Study of tocopherol content and its potential antioxidant activity in commercial lipid emulsions for parenteral nutrition

The objective of this study was to determine the content and evaluate the potential antioxidant effect of tocopherols in commercially available lipid emulsions, using a simple validated method adequate for further routine use. During the study, variability between manufacturers as well as between three non-consecutive batches of the same emulsion was observed. Furthermore, addition of α-tocopherol to lipid emulsions as excipient yields more stable emulsions and potentially a beneficial clinical effect. It was concluded that the variation of the tocopherol content between batches implies the importance of control and specification of tocopherol content by the manufacturers.

Study of hyperglycemia in non critically-ill patients receiving parenteral nutrition: incidence and risk factors

BACKGROUND

The objectives of our study on non-critically ill patients receiving parenteral nutrition (PN) are to assess the incidence of hyperglycemia, the risk factors associated to its development and its influence in patient's evolution.

METHODS

A multicentric prospective observational study was performed in 9 hospitals. Four multivariate studies were developed to study the temporal risk in the occurrence of hyperglycemia (endpoint), intensive care unit (ICU) admission, length of stay (LOS) and death. Demographics, nutrients, drugs and clinical variables were collected. Independent variables studied as a possible risk factors were: sex, diabetes mellitus 2, baseline glycemia, albuminemia, pancreatitis, surgery in the 7 days prior to the end point, infection, insulin/somatostatin/corticoids administration during the study, glomerular filtration rate (GFR), and difference in the amount of glucose administration between the endpoint and one day before.

RESULTS

119 patients were enrolled in the study, 25 cases of hyperglycemia were detected. In the clinical factors associated with PN hyperglycemia, significant variables were: surgery in the 7 days before the end point, GFR, glucose load in the 24 hours previous to the end point insulin administration and somatostatine/octreotide administration during the study. Hyperglycemia was significantly associated with ICU admission and increased LOS.

CONCLUSIONS

Glucose administration in non-critically ill patients receiving PN should be reassessed downwards, especially in the immediate postsurgery, renal impairment and in patients treated with somatostatin analogues. It should be taken into account that an increase in glucose dose may lead to hyperglycemia in these patients and hyperglycemia correlates with longer hospital stay and increased frequency of ICU admissions.

[Nutritional support and risk factors of appearance of enterocutaneous fistulas]

INTRODUCTION

Among the different factors described, nutritional support has been associated to prevention and management of enterocutaneous fistulae (ECF).

OBJECTIVES

To assess the influence that the parameters related to nutritional, clinical status, and surgical variables have on the occurrence of ECF.

METHODS

An observational case/control retrospective study was performed on patients admitted to the General and Digestive Surgery Department. The parameters analyzed were: diagnosis, body mass index (BMI), pathologic personal history, number of surgical interventions (SI) and complications (previous infection, bleeding, and ischemia). In patients with SI, we analyzed: number and type of SI, time until onset of nutritional support, and type of nutritional support. We performed a multiple logistic uni- and multivariate regression analysis by using the SPSSv.19.0 software.

RESULTS

The primary diagnoses related to the occurrence of ECF were pancreatic pathology (OR = 5.346) and inflammatory bowel disease (IBD) (OR = 9.329). The surgical variables associated to higher prevalence of ECF emergency SI (OR = 5.79) and multiple SI (OR = 4.52). Regarding the nutritional variables, the late onset of nutrition (more than three days after SI) was associated to the occurrence of ECF (OR = 3.82).

CONCLUSIONS

In surgical patients, early nutritional support , independently of the route of administration, decreases the occurrence of fistulae. Pancreatic pathology, IBD, emergency SI, and multiple SI were associated to higher prevalence of ECF. The variable hyponutrition appears as a risk factor that should be confirmed in further studies.

Use of colistin in the treatment of multiple-drug-resistant gram-negative infections

PURPOSE

The use of colistin for the treatment of infections caused by multiple-drug-resistant (MDR) gram-negative microorganisms was studied.

METHODS

The efficacy of colistin for treating infections caused by MDR gram-negative microorganisms and the development of renal toxicity were studied in hospitalized adult patients in Spain. Patients treated between January 2001 and October 2001 were included.

RESULTS

Over the study period, 71 courses of inhaled colistin, 12 courses of i.v. or intramuscular (i.m.) colistin, and 2 courses of intrathecal colistin were administered to 80 patients. All were infected by MDR organisms: 69 (86%) by Acinetobacter baumannii and 11 (14%) by Pseudomonas aeruginosa. In 41 patients (51%), the episodes were caused by A. baumannii strains susceptible exclusively to colistin. The causative organisms were cleared in 92% of the patients from whom posttreatment repeat specimens were obtained. The in-hospital mortality rate was 18% (14 patients). There were no significant changes in mean serum urea or creatinine concentrations in patients receiving i.v. or i.m. therapy.

CONCLUSION

Colistin was used in 80 patients infected with A. baumannii or P. aeruginosa and appeared to be efficacious and safe.

Serum albumin as indicator of clinical evolution in patients on parenteral nutrition. Multivariate study

BACKGROUND AND AIMS

The aim of this study is to establish whether serum albumin concentration at the beginning of parenteral nutrition is related to morbidity and mortality.

