Qualidade da terapia nutricional enteral em unidades de terapia intensiva
Quality of enteral nutritional therapy in intensive care units
Renata de Sousa Gomes, Nayra Anielly Lima Cabral, Amanda Thaís Viana Oliveira
Resumo
Introdução: O monitoramento da qualidade da terapia nutricional é de extrema importância para a identificação de não conformidades em relação às metas nutricionais e à real oferta enérgico-proteica, e, consequentemente, proporcionar melhorias na assistência ao paciente grave. Objetivo: Avaliar a adequação da nutrição enteral (NE) por meio da aplicação de indicadores de qualidade da terapia nutricional em Unidades de Terapia Intensiva. Método: Foi avaliada a adequação de calorias e proteínas calculadas, prescritas e ofertadas. Também foram aplicados indicadores de qualidade da terapia nutricional enteral propostos pelo International Life Sciences Institute Brasil. Resultados: Foram avaliados 53 pacientes, com idade média de 59,3±17,64 anos; 56,6% eram do sexo masculino. A adequação entre o prescrito e o calculado foi 72,15% para caloria e 57,58% para proteína, entre prescrito e infundido foi de 71,67% tanto para caloria e proteína, e a razão entre o calculado e infundido foi de 53,36% e 40,7% de caloria e proteína, respectivamente. Foram observadas não conformidades em relação às metas pré-estabelecidas nos seguintes indicadores de qualidade: dias com oferta calórica administrada maior ou menor que 20% da oferta prescrita em pacientes em NE (25%), dias com aporte proteico insuficiente no total de dias (49,37%) e pacientes em jejum por mais de 24 horas (52,83%). Conclusão: Foram encontradas inadequações na prescrição e oferta da NE, principalmente proteica. Assim como, frequência elevada de jejuns inadequados e alta mortalidade no grupo estudado.
Palavras-chave
Abstract
Background: Monitoring the quality of nutrition therapy is extremely important to identify non-conformities in relation to nutritional goals and the real energetic-protein supply, and consequently provide improvements in care for critically ill patients. Objectives: To assess the adequacy of enteral nutrition through the application of nutritional therapy quality indicators in Intensive Care Units. Methods: It was evaluated the adequacy of calories and proteins calculated, prescribed and offered. Also enteral nutrition therapy quality indicators were applied. Results: Fifty-three patients were evaluated,with a mean age of 59.3±17.64 years; 56.6% were male. The suitability of prescribed and calculated was 72.15% to calories and 57.58% protein, between prescribed and infused was 71.67% for both calories and protein, and the ratio between the calculated and infused was 53.36% and 40.7% of calorie and protein, respectively. It was observed non-conformities in relation to pre-established goals in the following quality indicators: days with higher administered energy intake or less than 20% of the prescribed offering in patients enteral nutrition therapy (25%), days with insufficient protein intake in total days (49.37%) and patients fasted for more than 24 hours (52.83%). Conclusion: Inadequacies were found in the prescription and supply of enteral nutrition, especially protein. As well as high frequency of inadequate fasts and high mortality in this group.
Keywords
Referências
1. Hoffer LJ, Bistrian BR. Why critically ill patients are protein deprived. JPEN J Parenter Enteral Nutr.2013;37(3):300-9.
2. McClave SA, Taylor BE, Martindale RG, Warren MM, Johnson DR, Braunschweig C, et al.; Society of Critical Care Medicine; American Society for Parenteral and Enteral Nutrition.Guidelines for the Provision and Assessment of Nutrition Support Therapy in the Adult Critically Ill Patient: Society of Critical Care Medicine (SCCM) and American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.). JPEN J Parenter Enteral Nutr.2016;40(2):159-211.
3. Kim H, Stotts NA, Froelicher ES, Engler MM, Porter C. Enteral nutritional intake in adult Korean intensive care patients. Am J Crit Care.2013;22(2):126-35.
