From “it’s gone” to “we’ll push it forward”: this is the (hectic) day-to-day in a critical unit, with the story of Dr. Juan Carlos López, intensive care worker at the Hospital Clínic in Barcelona
“We put a lot of love on it because it ceases to be an art. We do it by vocation. There is no other explanation.” Who speaks to El Periódico de España, from Prensa Ibérica, It’s Dr. Juan Carlos Lopezintensivist of Hospital Clinic of Barcelona. It explains about what you know well -The obese critical patient and his nutrition-but also recounts, with great enthusiasm, what is the hectic day to day in an Intensive Care Unit (ICU). One in three patients who go through these units are obese and the intensivists admit that they must do more emphasis on your nutrition artificial. Because, says Dr. López, recovering highly complex patientsto the limit, it is the greatest gift of his profession. A luck, expressed in a summarized way, from “it goes away” to “we push it forward”. The greatest joy, she confesses.
The intensivist, with a professional career closely linked to the Hospital de Bellvitge (also in Barcelona), where he trained, is member of the Metabolism and Nutrition Working Group of the Spanish Society of Intensive, Critical Medicine and Coronary Units (SEMICYUC), which this Wednesday concludes its LVIII National Congress in Malaga. ANDhe group is responsible for the ENPIC Studywhich is allowing intensivists to analyze nutritional practices in ICUs.
It is the first study -with RedCAP database, a platform on-line that allows to build data of research projects of the scientific society – that offers a real-time x-ray of this type of food in critics. the intensivists -Dr. López is responsible for ENPIC together with doctors Lluís Servià (Arnau de Vilanova Hospital, Lleida) and Teodoro Grau (12 de Octubre Hospital, Madrid)- focus on obesity as it is a growing health problem, not only by being overweight itself, indicate, but also due to the associated cardiovascular diseases: hypertension, diabetes…
more risk
“In itself, the patient with obesity is more at risk. It’s true. For example, in covid, it was a risk factor. But, in recent years, we have achieved, thanks to specialization, that they have the same mortality as the rest, “he points out. From there, how should a critically ill and obese patient be treated?.”Maybe we are a little more cautious. You have the feeling that, being obese, you can leave him longer than normal without nourishment. Because you think you can have reservations. Which is not true”, he points out when he talks about his specialization.
In Malaga, the group’s doctors have presented preliminary data on how this care should be in patients who have a reduction in their muscle mass, which is known as sarcopenia of obesitywhich, in turn, has effects, both in survival and in the complications that may occur during hospitalization. What they have seen is that, in the case of these people, the majority, although they are given a caloric intake that is correct, They do not receive an adequate protein intake.
Medical training in Spain “is of very high quality. We are not only talking about critically ill or obese patients, but complex, very old patients”
“Not out of negligence, but because we have to make a more specific approach than in the rest. It’s not that we’re doing it wrong. It’s that we have to do More emphasis on your nutrition. They are not a small population”, indicates the intensivist. An occasion to highlight that medical training in Spain “It is of very high quality. We are not only talking about critically ill or obese patients, but of complex patients, very aged. This management, this experience, serves to treat very complicated situations”, adds the doctor, who has had the opportunity to learn how work is done in other countries, like UK or Italy.
more research
Doctor López explains that, in his field, they should investigate more because the amount of muscle in patients with obesity plays a fundamental role in their survival when they are critical Medical nutrition therapy can help not only to the reduction of mortality, but also to complications and to improve nutritional status at discharge. It translates into a better recovery and also in a reduction in healthcare costs. This nutritional treatment must begin as soon as possible, they warn, once the patient is stablewithin the first 24 or 48 hours. The objective: to prevent him from developing malnutrition and worsening his prognosis.
In addition, good nutrition also impacts the functionality of the patient after passing through the ICU. Because, the doctor repeats, one in three people admitted to these units are obese. They are not isolated cases, he stresses. in units see “many cases” of young people –in the older ones there is above all overweight– with morbid obesity -when the body mass index (BMI) is over 40- and have sarcopenia.
That there where they cling to youth “to get them forward, because it’s really worth it. She is a person who is seriously ill and who can live for many years, “says the intensivist. Deep down, everything is going of what is the daily fight for patients. As complex as they are.
“It is worth trying to save their lives because, on many occasions, we succeed”
He recounts one of the last cases he remembers. A young boy with morbid obesity. He had respiratory failure due to covid-19 approximately a year ago, and they had to implant him with Extracorporeal Membrane Oxygenation or (ECMO, for its acronym in English). The doctors had some doubts -It is a very aggressive support therapy- but everything went well and evolved favorably. “It is worth trying to save their lives because, on many occasions, we succeed,” he says. Dr. Juan Carlos Lopez.
The return to the ICU
It is true, he admits, that one of the greatest joys that intensivists can experience is to see again, after discharge, to those people who one day were critical and to those who have saved their lives. “It has happened to me to see a person die and then come to see me, dressed for the street, elegant… and that is the most beautiful thing that can happen“, confesses the doctor.
Go back to the story of that obese young boy you recently treatedwho recovered from respiratory failure and an important picture of sepsis. There was multiorgan failure. “There were complications. From a nutritional point of view, we did very well. If you see it on the 3rd or 10th, it had nothing to do with it. But the nice thing was to see how we thought it was going away, and with the good work, we could pull it forward“, says the intensivist with undisguised pride.
In the ICU, he explains, the young man lost a lot of weight, thanks, he points out, to the work of the physiotherapists. “Nutrition and physiotherapy is a binomial that cannot be divided. you recover much faster“He points out. When he visited them, he was another person. “It was spectacular. I remember because we don’t have such young people in the ICU. It is true that obesity has an impact on recovery. But when he came to see us, he had lost a lot of weight“he finishes.