiones del III Foro de Debate SENPE-Abbott sobre diferentes aspectos éticos del soporte nutricional especializado en el paciente hospitalizado y en el domiciliario y ambulatorio. Se profundiza en el principio de equidad dependiendo de la localización geográfica, en las indicaciones tanto como terapia primaria y como cuidados paliativos y, en el consentimiento informado. Conclusions of the III SENPE-Abbott Debate Forum on several ethical issues of specialized nutritional support in hospitalized patients and outpatients. An insight in the principle of equity is given depending on geographical location, in its indications both as a primary therapy and palliative care, and in informed consent.
Guidelines for specialized nutritional and metabolic support in the critically-ill patient: Update. Consensus SEMICYUC-SENPE: Cardiac patient Recomendaciones para el soporte nutricional y metabólico especializado del paciente crítico: Actualización. Consenso SEMICYUC-SENPE: Paciente cardíaco  [cached]
F. J. Jiménez Jiménez,M. Cervera Montes,A. L. Blesa Malpica
Nutrición Hospitalaria , 2011,
Abstract: Patients with cardiac disease can develop two types of malnutrition: cardiac cachexia, which appears in chronic congestive heart failure, and malnutrition due to the complications of cardiac surgery or any other type of surgery in patients with heart disease. Early enteral nutrition should be attempted if the oral route cannot be used. When cardiac function is severely compromised, enteral nutrition is feasible, but supplementation with parenteral nutrition is sometimes required. Sustained hyperglycemia in the first 24 hours in patients admitted for acute coronary syndrome, whether diabetic or not, is a poor prognostic factor for 30-day mortality. In critically-ill cardiac patients with stable hemodynamic failure, nutritional support of 20-25 kcal/kg/day is effective in maintaining adequate nutritional status. Protein intake should be 1.2-1.5 g/kg/day. Routine polymeric or high protein formulae should be used, according to the patient's prior nutritional status, with sodium and volume restriction according to the patient's clinical situation. The major energy source for myocytes is glutamine, through conversion to glutamate, which also protects the myocardial cell from ischemia in critical situations. Administration of 1 g/day of omega-3 (EPA+DHA) in the form of fish oil can prevent sudden death in the treatment of acute coronary syndrome and can also help to reduce hospital admission for cardiovascular events in patients with chronic heart failure. El paciente con patología cardíaca puede presentar 2 tipos de desnutrición: la caquexia cardíaca, que aparece en situaciones de insuficiencia cardíaca congestiva crónica, y una malnutrición secundaria a complicaciones de la cirugía cardíaca o de cualquier cirugía mayor realizada en pacientes con cardiopatía. Se debe intentar una nutrición enteral precoz si no se puede utilizar la vía oral. Cuando la función cardíaca esté profundamente comprometida la nutrición enteral es posible, pero a veces precisará suplementación con nutrición parenteral. La hiperglucemia aguda sostenida en las primeras 24 h en pacientes ingresados por síndrome coronario agudo, sean o no diabéticos, es un factor de mal pronóstico en términos de mortalidad a los 30 días. En el paciente crítico cardíaco con fallo hemodinámico en situación estable, un soporte nutricional de 20-25 kcal/kg/día es eficaz para mantener un estado nutricional adecuado. El aporte proteico debe ser de 1,2-1,5 g/kg/día. Se administrarán fórmulas poliméricas o hiperproteicas habituales, según la situación nutricional previa del paciente, con restricción de sodio y vo
Guidelines for specialized nutritional and metabolic support in the critically-ill patient: Update. Consensus SEMICYUC-SENPE: Multiple trauma patient Recomendaciones para el soporte nutricional y metabólico especializado del paciente crítico: Actualización. Consenso SEMICYUC-SENPE: Paciente politraumatizado  [cached]
A. L. Blesa Malpica,A. García de Lorenzo y Mateos,A. Robles González
Nutrición Hospitalaria , 2011,
