Monitoramento da Terapia Nutricional Enteral em Unidade de Terapia Intensiva: Adequação calóricoproteica e sobrevida
Monitoring of Enteral Nutrition Therapy in Intensive Care Unit: energy and protein adequacy and survival
Cíntia Valente Gonçalves, Lúcia Rota Borges, Silvana Paiva Orlandi, Renata Torres Abib Bertacco.
Resumo
Objetivos: Avaliar o estado nutricional, a adequação da terapia nutricional enteral, os fatores que interferem na sua administração e a sobrevida de pacientes críticos. Método: Estudo observacional prospectivo, com pacientes internados na Unidade de Terapia Intensiva de um Hospital Universitário. Foram incluídos pacientes com idade superior a 18 anos que receberam nutrição enteral por período superior a 72 horas.O estado nutricional foi avaliado pela Avaliação Subjetiva Global e a terapia nutricional enteral foi considerada adequada quando superior a 70% (valor prescrito/administrado quanto a calorias e proteínas). A sobrevida após seis meses da alta foi analisada pelo teste de Mann Whitney. Resultados: Foram avaliados 32 pacientes, com idade média de 56,4±17,4 anos, sendo 59,4% homens. Na admissão, 75% dos pacientes apresentavam algum grau de desnutrição. A adequação foi de 72,3% para valor calórico e 70,2% para proteínas. A principal causa de interrupção da nutrição enteral foi pausa para procedimentos e exames (81,3%). Pacientes bem nutridos no momento da internação apresentaram sobrevida significativamente maior que pacientes com algum grau de desnutrição após seis meses (p=0,03). Conclusão: A maior parte dos pacientes apresentou desnutrição na admissão e a meta calóricaproteica proposta foi alcançada pela maioria. A sobrevida em seis meses dos pacientes bem nutridos foi significativamente maior do que os demais.
Palavras-chave
Abstract
Objectives: To evaluate the nutritional status, the adequacy of enteral nutritional therapy, the factors that influence enteral nutrition management and the survival analysis of critically ill patients. Methods: A prospective, observational study conducted with patients admitted to the intensive care unit of a university hospital. Patients above 18 years under exclusive enteral nutrition therapy for at least 72 hours were included. Nutritional status was evaluated by the Subjective Global Assessment and enteral nutritional therapy was considered adequate up to 70% of the prescribed (energy and protein). Survival after six months of discharge was analyzed by Mann Whitney test. Results: 32 patients were included; the mean of age was 56.4±17.4 years and 59.4% were man.On admission, 75% of patients had some degree of malnutrition. The adequacy was 72.3% for calories and 70.2% for proteins. The main cause of interruption of enteral nutrition was breaks procedures and tests (81.3%). Well-nourished patients at admission had a significantly longer survival than patients with some degree of malnutrition after six months (p=0.03). Conclusion: Most of the patients presented malnutrition at admission and the proposed caloric-protein target was reached by the majority. The survival rate at six months of well-nourished patients was higher than others.
Keywords
Referências
1. Bector S, Vagianos K, Suh M, Duerksen DR. Does the Subjective Global Assessment predict outcome in critically ill medical patients? J Intensive Care Med. 2016;31(7):485-9.
2. Lim SL, Ong KC, Chan YH, Loke WC, Ferguson M, Daniels L. Malnutrition and its impact on cost of hospitalization, length of stay, readmission and 3-year mortality. Clin Nutr. 2012;31(3):345-50.
3. Nunes ALB, Koterba E, Alves VGF, Abrahão V, Correia MITD. Terapia nutricional no paciente grave. Projeto Diretrizes. São Paulo: Associação Médica Brasileira;2011. p.1-16.
4. Martins JR, Shiroma GM, Horie LM, Logullo L, Silva ML, Waitzberg DL. Factors leading to discrepancies between prescription and intake of enteral nutrition therapy in hospitalized patients. Nutrition. 2012;28(9):864-7.
5. 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.
6. Ribas BLP, Garcia RS, Abib RT. Motivos para interrupção da terapia nutricional enteral em pacientes hospitalizados. Rev Bras Nutr Clin. 2014;29(4):331-4.
