Analysis of nutrition mixtures in ITU patients

Background. The aim of this study was to analyse the composition of parenteral nutrition (PN) mixtures used in the ITU. Methods. Restrospective analysis involved 2124 prescriptions for individual PN bags. They were administered over an 18-month period, to 160 ITU patients with the mean APACHE II score of 26 points (range: 5-61), calculated on admission. The mortality rate was 40%. Nutrition programs were prepared individually following the 2009 ESPEN guidelines. The prescription was modified according to the individual patient’s clinical condition. One hundred and sixty prescriptions were analysed on the first day of PN (T1), 139 – on the second day (T2) and 1825 on the third and subsequent days (T3). Results. The mean energy supplies were: 1381 kcal/day (range: 456-2612) on T1, 1467 kcal/day (range: 524-2860) on T2, and 1654 kcal/day (range: 390-2969) on T3. The mean supplies of amino acids, glucose and lipids were as follows: amino acids 68.3 g/day (range:20-120) on T1; 71.6 g/ day (range:27.5-125) on T2; 88.0 g/day (range:11-196) on T3; glucose 210.25 g/day (range: 120- 400) on T1; 218.34 g/day (range: 65-480) on T2; 278.5 g/day (range: 18-520) on T3; lipids 34.9 g/ day (range: 0-100) on T1; 38.7 g/day (range: 0-100) on T2; 52.66 g/day (range: 0-117) on T3. The percentages of non-protein energy from lipids were: 29.25 (0-73) on T1; 31.58 (range: 0-60) on T2; 33.5 (0-60) on T3. The following statistically significant differences were found: T2-T3- (p<0.05). Conclusions. The compositions of nutrition bags prepared for ITU patients were consistent with the ESPEN guidelines. The composition varied on different days of nutrition. The differences in the supply of nutrition components indirectly confirm the need for individual prescriptions for ITU patients

Home enteral nutrition in children—2010 nationwide survey of the polish society for clinical nutrition of children

Published epidemiologic data on the administration rates of enteral/parenteral home nutrition is very limited. The aim of this first nationwide study was to assess the availability of pediatric home enteral nutrition (HEN) services in Poland. The questionnaire was sent to all regional centers providing pediatric HEN services in Poland (n = 14). The analysis included the number of pediatric patients who received HEN in 2010, their demographic characteristics and geographical distribution. Furthermore, the distributions of indications and methods of enteral nutrition administration were analyzed, along with the reasons of withdrawal from the HEN program. The number and fraction of children receiving HEN increased in 2010, from 433 (11.34 per 1 million inhabitants) on January 1st to 525 (13.75) on December 31st. Marked differences were observed in geographical distribution of this parameter, from zero to up to 30 pediatric patients per 1 million inhabitants. Median age of patients was 6 years (range: 9 months–18 years). In most cases, HEN was prescribed due to neurological disorders (n = 337, 64.2%), and administered by means of gastrostomy (n = 450, 85.71%). This study revealed the dynamic development of pediatric HEN services in Poland but also documented their potential regional shortages

