Parecer BRASPEN/AMIB para o enfrentamento da COVID-19 em pacientes hospitalizados

Abstract

O combate à pandemia da COVID-19 se tornou o grande desafio atual, e a terapia nutricional é parte fundamental do cuidado integral na atenção ao paciente crítico. A maioria dos pacientes contaminados tem sido tratada em casa, em isolamento domiciliar. Entretanto, uma parte destes pacientes complica e necessita hospitalização, e cerca de 5% precisam de terapia intensiva. Neste subgrupo, as complicações mais frequentes são a disfunção respiratória, seguida da disfunção renal. Sendo assim, BRASPEN/AMIB divulgam, a seguir, sugestões para orientar as equipes multidisciplinares de terapia nutricional (EMTNs) no nosso País

<strong>Practical Guide of References and Nutritional Recommendations for Individuals Affected by Coronavirus Disease 2019</strong>

“…Nutritional risk screening  Ideally, Nutritional Risk Screening must be performed within the first 24 hours after admission [18,19].  Resources used to perform screening: telenutrition, telephone, secondary data from the multidisciplinary team records [11,18].  In addition to the aforementioned resources, criteria designed to determine nutritional risk based on the main risk factors can be used (consider at least 1 factor): elderly (> 65 years), adult with BMI <20.0 kg/m², patients at high risk or pressure injury, immunosuppressed, inappetent, persistent diarrhea, history of weight loss, chronic obstructive pulmonary disease (COPD), asthma, structural lung diseases, heart diseases (including major arterial hypertension), insulin-dependent diabetes, renal failure, pregnant [18].…”

“… In addition to the aforementioned resources, criteria designed to determine nutritional risk based on the main risk factors can be used (consider at least 1 factor): elderly (> 65 years), adult with BMI <20.0 kg/m², patients at high risk or pressure injury, immunosuppressed, inappetent, persistent diarrhea, history of weight loss, chronic obstructive pulmonary disease (COPD), asthma, structural lung diseases, heart diseases (including major arterial hypertension), insulin-dependent diabetes, renal failure, pregnant [18].  Patients who stay in the ICU for more than 48 hours must be considered at risk of malnutrition [11,20].…”

“…Oral feeding  Preferable oral feeding (OF) [11,19,21].  Oral feeding supplementation (OFS) is indicated when the estimated caloric intake is less than 60% of the nutritional needs [11].  It must be started, preferably, by OF associated with nutritional education work and OFS when necessary [22].…”

“…Nutritional support, is necessary and prophylactic for complications of nutritional status such as malnutrition, sarcopenia, muscle weakness, beyond increasing survival, reducing the incidence of deaths, readmissions and early reintubations [9,11]. It is already very well evidenced in the scientific literature that patients in intensive care, present nutritional risk as an independent factor, and the worsening of the nutritional status is predicted when they are elderly, immunosuppressed or have comorbidities.…”

“…It is already very well evidenced in the scientific literature that patients in intensive care, present nutritional risk as an independent factor, and the worsening of the nutritional status is predicted when they are elderly, immunosuppressed or have comorbidities. Moreover, anabolic resistance and dysglycemia are present in the flow phase of critical illness, which increases the negative clinical outcomes [9,[11][12][13].…”