Abstract: Patients with polytrauma can be viewed as paradigmatic of the critically-ill patient. These previously healthy patients undergo a life-threatening aggression leading to an organic response that is no different from that in other types of patients. The profile of trauma patients has changed and currently corresponds to patients who are somewhat older, with a higher body mass index and greater comorbidity. Severe injuries lead to intense metabolic stress, posing a risk of malnutrition. Therefore, early nutritional support, preferentially through the enteral route, with appropriate protein intake and glutamine supplementation, provides advantages over other routes and types of nutritional formula. To avoid overnutrition, reduced daily calorie intake can be considered in obese patients and in those with medullary lesions. However, little information on this topic is available in patients with medullary lesions. El paciente traumatizado puede considerarse el paradigma del paciente crítico que, previamente sano, sufre una agresión que pone su vida en riesgo y que determina una respuesta orgánica en nada diferente a la presente en otro tipo de pacientes. El perfil del paciente traumático ha cambiado, siendo en la actualidad algo más mayores, con índices de masa corporal más elevados y con una mayor comorbilidad. Cuando la agresión es grave, su respuesta metabólica es intensa y condiciona un riesgo nutricional. por ello, el soporte nutricional precoz, de preferencia enteral, con aporte proporcionado de proteínas y suplementado con glutamina, condiciona ventajas competitivas con otras vías y tipos de fórmulas nutricionales. La presencia de obesidad y/o lesión medular debe hacernos considerar una disminución proporcionada del aporte calórico diario, evitando la sobrenutrición, aunque en los pacientes con lesión medular es escasa la información disponible.
Guidelines for specialized nutritional and metabolic support in the critically-ill patient: Update. Consensus SEMICYUC-SENPE: Obese patient Recomendaciones para el soporte nutricional y metabólico especializado del paciente crítico: Actualización. Consenso SEMICYUC-SENPE: Paciente obeso  [cached]
A. Mesejo,C. Sánchez álvarez,J. A. Arboleda Sánchez
Nutrición Hospitalaria , 2011,
Abstract: As a response to metabolic stress, obese critically-ill patients have the same risk of nutritional deficiency as the non-obese and can develop protein-energy malnutrition with accelerated loss of muscle mass. The primary aim of nutritional support in these patients should be to minimize loss of lean mass and accurately evaluate energy expenditure. However, routinelyused formulae can overestimate calorie requirements if the patient's actual weight is used. Consequently, the use of adjusted or ideal weight is recommended with these formulae, although indirect calorimetry is the method of choice. Controversy surrounds the question of whether a strict nutritional support criterion, adjusted to the patient's requirements, should be applied or whether a certain degree of hyponutrition should be allowed. Current evidence suggested that hypocaloric nutrition can improve results, partly due to a lower rate of infectious complications and better control of hyperglycemia. Therefore, hypocaloric and hyperproteic nutrition, whether enteral or parenteral, should be standard practice in the nutritional support of critically-ill obese patients when not contraindicated. Widely accepted recommendations consist of no more than 60-70% of requirements or administration of 11-14 kcal/kg current body weight/day or 22-25 kcal/kg ideal weight/day, with 2-2.5 g/kg ideal weight/day of proteins. In a broad sense, hypocaloric-hyperprotein regimens can be considered specific to obese critically-ill patients, although the complications related to comorbidities in these patients may require other therapeutic possibilities to be considered, with specific nutrients for hyperglycemia, acute respiratory distress syndrome (ARDS) and sepsis. Howe - ver, there are no prospective randomized trials with this type of nutrition in this specific population subgroup and the available data are drawn from the general population of critically-ill patients. Consequently, caution should be exercised when interpreting these data. El paciente obeso crítico, como respuesta al estrés metabólico, tiene igual riesgo de depleción nutricional que el paciente no obeso, pudiendo desarrollar una malnutrición energeticoproteica,con una acelerada degradación de masa muscular. El primer objetivo del soporte nutricional en estos pacientes debe ser minimizar la pérdida de masa magra y realizar una evaluación adecuada del gasto energético. Sin embargo, la aplicación de las fórmulas habituales para el cálculo de las necesidades calóricas puede sobrestimarlas si se utiliza el peso real, por lo que sería más correcto su ap
Page 1 /100
Display every page Item


Home
Copyright © 2008-2017 Open Access Library. All rights reserved.