RESUMEN
Objective To identify the predictive factors for the need for transfusion during and after surgery to treat hip fractures in the elderly and to evaluate a protocol to guide the request for blood reserves for surgery. Methods The medical records of 172 elderly patients undergoing surgical treatment for proximal femoral fractures were collected. Data on sex, age, preoperative hemoglobin level, diagnosis, and type of surgery were tested for correlation with blood transfusion. In our sample, we determined the number of units of packed red blood cells reserved, the transfusion rate, and the cross-test:transfusion ratio. We made the same calculations in a hypothetical situation in which the request for blood reserves for our sample followed the criteria of a defined protocol. Results We found a correlation between the American Society of Anesthesiologists (ASA) classification and the occurrence of transfusions, and an inverse correlation between the hemoglobin level on admission and the number of bags transfused. A reserve of 328 units of packed red blood cells was requested for 167 surgeries. Had the proposed protocol been applied, 72 units would have been requested for 61 surgeries. Conclusion We found a correlation regarding the variables ASA classification and preoperative hemoglobin level and the occurrence of transfusion. Applying a proposed protocol to decide between requesting a reserve and only typing for elderly individuals undergoing surgical treatment for hip fracture proved suitable to reduce the number of packed red blood cell reserves.
RESUMEN
Given the special energy and nutrient needs and the malnourishment commonly seen in hospitalized patients, the energy density of a soft diet, low potassium diet, low sodium diet and bedtime fruit shakes and porridges offered to patients of a Nutrition and Dietetics Unit of Brasília, DF, was assessed. Data were collected by direct observation and technical cards regarding the preparation of foods and dishes were done to calculate the energy density (ED) of the preparations according to the "Food and energy-containing beverages method." The ED values were classified according to the CDC, 2005. Roughly 16.7% of the soft diets had an ED of 0.7 to 1.5kcal/g (low ED), 58.3% had an ED below 0.6kcal/g (very low ED) and 25% had an ED between 1.5 and 4.0kcal/g (average ED). The analysis of low-sodium and low-potassium diets showed that 20% had a low ED, 30% had a very low ED and 50% had an average ED. All fruit shakes and porridges had a low ED. The results show that the patients who receive the analyzed preparations are at risk of ingesting an amount of energy that is below their needs. The need for standardization, menu planning and attention to individual dietary requirements is evident within the studied nutrition and Dietetic Unit.
En función de las necesidades especiales de energía, nutrientes y de la mal nutrición que a menudo constatamos en pacientes internados, fue analizada la densidad energética de las preparaciones de la dieta pastosa, de las preparaciones de la dieta hipocalémica e hiposódica, de la leche batida con frutas y papillas servidas a los pacientes de una Unidad de Nutrición y Dietética de Brasilia (DF). Los datos se recolectaron por medio de observación directa y se elaboraron fichas técnicas de 12 preparaciones de dieta pastosa, nueve de la hipocalémica e hiposódica, cinco de leche con frutas y cuatro papillas en 3 días de la semana, para el cálculo de la densidad energética (DE) de acuerdo con el "Food and energy-containing beverages method". Las DE se clasificaron de acuerdo con el CDC de 2005. Se observó que un 16,7% de las preparaciones de la dieta pastosa presentaron DE entre 0,7 y 1,5kcal/g (DE baja), un 58,3% DE menor que 0,6kcal/g (DE muybaja) y un 25% DE entre 1,5 y 4,0 /g (DE media). El análisis de la dieta hiposódica y hipocalémica mostró que 20% presentaban DE baja, 30% DE muy baja y 50% DE media. Todas las leches con frutas y papillas presentaron DE baja. Los resultados indican que los pacientes que reciben las preparaciones analizadas corren el riesgo de ingerir una cantidad de energía inferior a sus necesidades energéticas, evidenciando la necesidad de una estandarización, planificación de menús y atención a los métodos dietéticos individualizados en la Unidad de Nutrición y Dietética estudiada.
Diante das necessidades especiais de energia, nutrientes e à má nutrição frequentemente observada em pacientes hospitalizados, foi analisada a densidade energética de preparações da dieta pastosa, das preparações da dieta hipocálica e hipossódica, e das vitaminas e mingaus servidos para todas as dietas aos pacientes de uma unidade de Nutrição e Dietética de Brasília - DF. Foram coletados dados por meio de observação direta e elaboradas fichas técnicas de 12 preparações da dieta pastosa, nove da hipocálica e hipossódica e cinco vitaminas e quatro mingaus em 3 dias da semana, para o cálculo da densidade energética (DE) de acordo com o "Food and energy-containing beverages method". As DE foram classificadas de acordo com o CDC, 2005. Observou-se que 16,7% das preparações da dieta pastosa apresentaram DE entre 0,7 e 1,5kcal/g (DE baixa), 58,3% DE menor que 0,6kcal/g (DE muito baixa) e 25% DE entre 1,5 e 4,0/g (DE média). A análise da dieta hipossódica e hipocálica mostrou que 20% apresentaram DE baixa, 30% DE muito baixa e 50% DE média. Todas as vitaminas e mingaus apresentaram DE baixa. Os resultados indicam que os pacientes que recebem as preparações analisadas correm o risco de ingerir uma quantidade de energia inferior às suas necessidades energéticas, ficando evidente a necessidade de padronização, planejamento de cardápios e atenção aos esquemas dietéticos individualizados dentro da Unidade de Nutrição e Dietética estudada.