Transfusiones sanguíneas Domiciliarias en Pacientes Paliativos

Introduction: Assistance of complex chronic patients occupies much of the health care activity of home care hospital bassed (HCHB). The chronic anemias are frequent as a secondary clinic picture due to the deficit of the tissues oxygenation capacity for lack of contribution.Aim: to know the prevalence of transfusions and the characteristics of the patients in the HCHB of the Hospital General Universitario de Alicante.Material and methods: Descriptive, cross-sectional study of transfused patients in the HCHB of General University of Alicante from the 1st of October 2016 until the 31th of march of 2017.Results: 136 transfusions were performed in 52 patients with a median of 82 years IQ [68-88]. The most of them were palliatives and the 53,8% were males.They were transfused using an average hemoglobin of 7,8g/dl ± 0,9 and all of them showed symptomatology. No type of adverse reaction was registered.The degree of patient satisfaction and their relatives was high. 9.7 ± 0.3. The prevalence was 121.86 transfusions / 1000 patients in the HAD.Conclusions: The transfusions have been a safe procedure at the patient’s home. The most part of the transfused patients were palliatives. All the recorded transfusions were indicated analytical and clinically. The high degree of patients satisfaction and their relatives makes infer that we are contributing to improve their quality of life.Introducción: La asistencia a los pacientes crónicos complejos ocupa gran parte de la actividad asistencial de las Unidades de Hospitalización a Domicilio (HAD), en los que son frecuentes los cuadros de anemia crónica que precisan ocasionalmente transfusiones por clínica secundaria al déficit de la capacidad de oxigenación de los tejidos por falta de aporte.Objetivo: Conocer la prevalencia de transfusiones y las características de los pacientes en la HAD del Hospital General Universitario de Alicante.Material y Método: Estudio descriptivo transversal de los pacientes transfundidos en la HAD del Hospital Universitario General de Alicante desde el 1 de Octubre de 2016 hasta el 31 de marzo de 2017.Resultados: Se realizaron 136 transfusiones a 52 pacientes con una mediana de 82 años IIQ [68-88] de los que 53,8% eran varones. Fueron mayoritariamente paliativos. La Hemoglobina media con la que se transfundieron fue de 7,8 g/dl ± 0,9 y todos presentaron sintomatología. No se registró ningún tipo de reacción adversa. El grado de satisfacción de los pacientes y familiares fue de elevado 9,7± 0,3. La prevalencia fue de 121,86 transfusiones /1000 pacientes en la HAD.Conclusiones: Las transfusiones han sido un procedimiento seguro en el domicilio del paciente. La mayor parte de los pacientes que han recibido transfusiones eran paliativos. Todas las transfusiones realizadas estaban indicadas analítica y clínicamente. El elevado grado de satisfacción de pacientes y familiares hace inferir que se está contribuyendo a mejorar la calidad de vida

Influencia de los suplementos nutricionales en la evolución de las heridas quirúrgicas abdominales complicadas de pacientes en hospitalización a domicilio

Objective: To evaluate the impact of nutritional supplements in patients admitted to the Home Hospitalization Unit with complicated abdominal surgical wounds.Material and methods: We have performed a retrospective study of 67 patients which presented complicated abdominal surgical wounds upon admission to the Home Hospitalization Unit. We have studied the type and amount of the supplement received, the body mass index (BMI), the albumin, and the time and cycles of antibiotic therapy.Results: The median age of the 67 patients was 69.2 ± 5.6. All patients had open abdominal wounds and 53.7% had infection with intravenous antibiotics. All patients received some type of nutritional supplement (62.7% standard, 25.4% immunomodulatory (Atempero®), 11.9% others). After one month of follow-up, the albumin mean value had increased in all patients p = 0.032, although the greatest difference was in patients who received immunomodulatory nutrition p = 0.001. The median follow-up was 84.05 ± 17.48 days until discharge. In the immunomodulatory supplement group it was 77.18 ± 13.72 days (p = 0.001).Conclusions: The data support a benefit of oral supplementation in this type of patients improving their nutritional status. The group that was supplemented with Atempero®, stood out both in the recovery of albumin levels and in a better evolution, which translates into a significantly earlier discharge.Objetivo: Evaluar el impacto de los suplementos nutricionales en pacientes ingresados en la Unidad de Hospitalización a Domicilio con heridas quirúrgicas abdominales complicadas.Material y Métodos: Estudio retrospectivo de 67 pacientes que a su ingreso en la Unidad de Hospitalización a Domicilio presentaban heridas quirúrgicas abdominales complicadas. Se estudió el tipo y cantidad de suplemento recibido, Índice de Masa Corporal (IMC), albumina, tiempo y ciclos de antibioterapia.Resultados: La edad media de los 67 pacientes fue de 69,2 ±5,6. Todos los pacientes presentaban heridas abdominales abiertas y el 53,7% presentaban infección con antibioterapia intravenosa. Todos los pacientes recibieron algún tipo de suplemento nutricional (estándar 62,7%; inmunomodulador (Atempero®) 25,4% y otros 11,9%). Al mes de seguimiento el valor medio de albumina se había incrementado en todos los pacientes p=0,032 aunque la mayor diferencia la presentaron los pacientes que recibieron nutrición inmunomoduladora p=0,001. La estancia media fue de 84,05±17,48 días hasta el alta, en el grupo del suplemento inmunomodulador fue de 77,18±13,72 días (p=0,001).Conclusiones: Los datos apoyan un beneficio de la suplementación oral en este tipo de pacientes mejorando su estado nutricional. El grupo que se suplementó con Atempero®, destacó tanto en la recuperación de los niveles de albumina como en una mejor evolución, lo que se traduce en un alta significativamente más precoz

