PubMed Health⌕ Search

Biomedical subjects

J C Montejo González

Publications and source records attributed to J C Montejo González.

16 recordsLinked to original sources
PubMed2006

[Contribution of nutritional support to treatment neuromuscular impairmets of critically ill patients].

Neuromuscular impairments occurring in the critically ill patient have been attributed to factors such as sepsis, release of inflammatory mediators, or the use of drugs unfavorably affecting neuromuscular function. The role of metabolic and nutritional factors in the development of this condition has received little attention. Currently, the use of protocols of intensive glycemia monitoring might be of great interest in preventing neuromuscular impairments in critically ill patients. The precise mechanisms of hyperglycemia involvement in this condition are still unknown, although evidence from research data is important. Cachectic myopathy (muscle atrophy) usually is the result of the obliged changes of metabolic response to stress. The effect of nutrients intake on muscle mass gaining is very limited, so that other actions aimed at more rapidly recovering lost muscle mass should be studied. Aggressive renutrition schedules should be avoided in order to prevent re-nutrition syndrome and further deterioration of muscle function. Intake of specific substrates, such as glutamine, might have a beneficial effect on recovering neuromuscular impairments in the critically ill patient. However, there are still no data to justify its use if the only purpose is to recover neuromuscular function.

Critical Illness↗
PubMed2005

[Artificial nutrition in hyperglycemia and diabetes mellitus in critically ill patients].

The need to strictly control glucose levels, even in nondiabetic patients, has recently emerged following the publication of the results that indicate the possibility of reducing the morbidity and mortality in critically ill patients. Since hyperglycemia is one of the most frequent metabolic impairments in these patients, insulin therapy is a necessity in most of the cases. In order to prevent hyperglycemia and its associated complications, nutritional support must be adjusted to the patient's requirements, avoiding hyponutrition. Whenever possible, nutrients supply should be done through the digestive route. Parenteral nutrition is more often accompanied by hyperglycemia and requires an increase in insulin dosage to control it. There are two types of enteral diets designed to help controlling hyperglycemic conditions: carbohydrates rich diets, and fat rich diets. In general terms, carbohydrates rich diets may be recommended in type 1 diabetic patients who are in a stable condition, and fat rich diets in type 2 diabetes and in stress hyperglycemia. In both cases, the use of low glycemic index carbohydrates is recommended. Protein intake should be adjusted to the patients' metabolic stress level. In diabetic patients with acute disease, an increase in antioxidants intake is recommended.

Critical Care↗
PubMed2000

[Nutritional support in pancreatitis].

Pancreatitis is an illness that can bring about nutritional changes in connection with the underlying cause, the metabolic reaction to stress or the limitations that this pathology may represent for the processes of digesting and absorbing nutrients or for tolerating the diet. Although nutritional support is well accepted as a therapeutic measure in patients with severe acute pancreatitis, there is some dispute over the route of administration. In patients with mild pancreatitis, the use of parenteral nutrition may be accompanied by an increase in complications, particularly due to catheter-related sepsis, but in severe cases, early parenteral nutrition has been associated with a lower incidence of complications and a drop in mortality. Although parenteral nutrition is the preferred conventional method for the nutritional support of patients with pancreatitis, enteral nutrition offers the advantages of being more physiological, safer and less costly, at the same time as it seems to have a favourable influence on the progress of the pancreatitis. For this reason, the current recommendations suggest the use of enteral nutrition via the jejunum in those cases where the severity of the pancreatitis indicates nutritional support. Further research is, however, necessary in this field to clarify the group of patients in which the benefits of nutritional support would be most evident, the most appropriate type of diet, and the role of enteral nutrition on the evolution, both locally and systemically, of the changes brought about by the inflammation of the pancreas.

Acute Disease↗
PubMed1993

[An analysis of the reliability of 2 types of enteral nutrition pumps].

The main advantages of infusion pumps are their enhanced accuracy and safety in providing enteral nutrition. We proposed to observe pumps reliability in connection with a variety of factors such as the type of pump used, the administration rate and the energy density of the diets used. An experimental design was prepared with two types of enteral nutrition pumps-VP, volumetric pump, and PP, peristaltic pump. The clinical simulation was done by connecting the enteral nutrition equipment to a graduated dosing system, making hourly measurements of the volume infused. The Reliability Index (RI) used was the ratio between the volume infused by the pump and the regulated dose (Vi/Do). Five volumetric pumps (FLEXIFLO COMPANION) and five peristaltic pumps (FLEXIFLO II) were selected at random from a single commercial outlet. Each was used for twenty-three hours, without interruption, to infuse five types of diet with different energy densities (D1:2 Kcal/ml, D2: 1.5 Kcal/ml, D3: 1.25 Kcal/ml, D4: diet with fibre, and D5: reconstituted powder diet) at three different flow rates (40, 80 and 120 ml/h), to provide fifteen experimental conditions with each pump. Reliability was maintained for both types of pump within the margin of error claimed by the manufacturer (+/- 10%) except in the first hour of infusion (RI = 71.4%). Comparison of the overall RI between the two pump types revealed significant differences, with an RI below the reference range for the VP only during hour 23 (p < 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)