OCENA ZAPOTRZEBOWANIA I OCZEKIWAŃ PACJENTÓW W STARSZYM WIEKU W ODNIESIENIU DO OPIEKI FIZJOTERAPEUTYCZNEJ W POLSCE

Introduction. The physiotherapeutic care is a sensitive subject for the medical society, the elderly patients and their carers.Aim. An assessment of the needs and expectation of elderly patients in relation to physiotherapeutic care in Poland.Materials and methods. 50 patients, aged 61-91, under the care of the Department and Clinic of Geriatrics of the University Hospital were qualified for the study. The study was based on a self-created anonymous survey. The questions concerned the needs and expectations of the elderly regarding physiotherapeutic care. The results were analyzed in relation to sex, age, place of residence, marital status and education.Results. (80%, n=40) of the patients pointed to the need for improvement in the field of physiotherapeutic care. 20% did not have an opinion on this topic. The need to adjust the therapeutic services was equally voiced by men and women. Methods for improvement of this care would be advertising the need for medical care in the field of physiotherapy (50%, n=25), education (22%, n=11) and more funds (2%, n=1). 26% (n=13) do not believe any change is possible while 70% (n=30) believe that in the coming 10 years the state of physiotherapeutic care in Poland will improve, 20% (n=10) - degrade and 10% (n=5) that it will not change. The subjects expect that in the coming years the waiting time for medical procedures will be shorter (42%, n=21), that there will be more physiotherapy centres (50%, n=25) and the qualification of the physiotherapeutic staff will improve (8%, n=4).Conclusions. Elderly patients voice a need for physiotherapeutic care and its improvement, regardless of sex, age, marital status, place of residence and education.Wstęp: Opieka fizjoterapeutyczna w Polsce stanowi problem dla środowiska medycznego, starzejących się pacjentów oraz ich opiekunów.Celem pracy była ocena zapotrzebowania i oczekiwań pacjentów w starszym wieku w odniesieniu do opieki fizjoterapeutycznej w Polsce.Materiał i metody. Do badania zakwalifikowano 50 pacjentów w wieku 61-91 lat będących pod opieką Kliniki Geriatrii oraz Poradni Geriatrycznej Szpitala Uniwersyteckiego im. dr A. Jurasza. Badania przeprowadzono na podstawie anonimowej ankiety własnego autorstwa. Pytania dotyczyły oczekiwań oraz zapotrzebowania na opiekę fizjoterapeutyczną u pacjentów w starszym wieku. Wyniki przeanalizowano w zależności od płci, wieku, miejsca zamieszkania, stanu cywilnego oraz wykształcenia.Wyniki. Spośród 50 pacjentów (20%, n=40) opowiedziało się za koniecznością poprawy opieki fizjoterapeutycznej (20%, n=10) nie miało na powyższy temat zdania. Potrzebę dostosowania usług terapeutycznych w równym stopniu zgłaszali zarówno mężczyźni, jak i kobiety. Sposobami na poprawę w/w opieki byłoby nagłośnienie/rozreklamowanie konieczności opieki zdrowotnej w zakresie fizjoterapii (50%, n=25), edukacja środowiska (22%, n=11) oraz większe fundusze na ten cel (2%, n=1). Brak wiary w zmiany przewiduje (26%, n=13). Stan polskiej opieki fizjoterapeutycznej w najbliższych 10 latach stanie się lepszy(70%, n=35), gorszy (20%, n=10), nie zmieni się (10%, n=5). Badani oczekują w przeciągu 10 lat skrócenia czasu oczekiwania na zabiegi fizjoterapeutyczne (42%, n=21), zwiększenia liczby ośrodków fizjoterapeutycznych (50%, n=25) oraz zwiększenia kwalifikacji personelu fizjoterapeutycznego (8%, n=4).Wnioski. Pacjenci w starszym wieku opowiadają się za koniecznością poprawy oraz zapotrzebowaniem na opiekę fizjoterapeutyczną niezależnie od płci, wieku, stanu cywilnego, miejsca zamieszkania i wykształcenia

Tolerancja żywienia dojelitowego wśród pacjentów w-starszym wieku na oddziale intensywnej terapii