Prevalencia de Desnutrición en los pacientes de Hospitalización a Domicilio

Objective: To estimate the prevalence of malnutrition in patients admitted to the UHD of the General University Hospital of Alicante.Material and methods: Prospective longitudinal study of a sample of 386 patients admitted to UHD randomly selected. Patients were evaluated with the HEN Nutritional Assessment Tool [https://www.evalnut.com/]. During the years 2016-2017.Results: The 386 selected patients had an average age of 72.87 years. 51.7 percent of them were male and 42.1 percent had a level of illness “acute mild / chronic stable” (Fig. 1). 24 of the patients (9.2 percent) were gastrostomy carriers. 42.1 percent of patients did not cover 75 percent of daily energy requirements. 69.7 percent of patients lost weight before admission in the HaD [mean 10.1 ± 6.1 percent of their usual weight], independent of sex (p = 0.343) and age (p = 0.712), presenting higher lost weight those who had done for more than a month (p <0.001), as well as those in whom the severity of the disease had increased (p <0.001) and not related to the decrease in reported intake (p = 0.395). 21.5 percent of patients had difficulty chewing and 18.4 percent of them had dysphagia (Fig2) of which 91.3 percent was from liquids. 91.6 percent of patients had some type of malnutrition, of which 54.4 percent were mild, highlighting that 71.3 percent of cases were mixed malnutrition (Fig 3). No relationship was found between the weight loss and the type of malnutrition (p = 0.054). However a relationship between the severity level of the disease and the type and degree of malnutrition (p = 0.005, p = 0.034) was found.Conclusions: Patients admitted to HaD have a very high prevalence of malnutrition, mostly of mixed type, which is more severe as the severity of the disease increases. The relationship between the degree and type of malnutrition with the severity of the disease suggests that it has been established for a long period of time.Objetivo: Estimar la prevalencia de desnutrición en los pacientes ingresados en la UHD del Hospital General Universitario de Alicante.Material y Métodos: Estudio longitudinal prospectivo de una muestra de 386 pacientes ingresados en UHD incluidos aleatoriamente. Los pacientes fueron evaluados con la Herramienta de Evaluación Nutricional HEN [https://www.evalnut.com/]. Durante el año 2016-2017.Resultados: Los 386 pacientes tenían una media de edad de 72,87años y 51,7% eran varones. El 42,1% de los pacientes tenían un nivel de enfermedad “agudo leve / crónico estable” (Fig1). Eran portadores de gastrostomía 24(9,2%). No cubría el 75% de los requerimientos energéticos diarios el 42,1%. Habían perdido peso antes de su ingreso en HaD el 69,7% de los pacientes [media 10,1±6,1% de su peso habitual] independiente del sexo (p=0,343) y la edad (p=0,712) presentando mayor pérdida los que lo habían hecho en más de 1 mes (p<0,001), también según se incrementa la gravedad de la enfermedad (p<0,001) y sin relación con la disminución de la ingesta declarada (p=0,395). Tenían dificultades para masticar 21,5%, presentaban disfagia 18,4% (Fig2) de los que 91,3% era a líquidos. El 91,6% de los pacientes tenía algún tipo de desnutrición, siendo leve el 54,4% y destacando la desnutrición mixta en el 71,3% de los casos (Fig3). No se encontró relación entre la pérdida de peso y el tipo de desnutrición (p=0,054) y sí entre el nivel de gravedad de la enfermedad y con el tipo de desnutrición y grado de desnutrición (p=0,005; p=0,034).Conclusiones: Los pacientes ingresados en HaD presentan una altísima prevalencia de desnutrición, mayoritariamente de tipo mixta, siendo ésta más severa a medida que se incrementa la gravedad de la enfermedad.La relación entre el grado y tipo de desnutrición con la gravedad de la enfermedad hace pensar que se ha ido instaurando durante un largo periodo de tiempo