Enteral Nutrition↗
PubMed1993

[Infections in the postoperative period of a liver transplant. A comparison of 2 protocols for anti-infectious prophylaxis].

We discuss the incidence of infection in 198 liver transplants during the immediate post-surgical period. All of them were treated with protocols with anti-infective prophylaxis, and have been divided in two groups regarding the antibiotic scheme used, in the second of said groups we have included parenteral vancomycin. Global incidence of infection was different for both groups (46.9% in group A and 15.3% in group B) (p < 0.01). We stress that the most frequent germ found in the cultures of the group without vancomycin was Staphylococcus aureus, with a great difference between groups (p < 0.01); global incidence of pneumonias was also different between both groups (p < 0.05). After the introduction of vancomycin in the second group the most frequent found germ was Candida but with a low percentage. Gram-negative germs appear preferably in both groups when hospital stay was over 10 days. It is important to stress that transplanted patients who did not show rejection got significantly lesser infected (p < 0.05) than patients who shown rejection. We think that parenteral prophylaxis with ceftazidime and vancomycin, associated with oral-rhino-gastric decontamination, is useful for the control of early infections in patients with liver transplant.

Anti-Bacterial Agents↗
PubMedDate not supplied

[An evaluation of a protocol of postoperative nutritional support in patients who have had a liver transplant].

Despite the fact that the incidence of malnutrition in patients subjected to liver transplants is high, there are no definite criteria on the most appropriate postoperative nutritional support characteristics. The present study is a review of our experience with the administering of a diet base on: 1) proteic saving techniques up to enteral nutrition tolerance, and 2) total parenteral nutrition in the event of intolerance (foreseen or proven) to enteral nutrition. The type of nutritional support used and nutritional evaluation data, both during hospitalization in intensive care, were studied over a period of 557 days, in a series of 70 patients subjected to liver transplants. In 61.9% of the study days, parenteral nutritional support techniques had to be used. Enteral nutrition was possible during 18.9% of the study period in patients who had been discharged, compared to 1.8% in patients who needed further transplants or died (p less than 0.001). The elimination of nitrogen gradually increased up to day 9, and then fell. No positive nitrogenated balance was observed until day 13. Glucemia levels remained high during the whole evolutive phase. Seric albumin and transferrin levels were normal at first, and fell during week two. Seric prealbumin levels were within normal limits. Seric Mg and Cu were lower that the reference values during the first 15 days of evolution, where as Zn reached normal levels on day 15. Normal cholesterol values were only observed on day 8. Our results show the level of intolerance to enteral nutrition during the evolution of the patients and the need for using a more aggressive nutritional support.

Adult↗
PubMedDate not supplied

[The detection of the bronchial aspiration of enteral nutrition in the ICU].

Description of a comparative study in order to evaluate the sensitivity and reliability of two techniques described in literature used to detect the bronchoaspiration of enteral nutrition. Technique A consists of measuring the glucose in bronchial secretions by strips reactive to glucose-oxidase, and Technique B consists of staining the enteral diets with Methylene Blue, and then watching for the possible presence of colouring in the bronchial secretions. Our study is a contribution to the possible enhancing of the detection of bronchoaspiration, by combining both techniques. A series of 38 patients (Series A) was analyzed, who were subjected to Technique A and a further 32 patients (Series B) were subjected to both Techniques. A comparative study was made on both techniques, based on days of enteral nutrition, and it was observed that the incidence of bronchoaspiration for Series A during the first day of enteral nutrition was 25.7%, and on the following days 9.9%. In Series B, for the first day (Technique A) the percentage of 20% compared to 0% (Technique B), during the following days, 7.2% and 0.93% respectively. We related other variables, in view of their direct handling by the nursing department, such as the pressure used to inflate the pneumoplugging, amount of gastric drainage, administration of antiemetics, the correct position of the nasogastric tube and the presence of peristaltism. The statistical correlation for glucose in bronchial secretions with these variables was not significant.(ABSTRACT TRUNCATED AT 250 WORDS)

Bronchi↗
PubMedDate not supplied

[Enteral nutrition in the multiple trauma patient].

