Optimal timing for the initiation of enteral and parenteral nutrition in critical medical and surgical conditions

Aguilar-Nascimento, José Eduardo de; Bicudo-Salomão, Alberto; Portari-Filho, Pedro Eder

doi:10.1016/j.nut.2012.01.013

Cited by 21 publications

(30 citation statements)

References 38 publications

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“…Studies (22)(23)(24) have demonstrated damage, mainly for critically ill patients, when they are kept on fasting or nil per tube, which is explained by their clinical instability. A meta-analysis (23) , carried out to evaluate whether there are benefits to keeping post-operative patients fasting, included 837 patients who underwent GIT surgery.…”

Section: Discussionmentioning

confidence: 99%

Nasoenteral tube: factors associated with delay between indication and use in emergency services

et al. 2017

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Objective: to know the time between indication and use of a nasoenteral tube (NET) and factors associated with delays. Method: A prospective cohort study that followed adults in a Brazilian emergency department, since the indication of the use of a NET, evaluating clinical variables and the work process. The Generalized Estimated Equations model was adopted to identify factors associated with the delays in each stage of the process. Results: the time between indication and use of NET was 573 (IQR: 360-1,093) minutes, in 150 insertions of NET. Insertions in patients who previously did not use it; delays in the medical, nutrition, and nursing care routine; use of mechanical ventilation; noradrenaline; and fasting were factors for longer time before the use of the tube. Conclusion: the time between indication and use of NET was high, exceeding 10 hours in half of the cases. Factors related to the clinical condition of the patient and to the care management would contribute to delays. Descriptors: Nursing Care; Emergency Medical Services; Gastrointestinal Intubation; Treatment Time; Patient Safety. RESUMO Objetivo: conhecer o tempo entre indicação e uso da sonda nasoenteral (SNE) e fatores associados a atrasos. Método: coorte prospectiva que acompanhou adultos de uma Emergência brasileira, desde a indicação ao uso da SNE, avaliando-se variáveis clínicas e do processo de trabalho. Adotou-se o modelo de Equações de Estimações Generalizadas para identifi car fatores associados a atrasos em cada etapa do processo. Resultados: o tempo entre indicação e uso da SNE foi 573 (IQR: 360-1093) minutos, em 150 inserções de SNE. Inserções em pacientes que anteriormente não a utilizavam, retardos na rotina assistencial médica, da nutrição e enfermagem, uso de ventilação mecânica, noradrenalina e jejum foram fatores para maior tempo até o uso da sonda. Conclusão: o tempo entre indicação e uso de SNE foi elevado, excedendo 10 horas em metade dos casos. Fatores relacionados às condições clínicas do paciente e à gestão da assistência contribuiriam para atrasos. Descritores: Cuidados de Enfermagem; Serviços Médicos de Emergência; Intubação Gastrointestinal; Tempo para o Tratamento; Segurança do Paciente. RESUMENObjetivo: conocer el tiempo entre indicación y uso de sonda nasogástrica (SNG) y factores asociados a demoras. Método: cohorte prospectivo que observó adultos en Servicio de Urgencia brasileño, desde indicación hasta uso de la SNG, evaluándose variables clínicas del proceso de trabajo. Se adoptó modelo de Ecuaciones de Estimación Generalizada para identifi car factores asociados a demoras en cada etapa del proceso. Resultados: el tiempo entre indicación y uso de SNG fue 573 (IQR=360α1093) minutos, en 150 inserciones de SNG. Las inserciones en pacientes que no la utilizaban previamente, demoras en rutina de atención médica, Rev Bras Enferm [Internet]. 2017 mar-apr;70(2):326-34. 327Nasoenteral tube: factors associated with delay between indication and use in emergency services

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Section: Discussionmentioning

confidence: 99%

Nasoenteral tube: factors associated with delay between indication and use in emergency services

et al. 2017

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“…Survival curve for patients with either critical protein deficit or non-critical protein deficit (Log-rank test: p < 0.01) (censored at 30 days). Nevertheless, the results come from a single hospital, taken by a single researcher and an experienced and well-qualified nutrition therapy team who has worked together for many years took care for all the patients (18,(30)(31). The nutritional prescriptions closely followed international society recommendations.…”

