Quality indicators for enteral and parenteral nutrition therapy: application in critically ill patients "at nutritional risk"

Filho, Ronaldo Sousa Oliveira

doi:10.20960/nh.563

Cited by 9 publications

(13 citation statements)

References 21 publications

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“…Thus, the appropriate sepsis stage for introducing and combining enteral or parenteral nutrition in intensive care patients to achieve the best glycemic control is under continuous debate (Wernerman ; Hoffer & Bistrian ; Oliveira Filho et al . ).…”

mentioning

confidence: 97%

“…For instance, both critically ill humans and CLP mice exhibit intestinal impairments that result in reduced glucose absorption (Deane et al 2014). Thus, the appropriate sepsis stage for introducing and combining enteral or parenteral nutrition in intensive care patients to achieve the best glycemic control is under continuous debate (Wernerman 2012;Hoffer & Bistrian 2016;Oliveira Filho et al 2016).…”

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confidence: 99%

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Glucose homeostasis in two degrees of sepsis lethality induced by caecum ligation and puncture in mice

Ferreira

Santos

Bruxel

et al. 2017

Int J Experimental Path

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Sepsis is associated with high mortality. Both critically ill humans and animal models of sepsis exhibit changes in their glucose homeostasis, that is, hypoglycaemia, with the progression of infection. However, the relationship between basal glycaemia, glucose tolerance and insulin sensitivity is not well understood. Thus, we aimed to evaluate this glucose homeostasis triad at the late stage of sepsis (24 h after surgery) in male Swiss mice subjected to lethal and sublethal sepsis by the caecal ligation and puncture (CLP) model. The percentage of survival 24 h after CLP procedure in the Lethal and Sublethal groups was around 66% and 100% respectively. Both Lethal and Sublethal groups became hypoglycaemic in fasting and fed states 24 h after surgery. The pronounced fed hypoglycaemia in the Lethal group was not due to worsening anorexic behaviour or hepatic inability to deliver glucose in relation to the Sublethal group. Reduction in insulin sensitivity in CLP mice occurred in a lethality-dependent manner and was not associated with glucose intolerance. Analysis of oral and intraperitoneal glucose tolerance tests, as well as the gastrointestinal motility data, indicated that CLP mice had reduced intestinal glucose absorption. Altogether, we suggest cessation of appetite and intestinal glucose malabsorption are key contributors to the hypoglycaemic state observed during experimental severe sepsis.

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mentioning

confidence: 97%

mentioning

confidence: 99%

Glucose homeostasis in two degrees of sepsis lethality induced by caecum ligation and puncture in mice

Ferreira

Santos

Bruxel

et al. 2017

Int J Experimental Path

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“…Mais de 70% da TNE prescrita foi infundida nos 93 pacientes que recebiam nutrição enteral exclusiva e mais de 80% dos pacientes receberam nutrição enteral precoce. O percentual de inadequação dos indicadores "frequência de saída inadvertida de sonda de nutrição", "frequência de diarreia em pacientes sob TNE" e "frequência de jejum por mais de 24 horas" foi inferior a 10% 18 .…”