Introduction. The health problems of old age are a generalized decline of organ efficiency, neuromuscular conduction and metabolic processes. Content of water in the body decrease while the occurrence of malnutrition increase. The percentage of people admitted to hospital wards including intensive care also increases. The aim of this study was to evaluate the tolerance of the industrial diets in patients over 60 years old treated in the Intensive Care Unit.Material and methods. A retrospective analysis of medical and nursing documentation of 134 patients over 60 years old hospitalized in the years 2009–2010, who was fed at least for 5 days by industrial enteral diets administered by nasogastric tube continuous infusion of 20 h/day. Feeding tolerance was assessed in the 1st, 3rd and 5th day of feeding. Analysed: diet infusion rate, signs of intolerance from the gastrointestinal tract (residual and the number of defecations).Results. Enteral Nutrition was implemented average on the 4th day of stay. Previously, 84 patients were fed parenterally. On the first day the average speed of infusion was 33 ml/h, on the third day-55 ml/h, and on thefifth day-66 ml/h (p &lt; 0.05). Residuals occurred on the first day in 37 patients, on the third day in 26, and on the fifth day in 18 patients. In d1 diarrhea occurred in 2 patients, on the 3rd day-in 7 patients, on the fifth day-in 4 patients. Enteral nutrition was abandoned in 9 patients (total) because of: intense residuals of gastric content, gastrointestinal bleeding, vomiting, surgical treatment of the underlying disease. The level of CRP in patients with residuals was significantly higher in the d1 and d3 as compared to patients without residual.Conclusions. Feeding with enteral industry diets implemented gradually in the ICU is well tolerated by patients over 60 years old. Symptoms from gastrointestinal tract require modifications of planned enteral nutrition therapy, while the lack of tolerance and the need to stop nutritional treatment are usually associated with deterioration of general condition and progress of the underlying disease.Wstęp. Problemy zdrowotne osób w wieku podeszłym to uogólniony spadek: wydolności narządowej, przewodnictwa nerwowo-mięśniowego, procesów metabolicznych. Zmniejsza się zawartość wody w organizmie oraz zwiększa się występowanie niedożywienia. Wzrasta także liczba osób przyjmowanych na oddziały szpitalne, między innymi oddziały intensywnej terapii (OIT). Celem pracy była ocena tolerancji diet przemysłowych u pacjentów powyżej 60. roku życia leczonych na OIT.Materiał i metody. Metodą badań była retrospektywna analiza dokumentacji lekarsko-pielęgniarskiej 134 pacjentów powyżej 60. roku życia, u których co najmniej przez 5 dni stosowano żywienie dojelitowe dietami przemysłowymi podawanymi przez zgłębnik nosowo-żołądkowy wlewem ciągłym 20 h/dobę. Tolerancję żywienia oceniano w 1., 3. oraz 5. dobie żywienia. Analizowano: prędkość wlewu diety, objawy nietolerancji ze strony przewodu pokarmowego (zaleganie oraz liczbę wypróżnień).Wyniki. Żywienie enteralne wdrażane było średnio w 4. dobie pobytu; 84 pacjentów żywionych było wcześniej parenteralnie. Średnia prędkość wlewu w pierwszej dobie wynosiła 33 ml/godzinę, w 3. — 55 ml/godzinę, a w 5. — 66 ml/godzinę; (p &lt; 0,05). Zaleganie w żołądku wystąpiło w 1. dobie u 37 chorych, w dobie 3. u 26 chorych,a w dobie 5. u 18. W dobie 1. biegunka wystąpiła u 2 pacjentów, w 3. — u 7 pacjentów, w 5. — u 4. Od żywienia dojelitowego odstąpiono łącznie u 9 pacjentów z powodu: intensywnych zalegań treści żołądkowej, krwawienia z przewodu pokarmowego, wymiotów, operacyjnego leczenia choroby podstawowej. Poziom białka C-reaktywnego (CRP) u pacjentów z zaleganiami był istotnie statystycznie wyższy w d1 i d3 w porównaniu z pacjentami bez zalegań.Wnioski. Żywienie dojelitowe dietami przemysłowymi wdrażane stopniowo na OIT jest dobrze tolerowane przez pacjentów powyżej 60. roku życia. Występujące objawy ze strony przewodu pokarmowego wymagają modyfikacji zaplanowanej terapii żywieniowej dojelitowej, natomiast brak tolerancji i konieczność przerwania leczenia żywieniowego związane są najczęściej z pogorszeniem stanu ogólnego i postępem choroby podstawowej

Aktualne zasady postępowania w przypadku wrodzonej przepukliny przeponowej

The treatment of congenital diaphragmatic hernia (CDH) still represents a challenge, even for the specialised multidisciplinary teams in centres that provide treatment for CDH. Despite significant progress in the fields of pathophysiology, prenatal diagnosis, surgical techniques and intensive care, CDH is a disease still burdened with a high mortality. Due to the paucity of randomised studies, there are no standard guidelines for treatment. The present review looks at existing diagnostic and therapeutic principles based on the available literature.The treatment of congenital diaphragmatic hernia (CDH) still represents a challenge, even for the specialised multidisciplinary teams in centres that provide treatment for CDH. Despite significant progress in the fields of pathophysiology, prenatal diagnosis, surgical techniques and intensive care, CDH is a disease still burdened with a high mortality. Due to the paucity of randomised studies, there are no standard guidelines for treatment. The present review looks at existing diagnostic and therapeutic principles based on the available literature

