Introduction
Paliperidone palmitate 1-month (PP1M) is a Long-acting injectable antipsychotic formulation, approved for the treatment of schizophrenia and schizoaffective disorder. Recently, paliperidone palmitate 3-months (PP3M) formulation was introduced, which maintains stability while offering a longer dosing interval for the maintenance treatment in patients previously treated with PP1M. Despite of this, many patients are treated with PP1M without transition to PP3M.
Objectives
To identify variables explaining maintenance of PP1M treatment instead of going to PP3M. We hypothesize that more severe patients are delayed in transition to PP3M because of expectation to complete stabilization.
Methods
A descriptive analysis of 123 patients, diagnosed with psychotic disorders, on treatment with paliperidone palmitate 1 month or 3 months, was performed. Age, sex, type of paliperidone treatment, hospitalizations after the initiaton of treatment, years since diagnosis, polytherapy and toxic habits were some of the variables measured and compared between both groups (PP1M and PP3M).
Results
Most of patients (63,41%) were on PP3M. Both groups shared characteristics like male sex predominance, schizophrenia as the most common diagnosis, having a recent onset diagnosis, same frequency of polypharmacy and same pattern of drug consumption. There was a slight difference between both groups regarding severity. PP1M and PP3M showed respectively 33% and 16,7% of admissions after initiation.
Conclusions
No clear pattern determines less transition to PP3M from PP1M. No statistical difference was found except form the difference found in admission after change of treatment (to PP1M or PP3M), which could reflect influence of severity in treatment. Future research is needed in order to better elucidate this association.
Disclosure
No significant relationships.
Background
Critically ill patients are characterised by hypercatabolism, representing a higher risk of malnourishment. In these patients, both nutrient deficits and overfeeding are harmful. Parenteral nutrition (PN) is an alternative approach when it is not possible to use other routes.
Purpose
To analyse the management of PN by prescribers in the intensive care unit (ICU) of our hospital, and their observance of the guidelines of scientific societies ESPEN and SENPE.
Materials and methods
A retrospective, observational study of ICU patients with PN support from June to August 2013. Data were collected from the Kabisoft 2012 PN software: age, diagnosis, duration of PN support, calories and protein supplied, types of lipid emulsion provided, addition of glutamine, and management of volume and hyperglycaemia.
Results
21 patients were studied, median age was 70 (49–83). Reason for ICU admission was postoperative (9), septic shock (6), hypovolemic shock (2), traumatism (2), acute pancreatitis (1) and acute renal failure (1). Median number of days with PN was 8 (1–46). Calories provided were fewer than 25 Kcal/Kg in 85.7% of patients and 25–30 Kcal/Kg in 14.3%. Regarding protein input, 76.2% patients received less than 1.3 g/Kg and 23.8% between 1.3–1.5 g/Kg. Forty patients (66.7%) received mixed MCT/LCT lipid emulsion, 5 (23.8%) fish-oil enriched emulsion, and 2 (9.5%) received both lipid emulsions. 38.1% PN bags were supplemented with glutamine (less than 0.2 mg/Kg). Prescribers tried to reduce the volume in 42.8% PN, and 28.6% added insulin to the PN.
Conclusions
Clinical practice patterns related to PN management in ICU did not follow ESPEN and SENPE guidelines in most of the cases. According to Jeejeebhoy K. N. 2012, an adequate protein delivery is required to obtain an optimal benefit, independently of whether energy goals are reached. In our study, a high percentage of patients were underfed, receiving an amount of both calories and protein lower than recommended.
No conflict of interest.
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