Spanish home enteral nutrition registry of the year 2014 and 2015 from the NADYA-SENPE Group

Objetivo: exponer los resultados del registro de nutrición enteral domiciliaria (NED) del año 2014 y 2015 del Grupo NADYA-SENPE. Métodos: se recopilaron los pacientes introducidos en el registro desde el 1 de enero al 31 de diciembre de 2014 y la mismas fechas de 2015, y se procedió al análisis descriptivo y analítico de los datos. Resultados: en el año 2014, se registraron 3.749 pacientes y en 2015, 4.202; la prevalencia fue de 80,58 pacientes/millón de habitantes en el año 2014 y de 90,51 en 2015. Por sexos, hubo un 49,9% de mujeres en 2014 y un 50,3% en 2015. La edad media fue de 73 años (IIQ 59-83) en ambos años. Finalizaron 684 episodios de NED en 2014 y 631 en 2015, la causa principal fue el fallecimiento en el 54,9% y 50,4% de los casos, respectivamente. Los portadores de sonda nasogástrica presentan una edad media superior a los pacientes con cualquier otra vía (p < 0,001). Se registraron 67 pacientes pediátricos en 2014 (56,7% niñas) y 77 en 2015 (55,8% niñas). La vía principal de administración fue la gastrostomía en el 52,0% de los casos de 2014 y sonda nasogástrica en el 50,8% de los casos de 2015. La causa principal de fi nalización de la nutrición fue el fallecimiento (57,1% en 2014 y 38,5% en 2015). Se observó que los niños más pequeños eran los que se alimentaban preferentemente por SNG (p 0,004 vs. 0,002).Tanto en pacientes pediátricos como en adultos el diagnóstico principal que motivó la necesidad de NED fue la enfermedad neurológica que cursa con afagia o disfagia severa. Conclusiones: se ha incrementado el número de pacientes del registro, así como el número de centros participantes y el número medio de pacientes comunicados por cada centro respecto a años anteriores, sin que se hayan modificado sustancialmente las características de los pacientes, salvo mayor duración de los episodiosObjective: To present the results of the Spanish home enteral nutrition (HEN) registry of the NADYA-SENPE group for the years 2014 and 2015. Methods: From January 1st 2014 to December 31st 2015 the HEN registry was recorded and afterwards a further descriptive and analytical analysis was done. Results: In 2014, 3749 patients were recorded, and 4202 in 2015; prevalence was 80.58 patients/one million inhabitants in Spain in 2014 and 90.51 in 2015. There were 49.9% females in 2014 and 50.3% in 2015. Median age was 73 years (IQI 59-83) in 2014 as well as in 2015. 684 episodes fi nished in 2014 and 631 in 2015, with death as the main cause, in 54.9% and 50.4%, respectively. The ones who were fed through nasogastric tube had a mean age higher than the ones fed by any other route (p-value < 0.001). Sisty-seven paediatric patients were recorded in 2014 (56.7% females) and 77 in 2015 (55.8% females). Median age at the beginning of HEN among children was 5 months in 2014 and 5 months in 2015. The main route of administration was gastrostomy, in 52.5% in 2014 and nasogastric tube in 50.8% in 2015. 7 episodes fi nished in 2014 and 13 in 2015, having death as the main cause (57.1% in 2014 and 38.5% in 2015). It was found that were younger children the ones who were mainly fed by nasogastric tubes (p-value 0.004 vs. 0.002). Among paediatric patients as well as adults, the main diagnosis leading to HEN was neurological disease which gives aphagia or severe dysphagia. Conclusions: There has been an increase in the number of patients in the registry as well as the participating centers and the number of patients per center, without any signifi cant change in the characteristics of the patients other than longer duration of the episode