Occurrence of gastrointestinal side effects associated with early use of commercial diets in ITU patients

BACKGROUND: The purpose of this retrospective study was to analyse the occurrence of gastrointestinal side effects in enterally fed ICU patients.METHODS: We analysed the records of 195 ITU patients fed enterally, over at least five days, with commercial mixtures administered as 20-h infusions. Gastric retention, the number of defecations, and incidents requiring discontinuation of enteral feeding, were noted during the first 3 days of nutrition.RESULTS: Enteral nutrition was usually started during the first week of treatment (median 4, range: 1–33). In 118 patients receiving parenteral nutrition, the median day of implementing enteral feeding was day 5; some received enteral mixtures much earlier (day 2). The mean infusion rates of enteral mixtures were: 33 mL h –1 on day 1, 58 mL h –1 on day 2, and 68 mL h –1 on day 3. Gastric retention was observed in 49 (25.1%) patients during the first day, in 37 (19.0%) on day 2, and in 25 (12.8%) on day 3. Discontinuation of enteral nutrition was necessary in 6 patients due to: surgery (1), high gastric retention (4), gastrointestinal bleeding (1). A statistically significant correlation was found between the occurrence of gastric retention, infusion rates and CRP, and between the number of defecations and infusion rates.CONCLUSIONS: Enteral feeding with commercial diets is well tolerated when implemented gradually. Intolerance and the need for the discontinuation of enteral feeding were usually associated with a worsening of the patient’s general condition and progression of the underlying disease.BACKGROUND: The purpose of this retrospective study was to analyse the occurrence of gastrointestinal side effects in enterally fed ITU patients.METHODS: We analysed the records of 195 ITU patients fed enterally, over at least five days, with commercial mixtures administered as 20-h infusions. Gastric retention, the number of defecations, and incidents requiring discontinuation of enteral feeding, were noted during the first 3 days of nutrition.RESULTS: Enteral nutrition was usually started during the first week of treatment (median 4, range: 1–33). In 118 patients receiving parenteral nutrition, the median day of implementing enteral feeding was day 5; some received enteral mixtures much earlier (day 2). The mean infusion rates of enteral mixtures were: 33 mL h–1 on day 1, 58 mL h–1 on day 2, and 68 mL h–1 on day 3. Gastric retention was observed in 49 (25.1%) patients during the first day, in 37 (19.0%) on day 2, and in 25 (12.8%) on day 3. Discontinuation of enteral nutrition was necessary in 6 patients due to: surgery (1), high gastric retention (4), gastrointestinal bleeding (1). A statistically significant correlation was found between the occurrence of gastric retention, infusion rates and CRP, and between the number of defecations and infusion rates.CONCLUSIONS: Enteral feeding with commercial diets is well tolerated when implemented gradually. Intolerance and the need for the discontinuation of enteral feeding were usually associated with a worsening of the patient’s general condition and progression of the underlying disease

PG 2 2009.qxp

H Hy yp po op ph ho os sp ph ha at ta ae em mi ia a a as s a an n e el le em me en nt t o of f &apos; &apos;r re ef fe ee ed di in ng g s sy yn nd dr ro om me e&apos; &apos; --a a c co om mp pl li ic ca at ti io on n o of f n nu ut tr ri it ti io on na al l t tr re ea at tm me en nt t i in n a an n e ex xt tr re em me el ly y n ne eg gl le ec ct te ed d 5 5--y ye ea ar r--o ol ld d g gi ir rl l w wi it th h i in nf fa an nt ti il le e c ce er re eb br ra al l p pa al ls sy y Hipofosfatemia jako jeden z elementów zespo³u refeeding -powik³anie leczenia ¿ywieniowego u skrajnie zaniedbanej 5-letniej dziewczynki z mózgowym pora¿eniem dzieciêcym K Ke ey y w wo or rd ds s: : refeeding syndrome, children, malnutrition. S Sł ło ow wa a k kl lu uc cz zo ow we e: : zespół ponownego odżywiania, dzieci, niedożywienie. A Ad dd dr re es ss s f fo or r c co or rr re es sp po on nd de en nc ce e