METHODS

In this cohort study spanning four years, a number of patients were classified into twelve groups, depending on their clinical status at the beginning of parenteral nutrition. Their serum albumin concentration and other clinical parameters were then measured and twelve multiple logistic regression models were thus generated in order to model the relationship between initial albumin concentration and risk of morbidity/mortality.

RESULTS

1953 (84%) of the 2321 patients studied were hypoalbuminemic. In six models, this condition was associated with a significant increase in the risk of nosocomial infection. However, no model could be associated to significant risk of renal failure, and only patients with previous hepatopathy were at risk for hepatic failure. In seven models, there was a significant increase in mortality.

CONCLUSIONS

Serum albumin concentration at the beginning of parenteral nutrition is related to mortality and morbidity associated with nosocomial infection in some groups of the study.

Staphylococcus saprophyticus sepsis related to total parenteral nutrition admixtures contamination

The aim of this study was to report an outbreak of sepsis related to contamination of total parenteral nutrition (TPN) admixtures with Staphylococcus saprophyticus. A total of four patients developed fever after administration of contaminated TPN. Results of cultures of blood, catheter hubs and tips, and TPN admixtures are presented. The strain responsible for the outbreak was able to grow in vitro in two common TPN formulations.

[Changes in the biochemical parameters during parenteral nutrition. The experience in Hospital de Bellvitge]

The purpose of this study is to evaluate the modifications in biochemical parameters before and after the initiation of nutritional therapy, and to observe whether there is a relationship between the patient's development (exitus or improvement) and the presence of sepsis. The study was performed on 578 adults treated in our hospital from January 1988 to October 1989. The parameters analyzed were the following: glucose, triglycerides, total proteins, albumin, cholesterol, alkaline phosphatase, GOT, GPT, bilirubin, GGT, urea, urates, creatinine and electrolytes. The average initial values of each parameter were compared against those obtained after interrupting the PN by means of the Student t test. The results showed that within the parameters indicating the hepatic function, GGT and alkaline phosphatase were those that showed the most significant differences after ceasing the PN. Furthermore, the parameters indicating hepatic function and the electrolytes showed greater variations, regardless of the clinical evolution of the patient (improvement or exitus). The remainder of the parameters showed significant variations based on the clinical evolution.

Effect of balanced amino acid solution on protein metabolism after surgery. A clinical study

The aim of this study was to investigate the nitrogen-sparing effect of hypocaloric parenteral nutrition (HPN) with a balanced amino acid supply compared with that of a standard Rose's formula. Eighteen well-nourished patients with colorectal cancer were randomly distributed into 3 groups: I control, II Study group, III Rose's formula. The amount of non-protein calories was similar in both groups: 8 kcal/kg administered as glucose, and 1.33 g of amino acid/kg was also infused during 5 days. There were no differences in the plasma protein levels of total proteins, albumin, and transferrin, but retinol-binding protein was higher in group II compared with the control. Nitrogen balance was significantly better in group II than in group III during the 3rd and 4th days. There were differences in the concentration of aspartic acid and glycine in the plasmatic aminograms between groups II and III. It was concluded that the balanced amino acid solution does not significantly improve a patient's nutritional state. Nor have we observed that the balanced amino acid solution causes fewer modifications in the plasma aminograms. However, it does achieve a slight improvement in the nitrogen balances and the synthesis of retinol-binding protein.

[Bacteriologic control of total parenteral nutrition formulations at the Bellvitge Hospital]

Septic complications often lead to halting nutritional parenteral therapy. In general, the source of infection lies in the mixture, the connection and/or point of catheter insertion. The objective of this study is to show the need for bacteriological control throughout the parenteral nutrition process in order to assess the efficacy of the methods used, discover the source of infection and establish an in-house quality control. Different methods for bacteriological control of parenteral nutrition mixtures are studied and are compared with the method used at our hospital which is based on routine culture sampling after the mixture is prepared and before it is perfused, on repeating bacteriological control cultures and on performing bacteriological assessments of the catheter. In order to achieve this goal, 28.501 nutritional parenteral samples from 1,782 patients were studied. Only 185 (0.65%) samples were originally positive, and only 59 of them (0.21%) remained positive following a verification culture. Of the 6 culture-verified septic cases, 5 corresponded to Enterobacter cloacae and 1 to Klebsiella pneumoniae.

[The bacteriological control of TPN mixtures at the Hospital de Bellvitge]

The complications of sepsis often make it necessary to suspend nutritional therapy. The origin of these is the nutritive mixture as well as the catheter connection and/or point where it has been inserted. The aim of this study is to show the need for bacteriological control of the whole process, in order to evaluate the effectiveness of the methods used, dilucidate the origin of the sepsis and establish an internal quality control. Study of different methods for bacteriological control of the nutritive mixtures, comparing them with the methods used in our Hospital, which is based on systematic culture of the mixtures, the collecting of samples after preparation and prior to perfusing the mixture through the patient, the performing of a further culture control and a bacteriological examination of the catheter. For this purpose, 28,501 nutritive mixtures were studied, corresponding to 1,782 patients. Of these, 185 samples were initially positive (0.65%) and only 59 samples showed positive cultures (0.21%). Of the 6 cases of sepsis discovered and confirmed by haemoculture, 5 corresponded to Enterobacter cloacae and 1 to Klebsiella pneumoniae.