4. Costa NAA, Marinho AD, Cançado LR.Necessidades nutricionais do doente crítico. Rev Bras Ter Intensiva. 2012;24(3):270-7.
5. Doig GS, Heighes PT, Simpson F, Sweetman EA, Davies AR. Early enteral nutrition, provided within 24h of injury or intensive care unit admission, significantly reduces mortality in critically ill patients: a meta-analysis of randomised controlled trials. Intensive Care Med. 2009;35(12):2018-27.
6. Kreymann KG, Berger MM, Deutz NE, Hiesmayr M, Jolliet P, Kazandjiev G, et al.; ESPEN (European Society for Parenteral and Enteral Nutrition). ESPEN Guidelines on Enteral Nutrition: Intensive care.Clin Nutr.2006;25(2):210-23.
7. Chumlea WC, Guo SS, Steinbaugh ML. Prediction of stature from knee height for black and white adults and children with application to mobility-impaired or handicapped persons. J Am Diet Assoc. 1994;94(12):1385-8.
8. Chumlea WC, Roche AF, Mukherjee D. Nutritional assessment of the elderly through anthropometry. Columbus: Ross Laboratories; 1987.
9. Burr ML, Phillips KM. Anthropometric norms in the elderly. Br J Nutr.1984;51(2):165-9.
10. Waitzberg DL, Enck CR, Miyahira NS, Mourão JRP,Faim MMR, Oliseski M, et al. Indicadores de qualidade em terapia nutricional. São Paulo: ILSI Brasil; 2008.
11. Matsuba CST, Ciosak SI, Serpa LF, Poltronieri M, Oliseski MS. Terapia nutricional: administração e monitoramento. In: Projeto Diretrizes. Brasília: Associação Médica Brasileira; 2011.
12. Oliveira NS, Caruso l, Soriano FG. Terapia Nutricional Enteral em UTI: seguimento longitudinal. Nutrire.2010;35(3):133-48.
13. Kim H, Stotts NA, Froelicher ES, Engler MM, Porter C. Why patients in critical care do not receive adequate enteral nutrition? A review of the literature. J Crit Care. 2012;27(6):702-13.
14. Cahill NE, Dhaliwal R, Day AG, Jiang X, Heyland DK. Nutrition therapy in the critical care setting: what is “best achievable” practice? An international multicenter observational study. Crit Care Med. 2010;38(2):395-401.
15. Oliveira NS, Caruso L, Bergamaschi DP, Cartolano FC, Soriano FG. Impacto da adequação da oferta energética sobre a mortalidade em pacientes de UTI recebendo nutrição enteral. Rev Bras Ter Intensiva. 2011;23(2):183-9.
16. Arabi YM, Tamim HM, Dhar GS, Al-Dawood A, Al-Sultan M, Sakkijha MH, et al. Permissive under feeding and intensive insulin therapy in critically ill patients: a randomized controlled trial. Am J Clin Nutr. 2011;93(3):569-77.
17. Elke G, Wang M, Weiler N, Day AG, Heyland DK. Close to recommended caloric and protein intake by enteral nutrition is associated with better clinical outcome of critically ill septic patients: secondary analysis of a large international nutrition database. Crit Care. 2014;18(1):R29.
18. Weijs PJ, Stapel SN, de Groot SD, Driessen RH, de Jong E, Girbes AR, et al. Optimal protein and energy nutrition decreases mortality in mechanically ventilated, critically ill patients: a prospective observational cohort study. JPEN J Parenter Enteral Nutr. 2012;36(1):60-8.
19. Reintam Blaser A, Deane AM, Fruhwald S. Diarrhoea in the critically ill. Curr Opin Crit Care.2015;21(2):142-53.
Submetido em:
18/11/2016
Aceito em:
03/02/2017
Facebook
Google+
Twitter
LinkedIn
Mendeley
StumbleUpon
CiteULike
Reddit
Email