Target, Prescription and Infusion of Enteral Nutritional Therapy of Critical Patients in Intensive Care Unit

Abstract

BACKGROUND: Enteral nutritional therapy (ENT) is the best route for the nutrition of critically ill patients with improved impact on the clinical treatment of such patients. OBJECTIVE: To investigate the energy and protein supply of ENT in critically ill in-patients of an Intensive Care Unit (ICU). METHODS: Prospective longitudinal study conducted with 82 critically ill in-patients of an ICU, receiving ENT. Anthropometric variables, laboratory tests (albumin, CRP, CRP/albumin ratio), NUTRIC-score and Nutritional Risk Screening (NRS-2002), energy and protein goals, and the inadequacies and complications of ENT were assessed. Statistical analysis was performed using the Chi-square or Fischer tests and the Wilcoxon test. RESULTS: A total of 48.78% patients were at high nutritional risk based on NUTRIC score. In the CRP/albumin ratio, 85.37% patients presented with a high risk of complications. There was a statistically significant difference (P<0.0001) for all comparisons made between the target, prescription and ENT infusion, and 72% of the quantities prescribed for both calories and proteins was infused. It was observed that the difference between the prescription and the infusion was 14.63% (±10.81) for calories and 14.21% (±10.5) for proteins, with statistically significant difference (P<0.0001). In the relationship between prescription and infusion of calories and proteins, the only significant association was that of patients at high risk of CRP/albumin ratio, of which almost 94% received less than 80% of the energy and protein volume prescribed (P=0.0111). CONCLUSION: The administration of ENT in severely ill patients does not meet their actual energy and protein needs. The high occurrence of infusion inadequacies, compared to prescription and to the goals set can generate a negative nutritional balance.

Adequação calórico-proteica, nutrição enteral precoce e tempo de permanência de pacientes críticos em uma unidade de terapia intensiva / Caloric-protein fitness, early enteral nutrition and time of stay for critical patients in an intensive care unit

“…(CHELKEBA, et al, 2017;COVELLO, et al, 2020;DAVARI et al, 2019;GOSTYŃSKA, et al, 2019;MCCLAVE, et al, 2016;PADILLA, et al, 2019;PAZ;COUTO, 2016;SINGER, et al, 2018) A implementação deste suporte ocorreu em 69,6% dos pacientes, tal resultado foi inferior à achados na literatura. (AZEVEDO, et al, 2019;JOSÉ, et al 2018;NUNES, et al, 2018;WEI, et al, 2015) No atual trabalho, a oferta de dieta em período precoce nos pacientes internados foi associada a uma maior adequação calórico-proteica durante a primeira semana de internamento e a um menor tempo de permanência na UTI. O suporte nutricional precoce é uma terapia que tem sido bem estabelecida diante do cenário do paciente crítico, tornando-se uma ferramenta que ajuda a atenuar as alterações metabólicas, diminuir a incidência de complicações infecciosas, bem como reduzir o tempo de internação e a mortalidade dos pacientes.…”

“…Em outro estudo, ficou evidente a dificuldade em alcançar as metas nutricionais, pois 89,09% não atingiram o mínimo de 80% para meta energética e 98% não atingiram o mínimo de 80% para meta proteica. (JOSÉ, et al, 2018) Na literatura existem divergências em relação a valores tidos como adequados em relação à ingestão calórica e proteica a ser fornecida aos pacientes críticos. (AL-DORZI et al, 2016;DAVARI et al, 2019;TOLEDO;CASTRO, 2019) Entretanto, a ingestão calórico-proteica insuficiente pode agravar a condição clínica do paciente.…”

Formas E Modelos De Financiamento Dos Gastos Em Saúde Da Ala De Ginecologia E Obstetrícia Em Um Hospital No Município De Araguari, Minas Gerais

“…Na TN, a TNE é a primeira via de escolha para a alimentação artificial do paciente crítico pela sua proximidade com a via fisiológica, praticidade no manejo pela equipe assistencial, pelos baixos riscos associados ao seu uso, bem como pela oportunidade de manutenção do trofismo intestinal, e consequentemente, de um microbioma que auxilie na condição de equilíbrio orgânico sistêmico (ESPEN, 2019;JOSÉ, LEANDRO-MEHRI, AQUINO, 2018;BRASPEN, 2018;TOLEDO 2017;FONSECA, COSTA, 2010).…”

Nutritional therapy in hospital care of in-patients with Covid-19: evidence, consensus and practice guidelines

“…In the case of critically ill in-patients, considering that this is the evidence base that we have available for decision-making with regard to Covid-19 critical patients, in general, the clinical evolution with high mortality rates can occur, especially if we consider malnourished patients and those with increased infections, complications, hypermetabolism and longer hospital stay, who can often have low energy and protein intake when fed by nutritional therapy [36][37][38][39][40][41][42][43]. When they are undergoing nutritional therapy, it is observed that these critical patients are unable to reach the goals that were defined for energy and proteins, and there is an influence of the energy and protein deficit on the length of hospital stay and mortality [40,44,45]. A study showed that critically ill patients on mechanical ventilation, with energy and protein adequacy were associated with a tendency to an increased mortality in 60 days [46].…”