Nutritional response and clinical complications in patients with post-pyloric and gastric enteral tubes
Palavras-chave:
Clinical trial, Enteral nutrition, Feeding methods, Gastrointestinal intubation, Intensive care units. NutritionalResumo
Objective
The present study assessed the differences in nutritional markers (albumin, transferrin, total body fat, and body mass index) and clinical complications (diarrhea, vomiting, and diet interruptions) associated with enteral nutrition.
Methods
This is an open-label, randomized, two-arm parallel-group controlled clinical trial. Out of 105 patients assessed for eligibility, 35 adult patients were randomly divided into two groups and followed for 28 days. The sample comprised a heterogeneous group of severely ill individuals initially treated in the intensive care units. Neurological conditions (i.e.,strokes and brain tumours) were the most common reasons for hospitalization. Patients had one singularity: the clinicalneed for exclusive enteral nutrition therapy. One group received the diet via gastric tube and the other via a post-pyloric tube.
Results
The groups presented increases in the calories prescribed and administered, as well as reduced diet discontinuation. Although similar values were observed up to day 21, the post-pyloric group showed increased albumin levels compared to the gastric group on Day 28. Transferrin levels increased over time in both groups.
Conclusion
There were no differences in the complications recorded between groups, albeit serum albumin significantly increased in the post-pyloric group.
Referências
Waitzberg DL, Caiaffa WT, Correia MIT. Hospital malnutrition: the Brazilian national survey (IBRANUTRI): a study of 4000 patients. Nutrition. 2001;17(7-8):573-80. https://doi.org/10.1016/S0899-9007(01)00573-1
Sauer AC, Goates S, Malone A, Mogensen KM, Gerwits G, Sulz I, et al. Prevalence of malnutrition risk and the impact of nutrition risk on hospital outcomes: results from nutrition day in the U.S. J Parenter Enteral Nutr. 2019;43(7):918-26. https://doi.org/10.1002/jpen.1499
Correia MIT, Perman MI, Waitzberg DL. Hospital malnutrition in Latin America: a systematic review. Clin Nutr. 2017;36(4):958-67. https://doi.org/10.1016/j.clnu.2016.06.025
Zhao VM, Ziegler TR, Davis KA. Parenteral nutrition. In: Davis KA, Rosenbaum SH, editors. Surgical metabolism. Switzerland: Springer; 2020 [cited 2020 Aug. 26]; 251-60. Available from: https://www.springer.com/gp/book/9783030397807
Valladares AF, Kilgore KM, Partridge J, Sulo S, Kerr KW, McCauley S. How a malnutrition quality improvement initiative furthers malnutrition measurement and care: results from a hospital learning collaborative. J Parenter Enteral Nutr. 2020; 45(2):367-71. ttps://doi.org/10.1002/jpen.1833
Council of Europe Committee of Ministers. Resolution RESAP (2003)3 on food and nutritional care in hospitals. France; 2003. [cited 2020 Aug. 26]. Available from: https://rm.coe.int/16805de855
Kopp Lugli A, Watteville A, Hollinger A, Goetz N, Heidegger C. Medical Nutrition Therapy in Critically Ill Patients Treated on Intensive and Intermediate Care Units: a literature review. J Clin Med. 2019;8(9):1395. https://doi.org/10.3390/jcm8091395
White JV, Guenter P, Jensen G, Malone A, Schofield M, Academy Malnutrition Work Group, et al. Consensus Statement: Academy of Nutrition and Dietetics and American Society for Parenteral and Enteral Nutrition: Characteristics Recommended for the Identification and Documentation of Adult Malnutrition (Undernutrition). J Parenter Enteral Nutr. 2012;36(3):275-83. https://doi.org/10.1177/0148607112440285
Ministério da Saúde (Brasil). Secretaria de Atenção à Saúde, Departamento de Atenção Especializada e Temática. Manual de terapia nutricional na atenção especializada hospitalar no âmbito do Sistema Único de Saúde – SUS. Brasília: Ministério; 2016 [citado 2020 ago. 26]. Disponível em: https://bvsms.saude.gov.br/bvs/publicacoes/manual_terapia_nutricional_atencao_especializada.pdf
Reber E, Gomes F, Vasiloglou MF, Schuetz P, Stanga Z. Nutritional risk screening and assessment. J Clin Med. 2019;8(7):1065. https://doi.org/10.3390/jcm8071065
Gubari MIM, Hosseinzadeh-Attar MJ, Hosseini M, Mohialdeen FA, Othman H, Hama-ghareeb KA, et al. Nutritional status in intensive care unit: a meta-analysis and systematic review. Galen Med. 2020;9. https://doi.org/10.31661/gmj.v9i0.1678
van Zanten ARH, De Waele E, Wischmeyer PE. Nutrition therapy and critical illness: practical guidance for the ICU, post-ICU, and long-term convalescence phases. Crit Care. 2019;23(1):368. https://doi.org/10.1186/s13054-019-2657-5
Ministério da Saúde (Brasil). Agência Nacional de Vigilância Sanitária. Resolução da Diretoria Colegiada 63, de 6 de julho de 2000. Aprova o regulamento técnico para fixar os requisitos mínimos exigidos para a terapia de nutrição enteral. Brasília: Ministério; 2000 [citado 2020 ago. 26]. Disponível em: https://www20.anvisa.gov.br/segurancadopaciente/index.php/legislacao/item/resolucao-da-diretoria-colegiada-rcd-n-63-de-6-de-julho-de-2000
