Enteral vs. parenteral nutrition for the critically ill patient: a combined support should be preferred

Heidegger, Claudia-Paula; Darmon, Patrice; Pichard, Claude

doi:10.1097/mcc.0b013e3283052cdd

Cited by 76 publications

(41 citation statements)

References 51 publications

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“…Isso porque podem ocorrer diversas condições as quais interferem na oferta nutricional planejada, causando sua suspensão temporária e/ou permanente e favorecendo o declínio do estado nutricional 8 . Dentre essas condições estão a disfunção gastrointestinal (vômito, diarreia, distensão abdominal, resíduo gástrico aumentado), o jejum para exames e procedimentos, a remoção de sonda e a instabilidade clínica do paciente [9][10][11] . Esses fatores contribuem para que sujeitos em terapia intensiva estejam em risco de receber menor volume e aporte energético-proteico do que o prescrito 12 .…”

Section: N T R O D U ç ã Ounclassified

Inadequação calórica e proteica e fatores associados em pacientes graves

et al. 2016

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ObjetivoInvestigar a adequação calórico-proteica de pacientes em terapia nutricional enteral exclusiva internados nas Unidades de Terapia Intensiva de um hospital universitário. MétodosEstudo longitudinal realizado entre abril e novembro de 2014 nas Unidades de Terapia Intensiva de um hospital universitário. Foram avaliados no período de 14 dias: percentual de adequação calórico-proteica, calculada pelas médias dos valores prescritos e administrados; condições clínicas (unidade e diagnóstico de internação, escore prognóstico Acute Physiology and Chronic Health Evaluation II, estado nutricional, tempo de internação); complicações gastrointestinais; e motivo de interrupção da dieta. Valores inferiores a 80% de adequação calórica e proteica foram considerados inadequados. Realizou-se análise multivariada por Regressão de Poisson com nível de significância de 5%. ResultadosO estudo contou com uma amostra de 38 pacientes, sendo 52,63% desnutridos. As médias de adequação calórica e proteica foram de 76,47% e 69,11%, respectivamente. A prevalência de inadequação calórica foi de 55,26% e de proteica, 68,42%. O jejum para procedimentos foi a causa mais frequente de interrupção da dieta. O volume residual gástrico e a diarreia foram as complicações gastrointestinais mais comuns. A inadequação calórica associou-se ao tempo de permanência ≤14 dias e ao volume residual elevado. A inadequação proteica associou-se ao tempo de permanência ≤14 dias, ao volume residual gástrico elevado e à saída ou obstrução da sonda.

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Inadequação calórica e proteica e fatores associados em pacientes graves

et al. 2016

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“…EN is, however, frequently char acterized by a low caloric intake predomi nantly in the early phase of underlying disease [12,25]. In order to improve en ergy delivery, an early supplemental use of PN is proposed [16]. The advantage of the one nutrition type is thereby regarded as the disadvantage of the other, as both have inherent risks of under or overfeed ing.…”

Section: Introductionmentioning

confidence: 99%

Enteral nutrition is associated with improved outcome in patients with severe sepsis

Elke¹,

Kuhnt

Ragaller

et al. 2013

Med Klin Intensivmed Notfmed

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“…12 However, if critically ill patients cannot tolerate sufficient enteral feedings, there is data to support a mixed nutritional plan involving both enteral and parenteral supplementation. 13 For postsurgical patients, some class C evidence exists to justify parenteral supplementation if 60% of estimated nutritional needs cannot be administered enterally after 3 days. 14 Patients with enteroatmospheric fistula, an entity that is often noted after trauma or abdominal catastrophe, have complex nutritional requirements exacerbated by persistent loss of fluid, electrolytes, and protein through both the fistula and the frequently associated open abdominal wound.…”

Section: Discussion Of Findings and Relevant Literature Nutritional Amentioning

confidence: 99%

Nutritional Aspects of Gastrointestinal Wound Healing

Mukherjee

Kavalukas

Barbul

2016

Advances in Wound Care

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Significance: Although the wound healing cascade is similar in many tissues, in the gastrointestinal tract mucosal healing is critical for processes such as inflammatory bowel disease and ulcers and healing of the mucosa, submucosa, and serosal layers is needed for surgical anastomoses and for enterocutaneous fistula. Failure of wound healing can result in complications including infection, prolonged hospitalization, critical illness, organ failure, readmission, new or worsening enterocutaneous fistula, and even death. Recent Advances: Recent advances are relevant for the role of specific micronutrients, such as vitamin D, trace elements, and the interplay between molecules with pro-and antioxidant properties. Our understanding of the role of other small molecules, genes, proteins, and macronutrients is also rapidly changing. Recent work has elucidated relationships between oxidative stress, nutritional supplementation, and glucose metabolism. Thresholds have also been established to define adequate preoperative nutritional status. Critical Issues: Further work is needed to establish standards and definitions for measuring the extent of wound healing, particularly for inflammatory bowel disease and ulcers. In addition, a mounting body of evidence has determined the need for adequate preoperative nutritional supplementation for elective surgical procedures. Future Directions: A large portion of current work is restricted to model systems in rodents. Therefore, additional clinical and translational research is needed in this area to promote gastrointestinal wound healing in humans, particularly those suffering from critical illness, patients with enterocutaneous fistula, inflammatory bowel disease, and ulcers, and those undergoing surgical procedures.

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Enteral vs. parenteral nutrition for the critically ill patient: a combined support should be preferred

Cited by 76 publications

References 51 publications

Inadequação calórica e proteica e fatores associados em pacientes graves

Inadequação calórica e proteica e fatores associados em pacientes graves

Enteral nutrition is associated with improved outcome in patients with severe sepsis

Nutritional Aspects of Gastrointestinal Wound Healing

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