Introduction: Failure to accurately estimate energy requirements may result in an impaired recovery. Overfeeding has been associated with increased carbon dioxide production, respiratory failure, hyperglycemia and fat deposits in the liver, while underfeeding can lead to malnutrition, muscle weakness and impaired immunity. Objective: This study aimed to determine the metabolic profile of infant and preschool children submitted to mechanical ventilation in the ICU. Methods: A prospective study was carried out in a pediatric ICU in Rio de Janeiro that included children aged from 1 month to 6 years submitted to mechanical ventilation from June 2013 to May 2015. Indirect calorimetry was used to obtain resting energy expenditure (REE) and oxygen consumption (VO 2) in the first 48 hours of admission. The predicted basal metabolic rate (PBMR) was calculated using the Schofield equation. The metabolic state of each patient was assigned as hypermetabolic (REE/PBMR >110%), hypometabolic (REE/PBMR <90%) or normal (REE/PBMR 90-110%). The ratio of caloric intake to REE was also calculated and ratios of >1.5 and <0.5 were classified as overfeeding and underfeeding respectively. Results: A total of 35 infants and 17 preschool children were included. The male/female ratio was 34/18. In respect of severity of sepsis, 19 patients had septic shock, 24 had sepsis, five had severe sepsis and four had systemic inflammatory response syndrome. We observed a high incidence of hypometabolism (88.5%) and a low incidence of normal metabolism (7.7%) and hypermetabolism (3.8%). A low value of VO 2 was observed in 46.1% of the patients (VO 2 ≤120 ml/minute/m 2), a normal value in 40.4% (VO 2 >120 to ≤160 ml/minute/m 2) and a high value in only 13.5% of the patients (VO 2 > 160 ml/minute/m 2). Among the 52 included patients, 18 were fasting at the moment of the examination. The ratio of caloric intake to REE for the remaining 34 patients showed 38.2% overfeeding, 11.8% underfeeding and 50.0% normal feeding. Conclusion: Predictive equations do not accurately predict REE in critically ill infants and preschool children, resulting in inadequate feeding. Although hypermetabolism and enhanced energy expenditure are the main clinical features of critical illness in adults, the majority of our patients were found to be hypometabolic which reinforces the need for a different approach between adult and pediatric critically ill patients.
BackgroundIn recent years, resistance of K pneumoniae E coli, and strains of methicillin resistant Staphylococcus aureus (MRSA) to carbapenems and fluoroquinolones has been increasing. To avoid antibiotic resistance, it is necessary to reserve carbapenems and fluoroquinolones for those situations where there is no therapeutic alternative, as they are a weapon that can play a decisive role in the fight against healthcare associated infections.PurposeTo analyse antibiotic prescriptions in hospital wardsto reduce consumption and duration of antibiotic therapy in hospitals; andto develop strategies to minimise errors found in the prescription of antibioticsMaterial and methodsSelection of cases through prescription analysis:– all antibiotic prescriptions.Data collection and recording in the database:– antibiotic prescriptions;– clinical Information;– laboratory analyses (C reactive protein, procalcitonin, antimicrobial susceptibility test);– pharmaceutical report;– if the pharmaceutical report is unfavourable, the prescribing physician will be contacted;– infectious disease specialist report.Data analysis to develop strategies that promote the rational use of antibiotics.Results331 antibiotic prescriptions were analysed: 48% were accepted, 28% were accepted when the laboratory results were available, 14% were suspended and 10% had to be changed to another antibiotic.Of the total antibiotic prescriptions, 11% were quinolones and 6% were carbapenems. About 18% of antibiotic prescriptions had a longer duration than the therapeutic indication. Of all antibiotic prescriptions, 59% had negative blood cultures.ConclusionThe role of the hospital pharmacist is essential in the coordination of various players: infectious disease services, pharmaceutical services and pathology laboratory.The need to implement stop orders as a tool in antibiotic prescriptions was identified, as was the need to monitor prescriptions with negative blood culture results.More than 50% of all antibiotic prescriptions reviewed were questionable, which reveals the need for monitoring of antibiotic prescriptions by a multidisciplinary team.References and/or AcknowledgementsAntimicrobial resistance: global report on surveillance 2014. Geneva: World Health Organisation; 2014 () or monitoring of antibiotic prescriptions by a multidisciplinary team.No conflict of interest.
Introduction: Failure to accurately estimate energy requirements may result in an impaired recovery. Overfeeding has been associated with increased carbon dioxide production, respiratory failure, hyperglycemia and fat deposits in the liver, while underfeeding can lead to malnutrition, muscle weakness and impaired immunity. Objective: This study aimed to determine the metabolic profile of infant and preschool children submitted to mechanical ventilation in the ICU. Methods: A prospective study was carried out in a pediatric ICU in Rio de Janeiro that included children aged from 1 month to 6 years submitted to mechanical ventilation from June 2013 to May 2015. Indirect calorimetry was used to obtain resting energy expenditure (REE) and oxygen consumption (VO 2) in the first 48 hours of admission. The predicted basal metabolic rate (PBMR) was calculated using the Schofield equation. The metabolic state of each patient was assigned as hypermetabolic (REE/PBMR >110%), hypometabolic (REE/PBMR <90%) or normal (REE/PBMR 90-110%). The ratio of caloric intake to REE was also calculated and ratios of >1.5 and <0.5 were classified as overfeeding and underfeeding respectively. Results: A total of 35 infants and 17 preschool children were included. The male/female ratio was 34/18. In respect of severity of sepsis, 19 patients had septic shock, 24 had sepsis, five had severe sepsis and four had systemic inflammatory response syndrome. We observed a high incidence of hypometabolism (88.5%) and a low incidence of normal metabolism (7.7%) and hypermetabolism (3.8%). A low value of VO 2 was observed in 46.1% of the patients (VO 2 ≤120 ml/minute/m 2), a normal value in 40.4% (VO 2 >120 to ≤160 ml/minute/m 2) and a high value in only 13.5% of the patients (VO 2 > 160 ml/minute/m 2). Among the 52 included patients, 18 were fasting at the moment of the examination. The ratio of caloric intake to REE for the remaining 34 patients showed 38.2% overfeeding, 11.8% underfeeding and 50.0% normal feeding. Conclusion: Predictive equations do not accurately predict REE in critically ill infants and preschool children, resulting in inadequate feeding. Although hypermetabolism and enhanced energy expenditure are the main clinical features of critical illness in adults, the majority of our patients were found to be hypometabolic which reinforces the need for a different approach between adult and pediatric critically ill patients.
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