SARS-CoV-2 Infection in Multiple Sclerosis

To understand COVID-19 characteristics in people with multiple sclerosis (MS) and identify high-risk individuals due to their immunocompromised state resulting from the use of disease-modifying treatments. Retrospective and multicenter registry in patients with MS with suspected or confirmed COVID-19 diagnosis and available disease course (mild = ambulatory; severe = hospitalization; and critical = intensive care unit/death). Cases were analyzed for associations between MS characteristics and COVID-19 course and for identifying risk factors for a fatal outcome. Of the 326 patients analyzed, 120 were cases confirmed by real-time PCR, 34 by a serologic test, and 205 were suspected. Sixty-nine patients (21.3%) developed severe infection, 10 (3%) critical, and 7 (2.1%) died. Ambulatory patients were higher in relapsing MS forms, treated with injectables and oral first-line agents, whereas more severe cases were observed in patients on pulsed immunosuppressors and critical cases among patients with no therapy. Severe and critical infections were more likely to affect older males with comorbidities, with progressive MS forms, a longer disease course, and higher disability. Fifteen of 33 patients treated with rituximab were hospitalized. Four deceased patients have progressive MS, 5 were not receiving MS therapy, and 2 were treated (natalizumab and rituximab). Multivariate analysis showed age (OR 1.09, 95% CI, 1.04-1.17) as the only independent risk factor for a fatal outcome. This study has not demonstrated the presumed critical role of MS therapy in the course of COVID-19 but evidenced that people with MS with advanced age and disease, in progressive course, and those who are more disabled have a higher probability of severe and even fatal diseas

Hyperoxemia and excess oxygen use in early acute respiratory distress syndrome : Insights from the LUNG SAFE study

Publisher Copyright: © 2020 The Author(s). Copyright: Copyright 2020 Elsevier B.V., All rights reserved.Background: Concerns exist regarding the prevalence and impact of unnecessary oxygen use in patients with acute respiratory distress syndrome (ARDS). We examined this issue in patients with ARDS enrolled in the Large observational study to UNderstand the Global impact of Severe Acute respiratory FailurE (LUNG SAFE) study. Methods: In this secondary analysis of the LUNG SAFE study, we wished to determine the prevalence and the outcomes associated with hyperoxemia on day 1, sustained hyperoxemia, and excessive oxygen use in patients with early ARDS. Patients who fulfilled criteria of ARDS on day 1 and day 2 of acute hypoxemic respiratory failure were categorized based on the presence of hyperoxemia (PaO2 > 100 mmHg) on day 1, sustained (i.e., present on day 1 and day 2) hyperoxemia, or excessive oxygen use (FIO2 ≥ 0.60 during hyperoxemia). Results: Of 2005 patients that met the inclusion criteria, 131 (6.5%) were hypoxemic (PaO2 < 55 mmHg), 607 (30%) had hyperoxemia on day 1, and 250 (12%) had sustained hyperoxemia. Excess FIO2 use occurred in 400 (66%) out of 607 patients with hyperoxemia. Excess FIO2 use decreased from day 1 to day 2 of ARDS, with most hyperoxemic patients on day 2 receiving relatively low FIO2. Multivariate analyses found no independent relationship between day 1 hyperoxemia, sustained hyperoxemia, or excess FIO2 use and adverse clinical outcomes. Mortality was 42% in patients with excess FIO2 use, compared to 39% in a propensity-matched sample of normoxemic (PaO2 55-100 mmHg) patients (P = 0.47). Conclusions: Hyperoxemia and excess oxygen use are both prevalent in early ARDS but are most often non-sustained. No relationship was found between hyperoxemia or excessive oxygen use and patient outcome in this cohort. Trial registration: LUNG-SAFE is registered with ClinicalTrials.gov, NCT02010073publishersversionPeer reviewe

“Long-term oncologic outcomes and risk factors for distant recurrence after pathologic complete response following neoadjuvant treatment for locally advanced rectal cancer. A nationwide, multicentre study”