Section: Resultsunclassified

Indicadores de qualidade em terapia nutricional: uma revisão integrativa

Hammes

2019

Rev. Adm. Saúde

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Introdução: Indicadores de qualidade em terapia nutricional são ferramentas mensuráveis com habilidade reconhecida para avaliar e acompanhar a efetividade e da aderência aos protocolos e procedimentos assistências em nutrição. O objetivo deste estudo é conhecer os principais indicadores de qualidade de terapia nutricional utilizados na gestão e monitoramento da assistência nutricional por meio de revisão de literatura. Métodos: Foi realizado um levantamento bibliográfico de artigos científicos, no período de 2014 a 2018 publicados nas bases de dados bases MEDLINE e LILACS em conformidade aos descritores em Ciências da Saúde. Resultados: A busca inicial nas bases de dados resultou na seleção de 72 artigos, dos quais 61 foram excluídos por duplicidade ou por não preencherem os critérios de inclusão. Dos 11 artigos selecionados, 8 eram artigos originais e 3 eram revisões. Sete dos artigos incluídos, tiveram como objetivo classificar ou propor indicadores para gestão da qualidade na terapia nutricional. Em sua maioria, sinalizavam para a necessidade de ter uma equipe especializada no atendimento nutricional, realização de avaliação nutricional, indicação e acompanhamento nutricional sistemático e direcionado. Quanto ao resultado da aplicação de indicadores na prática clínica, 3 estudos mostraram a necessidade de adequação de indicadores para infusão de dieta na quantidade adequada, tempo de jejum e ocorrência de diarreia. Dois estudos incluídos avaliaram indicadores em outros cenários que não o ambiente hospitalar e apontavam para o uso de indicadores para triagem, avaliação e acompanhamento nutricional, bem como os respectivos registros em prontuário. Conclusão: Os principais indicadores de qualidade na terapia nutricional são relacionados a triagem e avaliação nutricional, indicação precoce e adequada de terapia nutricional, monitoramento da oferta nutricional frente prescrição e acompanhamento de intercorrências relacionada a terapia nutricional.Palavras-chave: Indicadores de Qualidade em Assistência à Saúde. Terapia Nutricional. Nutrição Enteral. Avaliação Nutricional. ABSTRACTIntroduction: Quality indicators in nutrition therapy are measurable tools with recognized ability to assessing and monitoring the effectiveness and adherence to nutrition assistance protocols and procedures. The aim of this study is to know the mainly quality indicators in nutrition therapy used in the management and monitoring of nutritional assistance through a literature review. Methods: A review of scientific articles was carried out from 2014 to 2018, published in the databases MEDLINE and LILACS according to the descriptors in Health Sciences. Results: The initial search in the databases resulted in the selection of 72 studies, of which 61 were excluded for duplicity or did not meet the inclusion criteria. Eight studies were original and 3 were reviews. Seven studies were included aimed to classify or propose quality indicators in the management in nutritional therapy. They indicated the need to have a team specialized in nutritional care and an adequate nutritional assessment and monitoring. Regarding the results of the application of indicators in clinical practice, 3 studies showed that is necessary to optimize the results of indicators for diet infusion in adequate quantity, fasting time and occurrence of diarrhea. Two studies evaluated indicators in other settings than the hospital settings and they pointed out to the use of quality indicators for the screening, evaluation and nutritional monitoring, as well as the registry in medical records. Conclusion: The main quality indicators in nutrition therapy are related to nutritional screening and evaluation, early and adequate indication of nutrition therapy, monitoring of nutritional supply in comparison to the prescription, and monitoring of intercurrences related to nutrition therapy.Keywords: Quality Indicators in Health Care. Nutritional Therapy. Enteral nutrition. Nutritional Evaluation

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“…Currently, the definition of which QINT are practical in clinical nutrition services is a challenge to nutritional therapy experts. There are no standardized rules to establish quality indicators, as these become clear as the consequences of the needs and experiences developed at each health institution [10].…”

Section: Discussionmentioning

confidence: 99%

“…Thus, MNTTs are extremely important in order to establish management and control criteria for EN and PN, as well as having specialists with different skills [10]. However, MNTTs and protocols alone do not guarantee the practice of QINT.…”

Section: Discussionmentioning

confidence: 99%

High Frequency of Non-Compliance with Quality Indicators of Enteral and Parenteral Nutritional Therapy in Hospitalized Patients

et al. 2020

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Quality indicators in nutritional therapy (QINT) are measures of the effectiveness and quality of nutrition support. The purpose of this study was to evaluate the frequency of the QINT adequacy of Enteral Nutritional Therapy (EN) and/or Parenteral (PN) in hospitalized patients and identify the best indicators according to health professionals. A prospective study was performed, including data from patients aged 18 years or over admitted to clinical or surgical wards. The patients who had received EN and/or PN were followed from the first day of nutritional prescription until discharge. Twelve indicators were calculated, as recommended by the literature. Regarding professional opinion, the QINT adequacy was evaluated by observing its utility, simplicity, objectivity, and cost. Of the 727 hospitalized patients, 101 were on EN and/or PN. Regarding the 12 QINT evaluated, only 25% (3) achieved the goals: involuntary withdrawal of enteral feeding tube (0.01%); feeding tube occlusion or withdrawal per occlusion (0%); the measurement of energy and protein requirements (92%). A high frequency of non-compliance (75% of QINT) was observed in clinical and surgical patients on EN and/or PN. With knowledge of the six best indicators chosen by health professionals in this service, it will be possible to elaborate protocols according to the real-life situation in the institution.

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Quality indicators for enteral and parenteral nutrition therapy: application in critically ill patients "at nutritional risk"

Cited by 9 publications

References 21 publications

Glucose homeostasis in two degrees of sepsis lethality induced by caecum ligation and puncture in mice

Glucose homeostasis in two degrees of sepsis lethality induced by caecum ligation and puncture in mice

Indicadores de qualidade em terapia nutricional: uma revisão integrativa

High Frequency of Non-Compliance with Quality Indicators of Enteral and Parenteral Nutritional Therapy in Hospitalized Patients

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