Comparação entre as necessidades energéticas prescritas e administradas a pacientes em terapia nutricional enteral

Abstract

Objective: evaluating the adequacy, prescription and energy supply of enteral nutrition therapy in hospitalized patients. Methods: was performed a retrospective survey of the evolution of TNE protocol of 59 patients hospitalized in a general hospital in Marília / SP / BR. Data collected included gender, age, clinical diagnosis, anthropometric and dietary data related to the prescribed dietary formula, route and method of administration of the enteral nutrition, the daily volume prescribed and administered, the daily amount of energy required and offered in the diet, as well as possible complications. Body mass index (BMI), triceps skinfold (TSF) and arm muscle circumference (AMC) were used to establish the nutritional status of the patients. The adequacy of ENT was done according to the daily energy requirement compared to the average energy received during the daily use of ENT. Results: The average found to the BMI was 21.4 kg/m 2 , and no differences were found comparing male and female. The data for TSF and AMC were different between genders (p<0.05) and suggest a more severe muscle mass in relation to adipose tissue.The averaged to the energy requirements was 1642 kcal/day but the average of energy prescribed was 1045 kcal/day and the amount offered was 1035 kcal/day. There was a significant difference between the necessity and the supplied energy offered through enteral nutrition (p=0.00) as well between the energy required and prescribed (p =0.00), both were shorter than the necessity. There was no significant difference (p>0.05) in energy supply, volume of enteral nutrition prescribed and administered among eutrophic, underweight or overweight patients. Conclusion: The results of this study indicate that the prescription and energy supply were not based on the needs of these patients, causing a significant energy deficit, which can lead to worsening of the nutritional status of the same. In hospitalized patients in use of ENT, the energy requirement must be made by a qualified professional within the multidisciplinary team, based on the needs of each patient.

Adverse events related to the use of enteral nutritional therapy

“…Evidence of ingestion of the diet at a volume that is less than that which is estimated, is similar to other studies (9,13) and it is lower than another (6) , which showed higher averages, since the patients received an average of 428 ml (±243ml/day) less, i.e., they did not receive 40% of the volume prescribed (6) .…”

“…The reasons for hospitalization of the patients on ENT corroborate a study in which the most frequent diagnoses were related to neurological, neoplastic and respiratory disorders (11) . Whereas other studies done on patients hospitalized in the ICU (12)(13) and hospital units (12) , showed that cardiovascular disorders were predominant.…”

“…In the literature (11)(12) a higher prevalence of nasoenteral feeding tubes was seen (95%), with post-pyloric positioning. In one study (13) the use of nasogastric feeding tubes was predominant (83%). There was no proven advantage to the post-pyloric instead of gastric positioning, but the choice of position of the feeding tube depends on whether or not the patient was at a risk for aspiration or intolerance, such as distension, refl ux or gastroparesis (14) .…”

“…In ICU patients, fasting was responsible for 41.6% of pauses of EN (6) . In addition to these reasons, other fi ndings included: constipation (8.8%) (16) , refl ux (15%), gastric residue (7.5%) and pulmonary aspiration (2.5%) (13) . In this study, 41 patients (89.13%) had the diet suspended for at least one day.…”

Terapia Nutricional Enteral Em Adultos: Necessidade Energética E Protéica Prescrita Versus Volume Administrado

“…Em um estudo realizado por Detregiachi et al (2011), com amostragem de 59 pacientes, ele encontrou entre os pacientes avaliados uma média de IMC de 21,4±6,4 kg/m2, não havendo diferença entre os sexos. A distribuição do diagnóstico nutricional, segundo este dado, foi de 54,2% dos pacientes com baixo peso, 32,2% eutróficos e 13,6% apresentavam excesso de peso.…”