7. Brinkman S, Jonge E, Abu-Hanna A, Arbous MS, Lange DW, Keizer NF. Mortality after hospital discharge in ICU patients. Crit Care Med. 2013;41(5):1229-36.
8. Ranzani OT, Zampieri FG, Besen BA, Azevedo LC, Park M. One-year survival and resource use after critical illness: impact of organ failure and residual organ dysfunction in a cohort study in Brazil. Crit Care. 2015;19:269.
9. Tripathy S, Mishra JC, Dash SC. Critically ill elderly patients in a developing world–mortality and functional outcome at 1 year: a prospective single-center study. J Crit Care. 2014;29(3):474. e7-13.
10. Detsky AS, McLaughlin JR, Baker JP, Johnston N, Whittaker S, Mendelson RA, et al. What is subjective global assessment of nutritional status? JJPEN J Parenter Enteral Nutr. 1987;11(1):8-13.
11. 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.
12. James R. Nutritional support in alcoholic liver disease: a review. J Hum Nutr Diet. 1989;2(5):315-23.
13. 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(3):183-9.
14. Waitzberg DL, Enck CR, Miyahira NS, Mourão JRP, Faim MMR, Oliseski M, et al. Terapia nutricional: indicadores de qualidade. Projeto Diretrizes. São Paulo: Associação Médica Brasileira; 2011.
15. Kim H, Choi-Kwon S. Changes in nutritional status in ICU patients receiving enteral tube feeding: a prospective descriptive study. Intensive Crit Care Nurs. 2011;27(4):194-201.
16. Cartolano FC, Caruso L, Soriano FG. Enteral nutritional therapy: application of quality indicators. Rev Bras Ter Intensiva. 2009;21(4):376-83.
17. Fernández-Ortega JF, Herrero Meseguer JI, Martínez García P; Metabolism and Nutrition Working Group of the Spanish Society of Intensive Care Medicine and Coronary units. Guidelines for specialized nutritional and metabolic support in the critically-ill patient: update. Consensus SEMICYUC-SENPE: indications, timing and routes of nutrient delivery. Nutr Hosp. 2011;26 Suppl 2:7-11.
18. Huang HH, Chang SJ, Hsu CW, Chang TM, Kang SP, Liu MY. Severity of illness influences the efficacy of enteral feeding route on clinical outcomes in patients with critical illness. J Acad Nutr Diet. 2012;112(8):1138-46.
19. Heyland DK, Stephens KE, Day AG, McClave SA. The success of enteral nutrition and ICU-acquired infections: a multicenter observational study. Clin Nutr. 2011;30(2):148-55.
20. Franzosi OS, Abrahão CLO, Loss SH. Aporte nutricional e desfechos em pacientes críticos no final da primeira semana na unidade de terapia intensiva. Rev Bras Ter Intensiva. 2012;23(3):263-9.
21. Couto CFL, Moreira JS, Hoher JA. Terapia nutricional enteral em politraumatizados sob ventilação mecânica e oferta energética. Rev Nutr. 2012;25(6):695-705.
22. De Waele E, Spapen H, Honoré PM, Mattens S, Rose T, Huyghens L. Bedside calculation of energy expenditure does not guarantee adequate caloric prescription in long-term mechanically ventilated critically ill patients: a quality control study. Scientific World Journal. 2012;2012:909564.
23. 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.
24. Gungabissoon U, Hacquoil K, Bains C, Irizarry M, Dukes G, Williamson R, et al. Prevalence, risk factors, clinical consequences, and treatment of enteral feed intolerance during critical illness. JPEN J Parenter Enteral Nutr. 2015;39(4):441-8.
25. Wei X, Day AG, Ouellette-Kuntz H, Heyland DK. The association between nutritional adequacy and long-term outcomes in critically ill patients requiring prolonged mechanical ventilation: a multicenter cohort study. Crit Care Med. 2015;43(8):1569-79.
Submetido em:
17/09/2017
Aceito em:
14/11/2023
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