Background: Pathologic complete response (pCR) after multimodal treatment for locally advanced rectal cancer (LARC) is used as surrogate marker of success as it is assumed to correlate with improved oncologic outcome. However, long-term oncologic data are scarce.Methods: This retrospective, multicentre study updated the oncologic follow-up of prospectively collected data from the Spanish Rectal Cancer Project database. pCR was described as no evidence of tumour cells in the specimen. Endpoints were distant metastases-free survival (DMFS) and overall survival (OS). Multivariate regression analyses were run to identify factors associated with survival.Results: Overall, 32 different hospitals were involved, providing data on 815 patients with pCR. At a median follow-up of 73.4 (IQR 57.7-99.5) months, distant metastases occurred in 6.4% of patients. Abdominoperineal excision (APE) (HR 2.2, 95%CI 1.2-4.1, p = 0.008) and elevated CEA levels (HR = 1.9, 95% CI 1.0-3.7, p = 0.049) were independent risk factors for distant recurrence. Age (years) (HR 1.1; 95% CI 1.05-41.09; p &lt; 0.001) and ASA III-IV (HR = 2.0; 95%-CI 1.4-2.9; p &lt; 0.001), were the only factors associated with OS. The estimated 12, 36 and 60-months DMFS rates were 96.9%, 91.3%, and 86.8%. The estimated 12, 36 and 60-months OS rates were 99.1%, 94.9% and 89.3%.Conclusions: The incidence of metachronous distant metastases is low after pCR, with high rates of both DMFS and OS. The oncologic prognosis in LARC patients that achieve pCR after neoadjuvant chemoradiotherapy is excellent in the long term. (c) 2023 Elsevier Ltd, BASO similar to The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved

Immunocompromised patients with acute respiratory distress syndrome: Secondary analysis of the LUNG SAFE database

Background: The aim of this study was to describe data on epidemiology, ventilatory management, and outcome of acute respiratory distress syndrome (ARDS) in immunocompromised patients. Methods: We performed a post hoc analysis on the cohort of immunocompromised patients enrolled in the Large Observational Study to Understand the Global Impact of Severe Acute Respiratory Failure (LUNG SAFE) study. The LUNG SAFE study was an international, prospective study including hypoxemic patients in 459 ICUs from 50 countries across 5 continents. Results: Of 2813 patients with ARDS, 584 (20.8%) were immunocompromised, 38.9% of whom had an unspecified cause. Pneumonia, nonpulmonary sepsis, and noncardiogenic shock were their most common risk factors for ARDS. Hospital mortality was higher in immunocompromised than in immunocompetent patients (52.4% vs 36.2%; p &lt; 0.0001), despite similar severity of ARDS. Decisions regarding limiting life-sustaining measures were significantly more frequent in immunocompromised patients (27.1% vs 18.6%; p &lt; 0.0001). Use of noninvasive ventilation (NIV) as first-line treatment was higher in immunocompromised patients (20.9% vs 15.9%; p = 0.0048), and immunodeficiency remained independently associated with the use of NIV after adjustment for confounders. Forty-eight percent of the patients treated with NIV were intubated, and their mortality was not different from that of the patients invasively ventilated ab initio. Conclusions: Immunosuppression is frequent in patients with ARDS, and infections are the main risk factors for ARDS in these immunocompromised patients. Their management differs from that of immunocompetent patients, particularly the greater use of NIV as first-line ventilation strategy. Compared with immunocompetent subjects, they have higher mortality regardless of ARDS severity as well as a higher frequency of limitation of life-sustaining measures. Nonetheless, nearly half of these patients survive to hospital discharge. Trial registration: ClinicalTrials.gov, NCT02010073. Registered on 12 December 2013

Home Parenteral Nutrition in Spain, 2015. Home and Ambulatory Artificial Nutrition (NADYA) Group report

Aim: To communicate the results of the Spanish Home Parenteral Nutrition (HEN) registry of the NADYA-SENPE group for the year 2015.Material and methods: Data was recorded online by NADYA group collaborators that were responsible of the HPN follow-up from 1st January to 31st December 2015.Results: Two hundred and thirty-six patients with 243 episodes of NPD were recorded from 40 hospitals. This represents a rate of 5.08 patients/million habitants for 2015. The most frequent pathology in adults was other (26.3%) followed by palliative oncological (21.6%). The most common complication was catheter-related sepsis which presented a rate of 0.53 infections/1,000 days of HPN. Sixty-four episodes were finished; the main cause was death (43.7%) and resuming to oral via (32.8%).Conclusions: we find increasing centers and professional partners, responding to the progressively more patients with parenteral nutrition support at home. The main indications for the establishment of NPD and causes termination of treatment remain stable