BackgroundArtificial nutrition is an essential component in the management of critically ill patients. These patients are at risk of developing malnutrition, which occurs in up to 40% of patients and is associated with increased mortality and morbidity.PurposeTo evaluate the difference between the estimated energy requirements in those that were prescribed and those who actually received artificial nutrition, for patients admitted to an intensive care unit (ICU), and to identify the reasons for the discrepancies.Material and methodsThe study was conducted in a 12 bed ICU of a referral hospital, from May to July 2015. Patients with nutritional support (NS) and ICU stay >7 days were selected. Demographic and clinical data were collected, and energy requirements were calculated using the Harris-Benedict equation adjusted by the stress factor. For NS, the following data were collected during the first week of ICU admission: start date, type of nutrition, kilocalories prescribed and administered, and grams of protein prescribed and administered. Also taken into account were the calories provided by propofol if prescribed.Results27 patients were included, with a mean age of 62.8 ± 17.5 years.71.4% were men. 42.8% were prescribed enteral nutrition and 57.2% parenteral nutrition. The average delay in the start of the NS was 3.1 ± 1.3 days. The average estimated kilocalories per kilogram (kcal/kg) was 25.5, with 16.6 kcal/kg prescribed and 14.6 kcal/kg actually administered (60% of the theoretically estimated requirements), resulting in a calorie deficit accumulated over 7 days of – 4763 ± 2739 kcal. For proteins, the requirement was 1.4 g/kg, with 0.7 g/kg prescribed and 0.6 g/kg administered (40% of the theoretically estimated requirements), with an average protein accumulated deficit of – 297 ± 167 g. This was due to the following factors: tolerance of enteral feeding, delayed prescription (in 11% of patients nutritional support began on day 5), prescription below estimated requirements and pauses in administration due to intra/extra procedures in the ICU.ConclusionThe amount of calories that patients received was low, being more pronounced for administered proteins. With these results, measures directed to optimising nutritional support of our patients are needed.No conflict of interest.
Background Pain is a common symptom that leads terminally ill patients to an emergency department. Opioids have a critical place in the management of terminal pain. Purpose To investigate the characteristics of patients admitted for palliative care and treatments prescribed for making pain bearable and to develop query tables on the dosage and exchange of opioids. Materials and methods The data of all the patients admitted to the hospital for palliative care from January to May 2012 (32 patients) were examined in order to study their demographics, admission date, sex, age, length of hospitalisation, reason for admission, the main disease, comorbidities, treatment used for pain and frequency of rescue from pain. Finally, we undertook a bibliographic review of the use of opioids for pain. Results 68.7% of enrolled patients were men, with a mean age of 75.87 years overall. 75% of patients admitted had cancer, the other patients (25%) had chronic obstructive pulmonary disease. The most common comorbidities were hypertension (27%), type II diabetes (17%), heart disease (16%) and dyslipidaemia (13%). 47% of patients experienced pain during admission, which was controlled in 67% of cases with strong opioids, 27% with NSAIDs, and 6% with weak opioids. 33% of patients required rescue medicines, with an average of less than two rescues a day. Three tables were developed showing doses, exchange and opioid rescue and were distributed throughout the hospital. Conclusions Most of the patients admitted had cancer and their pain was controlled with morphine. On average they needed fewer than two daily rescues, which could indicate that the pain was controlled. The proposed dosing and opioid exchange tables, and with the Palliative Care Unit agreement, helping to better management and safety in the administration of these drugs in the hospital. No conflict of interest.
Background Inappropriate prescribing is highly prevalent in older people and has become a global healthcare concern. Purpose To detect inappropriate prescriptions for patients hospitalised in the Internal Medicine Ward according to STOPP/START criteria. To define the profile of patients who would benefit more from a pharmaceutical intervention. Materials and methods Observational and retrospective study of drugs prescribed to patients who were admitted and discharged from the Internal Medicine Ward of a second-level university hospital from October 2012 to February 2013. Patients were over the age of 65 and prescribed ≥5 drugs. The data were obtained from the patients’ medical records. STOPP and START criteria were applied to the drugs prescribed upon hospital admission and discharge. Results A group of 50 patients were studied at the time. The average age was: 80.4 (65–96). According to STOPP/START criteria 32 patients (64%) with inappropriate prescriptions were detected upon hospital admission and 18 (36%) upon hospital discharge. Regarding the age of the sample group, patients were classified into the following groups: 65–70 years old (8%), 71–80 years old (48%), 81–90 years old (30%), >90 (12%). According to STOPP criteria there were 45 non-recommended prescriptions upon hospital admission and 21 upon hospital discharge: NSAIDs with mild/severe hypertension (15% admission, 19% discharge) and duplicate drug class prescriptions (13% admission, 9% discharge). According to START criteria there were 59 cases upon hospital admission in which a non-prescribed drug had to be added and 30 on discharge, pointing out: ACE inhibitors in chronic heart failure (14% admission, 30% discharge) and ACE inhibitors or ARBsII in diabetes with nephropathy (12% admission, 13% discharge). Conclusions There was a high percentage of patients with inappropriate prescriptions. 48% of inappropriate prescriptions were corrected according to STOPP criteria and 53% according to START criteria during hospitalisation. As described by Sevilla-Sánchez et al (2012) the cardiovascular system group of medicines was the most frequently inappropriately prescribed. Patients between 81–90 years old would benefit more from a pharmaceutical intervention. As Lee et al (2013) prove, START/STOPP criteria can help doctors and pharmacists to prescribe properly in clinical practice. No conflict of interest.
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