Section: Discussionmentioning

confidence: 99%

Déficit crítico de energía y mortalidad en pacientes críticos

Siqueira-Paese¹,

Dock-Nascimento

Aguilar-Nascimento

2016

Nutr Hosp

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ResumenObjetivo: investigar la infl uencia del défi cit de calorías y proteínas en la mortalidad y la duración de la estancia hospitalaria de pacientes críticos. Métodos: se realizó un estudio prospectivo de cohorte incluyendo 100 pacientes consecutivos en una unidad de cuidados intensivos (UCI) terciaria que recibían nutrición enteral o parenteral. Se registraron diariamente los défi cits de calorías y proteínas durante un máximo de 30 días. Los défi -cit de energía y proteínas fueron divididos en: défi cit crítico de calorías (≥ 480 kcal/día), défi cit calórico no crítico (≤ 480 kcal/día), défi cit crítico de proteínas (≥ 20 g/día) y défi cit de proteínas no crítico (≤ 20 g/día). Los resultados se correlacionaron con la estancia hospitalaria y la mortalidad. Resultados: la tasa de mortalidad fue de 33%. En general, los pacientes recibieron 65,4% y 67,7% de las necesidades calóricas y proteicas. El défi cit calórico crítico se encontró en el 72% de los casos y el défi cit proteico crítico en el 70% de ellos. Hubo una correlación signifi cativa entre la duración de la estancia con el défi cit calórico (R = 0,37; p < 0,001) y el défi cit de proteínas (R = 0,28; p < 0,001). El análisis de sobrevida mostró que la mortalidad fue mayor en los pacientes con défi cit calórico crítico (p < 0,001) o con défi cit proteico crítico (p < 0,01). El análisis de regresión de Cox mostró que el défi cit crítico de proteínas se asoció con mayor mortalidad (HR 0.25, IC 95% 0,07-0,93; p = 0,03). Conclusiones: la incidencia de défi cit de calorías y de proteínas en la UCI es alta. Tanto los défi cit calóricos como proteicos aumentan la duración de la estancia hospitalaria, y el défi cit de proteínas superior a 20 g/día es un factor independiente de mortalidad en la ICU. AbstractObjective: We investigate the infl uence of caloric and protein defi cit on mortality and length of hospital stay of critically ill patients. Methods: A cohort prospective study including 100 consecutive patients in a tertiary intensive care unit (ICU) receiving enteral or parenteral nutrition. The daily caloric and protein defi cit were collected each day for a maximum of 30 days. Energy defi cits were divided into critical caloric defi cit (≥ 480 kcal/day) and non-critical caloric defi cit (≤ 480 kcal/day); and in critical protein defi cit (≥ 20 g/day) and non-critical protein defi cit (≤ 20 g/day). The fi ndings were correlated with hospital stay and mortality. Results: The mortality rate was 33%. Overall, the patients received 65.4% and 67.7% of the caloric and protein needs. Critical caloric defi cit was found in 72% of cases and critical protein defi cit in 70% of them. There was a signifi cant correlation between length of stay and accumulated caloric defi cit (R = 0.37; p < 0.001) and protein defi cit (R = 0.28; p < 0.001). The survival analysis showed that mortality was greater in patients with both critical caloric (p < 0.001) and critical protein defi cits (p < 0.01). The Cox regression analysis showed that critical protein defi cit was associated w...

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“…8 Nutritional therapy should begin as early as possible in the ICU, provided that the patient is hemodynamically stable. 9 Enteral nutrition has been preferred over total parenteral nutrition in the past decade for several reasons, including lower morbidity, lower costs, a shorter length 2. ANTIOXIDANTS AND AGING of hospital stay, and the preservation of both the mucosal barrier and immune competence.…”

Section: Enteral Nutrition In Elderly Patientsmentioning

confidence: 99%

Enteral Nutrition to Increase Antioxidant Defenses in Elderly Patients

Aguilar-Nascimento

2014

Aging

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Optimal timing for the initiation of enteral and parenteral nutrition in critical medical and surgical conditions

Cited by 21 publications

References 38 publications

Nasoenteral tube: factors associated with delay between indication and use in emergency services

Nasoenteral tube: factors associated with delay between indication and use in emergency services

Déficit crítico de energía y mortalidad en pacientes críticos

Enteral Nutrition to Increase Antioxidant Defenses in Elderly Patients

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