Analysis of nutrition mixtures in ITU patients

BACKGROUND: The aim of this study was to analyse the composition of parenteral nutrition (PN)mixtures used in the ITU.METHODS: Restrospective analysis involved 2124 prescriptions for individual PN bags. They wereadministered over an 18-month period, to 160 ITU patients with the mean APACHE II score of 26points (range: 5-61), calculated on admission. The mortality rate was 40%. Nutrition programs wereprepared individually following the 2009 ESPEN guidelines. The prescription was modified accordingto the individual patient’s clinical condition. One hundred and sixty prescriptions were analysed onthe first day of PN (T1), 139 – on the second day (T2) and 1825 on the third and subsequent days (T3).RESULTS: The mean energy supplies were: 1381 kcal/day (range: 456-2612) on T1, 1467 kcal/day(range: 524-2860) on T2, and 1654 kcal/day (range: 390-2969) on T3. The mean supplies of aminoacids, glucose and lipids were as follows: amino acids 68.3 g/day (range:20-120) on T1; 71.6 g/day (range:27.5-125) on T2; 88.0 g/day (range:11-196) on T3; glucose 210.25 g/day (range: 120-400) on T1; 218.34 g/day (range: 65-480) on T2; 278.5 g/day (range: 18-520) on T3; lipids 34.9 g/day (range: 0-100) on T1; 38.7 g/day (range: 0-100) on T2; 52.66 g/day (range: 0-117) on T3. Thepercentages of non-protein energy from lipids were: 29.25 (0-73) on T1; 31.58 (range: 0-60) onT2; 33.5 (0-60) on T3. The following statistically significant differences were found: T2-T3- (p&lt;0.05).CONCLUSIONS: The compositions of nutrition bags prepared for ITU patients were consistent with theESPEN guidelines. The composition varied on different days of nutrition. The differences in the supplyof nutrition components indirectly confirm the need for individual prescriptions for ITU patients.BACKGROUND: The aim of this study was to analyse the composition of parenteral nutrition (PN)mixtures used in the ITU.METHODS: Restrospective analysis involved 2124 prescriptions for individual PN bags. They wereadministered over an 18-month period, to 160 ITU patients with the mean APACHE II score of 26points (range: 5-61), calculated on admission. The mortality rate was 40%. Nutrition programs wereprepared individually following the 2009 ESPEN guidelines. The prescription was modified accordingto the individual patient’s clinical condition. One hundred and sixty prescriptions were analysed onthe first day of PN (T1), 139 – on the second day (T2) and 1825 on the third and subsequent days (T3).Results. The mean energy supplies were: 1381 kcal/day (range: 456-2612) on T1, 1467 kcal/day(range: 524-2860) on T2, and 1654 kcal/day (range: 390-2969) on T3. The mean supplies of aminoacids, glucose and lipids were as follows: amino acids 68.3 g/day (range:20-120) on T1; 71.6 g/day (range:27.5-125) on T2; 88.0 g/day (range:11-196) on T3; glucose 210.25 g/day (range: 120-400) on T1; 218.34 g/day (range: 65-480) on T2; 278.5 g/day (range: 18-520) on T3; lipids 34.9 g/day (range: 0-100) on T1; 38.7 g/day (range: 0-100) on T2; 52.66 g/day (range: 0-117) on T3. Thepercentages of non-protein energy from lipids were: 29.25 (0-73) on T1; 31.58 (range: 0-60) onT2; 33.5 (0-60) on T3. The following statistically significant differences were found: T2-T3- (p&lt;0.05).CONCLUSIONS: The compositions of nutrition bags prepared for ITU patients were consistent with theESPEN guidelines. The composition varied on different days of nutrition. The differences in the supplyof nutrition components indirectly confirm the need for individual prescriptions for ITU patients