The hypermetabolism that develops in patients with severe polytraumatism has led to the need for an aggressive metabolic-nutritional support from the start. Parenteral Nutrition is the preferred technique in many instances, due to the doubts on the effectiveness of enteral nutrition in the control of the metabolic response and to problems of gastrointestinal tolerance derived from its administration. However, the role of enteral nutrition as an important factor which limits the development of bacterial translocation and the chain of events leading to multiorganic failure appears to be more and more well-established and is an important argument for justifying the early administration of enteral nutrition in these patients. In accordance with the accumulated experience of several authors over the past few years, enteral nutrition may be administered early in polytraumatized patients. This is not only accompanied by the evidence of acceptable gastrointestinal tolerance to the diet, but also by additional advantages compared to parenteral nutrition, such as the maintenance of trophism and immunocompetence of the digestive mucosa, the reduction of septic complications and also greater nutritional effectiveness which can be evaluated by the behaviour of the seric proteins used as nutritional evolution markers. The interest of the different diet formulae which exist at present, for example diets enriched with branched-chain amino acids, diets with added fibre, peptidic diets, specific pulmonary diets or "euglycaemic diets" is evaluated in this review. All these diets may mean an increase in the effectiveness and/or tolerance of enteral nutrition in polytraumatized patients, and also contribute to the handling of specific problems such as "stress" hyperglycaemia or the withdrawal of mechanical ventilation support. The use of specific nutrients for the digestive mucosa, such as glutamine or short chain fatty acids seems to be an important factor in the reduction of bacterial translocation. The new concept of immunonutrition is opening up new expectations with regard to the possibility of reducing septic complications, which often lead to problems in the evolution of patients, by means of nutritional manipulation. Current knowledge has permitted the early administration of enteral nutrition in polytraumatized patients, although on occasions the nutritional requirements will have to be administered by the complementary use of enteral and parenteral nutrition.

Diet↗
PubMedDate not supplied

[Nutrition in the liver transplant].

The evaluation of nutrition in patients who are candidates for liver transplants often indicates the presence of a state of malnutrition with regard to calories and proteins, which may lead to posterior complications. The transplant reverts the metabolic alterations in cases of good evolution, and there is evidence of a correct hepatic treatment of amino acids in the studies performed. Thus, this group of patients may be treated with a similar nutritional support to that indicated in other types of critical patients. On the other hand, in patients with an unfavourable evolution of the graft, the use of nutritional formulae that take into account an increase in the BCAA/AAA ratio is indicated. However, the high level of metabolic stress in the immediate postoperative period and the need for substrata to favour hepatic regeneration seem to indicate the need for early, aggressive nutritional treatment, which should be accompanied by a correct evaluation of its effect on postoperative evolution.

Humans↗
PubMedDate not supplied

[Percutaneous endoscopic gastrojejunostomy in the Guillain-Barré syndrome].

The nutritional support through an enteral route in patients diagnosed with Guillain-Barré syndrome, may be affected by the digestive alterations derived from the non-autonomic affliction. Even though the percutaneous endoscopic gastro-jejunostomy is still an infrequent technique in intensive-care units, its use in certain patients may ease the application of enteral nutrition. We present a case of Guillain-Barré syndrome, treated with enteral nutrition in an ICU during 100 days, 85 of which were by means of a gastro-jejunostomy tube, with good results.

Aged↗
PubMedDate not supplied

[Acute respiratory distress syndrome. Nutritional and metabolic support].

The application of artificial nutritional treatment in critical patients, nowadays is a completely accepted fact. To a large degree this is due to the advances made in the understanding of the metabolic response shown by patients against a severe and persistent aggression. One of the entities which presents the highest mortality in critical patients, is the Acute Respiratory Distress Syndrome (ARDS), which one understands as the pulmonary response to different types of aggression. To understand the metabolic implications in the face of the development of this syndrome, would permit a better understanding of the need to treat these patients and to establish the nutritional standards which are most adequate to each different metabolic alteration. It would not only be important to understand the most effective method for calculating the caloric needs of these patients, but we shall also have to deepen our understanding of possible harmful effects of the different substrates, which undoubtedly could condition morbidity. This is why in this review we focus on the intimate pulmonary mechanism, both in healthy conditions as in those of disease, in order to extrapolate conclusions which are potentially applicable to patients suffering from an acute pulmonary lesion, as those suffering from ARDS: A main role shall be played the assessment of the administration of macronutrients in the form carbohydrates, lipids, and amino acid particles, due to the implications which each of these may have on the lesioned lung and its ventilatory capacity.

Acute Disease↗