Alkhawaja S, Martin C, Butler RJ, Gwadry-Sridhar F. Post-pyloric versus gastric tube feeding for preventing pneumonia and improving nutritional outcomes in critically ill adults. Cochrane Database of Syst Rev. 2015;(8). https://doi.org/10.1002/14651858.CD008875.pub2
McClave SA, Taylor BE, Martindale R, et al. Guidelines for the provision and assessment of nutrition support therapy in the adult critically ill patient: Society of Critical Care Medicine (SCCM) and American Society for Parenteral and Enteral Nutrition (ASPEN). J Parenter Enteral Nutr. 2016;40(2):159-211. https://doi.org/10.1177/0148607115621863
Singer P, Blaser AR, Berger MM, Alhzzani W, Calder PC, Caeser MP, et al. ESPEN guideline on clinical nutrition in the intensive care unit. Clin Nutr. 2019;38(1):48-79. https://doi.org/10.1016/j.clnu.2018.08.037
Salciute-Simene E, Stasiunaitis R, Ambrasas E, Tutkus J, Milkeviius I, Sostakaite G, et al. Impact of enteral nutrition interruptions on underfeeding in intensive care unit. Clin Nutr. 2020;40(3):1310-7. https://doi.org/10.1016/j.clnu.2020.08.014
Lewis K, Alqahtani Z, McIntyre L, Almenawer S, Alshami F, Rhodes A, et al. The efficacy and safety of prokinetic agents in critically ill patients receiving enteral nutrition: a systematic review and meta-analysis of randomized trials. Crit Care. 2016;20(1):259. https://doi.org/10.1186/s13054-016-1441-z
José IB, Leandro VA, Aquino JLB. Target, prescription and infusion of enteral nutritional therapy of critical patients in intensive care unit. Arq Gastroenterol. 2018;55(3):283-9. https://doi.org/10.1590/s0004-2803.201800000-7220. Biodynamics. Quick start guide for the BIA 310e. Seattle: Biodynamics Corporation; 2017.
McLaren S, Arbuckle C. Providing optimal nursing care for patients undergoing enteral feeding. Nurs Stand. 2020;35(3):60-5. https://doi.org/10.7748/ns.2020.e11520
Cendron G, Silva LJ, Closs VE, Schwanke CHA, El Kik RM. Estado Nutricional e Capacidade Funcional em idosos hospitalizados. Rev Graduação. 2016;[citado 2020 ago. 26]9(1):1-6. Disponível em: https://revistaseletronicas.pucrs.br/ojs/index.php/graduacao/article/view/23955
Fugolar F, Hacke A, Polakowski CB, Kato M. Relação do índice de risco nutricional com complicações pós-operatórias de cirurgias do sistema digestório em um hospital oncológico. Nutr Clin Diet Hosp. 2016;36(4):34-40. https://doi.org/10.12873/364fugolar
Gohel TD, Kirby DF. Access and Complications of Enteral Nutrition Support for Critically Ill Patients. In: Nutrition Support for the Critically Ill. Springer; 2016[cited 2020 Aug. 26]:63-9. Available from: https://link.springer.com/chapter/10.1007/978-3-319-21831-1_5
Kampa JCC, Oliveira Reis L, Mezzomo TR, Quadros Camargo C. Pacientes sob terapia nutricional enteral e prevalência de interações fármaco-nutrientes no ambiente hospitalar. Res Soc Dev. 2020;9(3):e162932680-e162932680. https://doi.org/10.33448/rsd-v9i3.2680
Javid Z, Shadnoush M, Khadem-Rezaiyan M, Honarvar NMZ, Sedaghat A, Hashemian SM, et al. Nutritional adequacy in critically ill patients: Result of PNSI study. Clin Nutr. 2020;40(2):511-7. https://doi.org/10.1016/j.clnu.2020.05.04727. Reintam Blaser A, Deane AM, Preiser J, Arabi YM, Jakob SM. Enteral feeding intolerance: updates in definitions and pathophysiology. Nutr Clin Pract. 2020;36(1):40-9. https://doi.org/10.1002/ncp.10599
Gonçalves CV, Borges LR, Orlandi SP, Bertacco RTA. Monitoramento da terapia nutricional enteral em unidade de terapia intensiva: adequação calórico proteica e sobrevida. Braspen J. 2017[citado 2020 ago 26];32(4):341-6. Disponível em: http://arquivos.braspen.org/journal/jul-ago-set-2019/artigos/12-AdequacaocaEenergia.pdf
Lins NF, Dias CA, Oliveira M, Nascimento C, Barbosa JM. Adequação da terapia nutricional enteral em pacientes críticos de um centro de referência em Pernambuco. Rev Bras Nutr Clin. 2015[citado 2020 ago 26];30(1):76-81. Disponível em: http://www.braspen.com.br/home/wp-content/uploads/2016/11/14-Adequa%C3%A7%C3%A3oda-Terapia-Nutricional.pdf
Santos F, Viana K. Avaliação do estado nutricional e da terapêutica dietética de pacientes internados em uma unidade de terapia intensiva. Rev Pesq Saúde. 2016[citado 2020 ago 26];17(1):42-6. Disponível em: http://www.periodicoseletronicos.ufma.br/index.php/revistahuufma/article/view/5502
Looijaard W, Denneman N, Broens B, Girbes A, Weijs P, Oudemans-Van Straaten H. Achieving protein targets without energy overfeeding in critically ill patients: a prospective feasibility study. Clin Nutr. 2019;38(6):2623-31. https://doi.org/10.1016/j.clnu.2018.11.012
Singer P. Preserving the quality of life: nutrition in the ICU. Crit Care Med. 2019;23(1):139. https://doi.org/10.1186/s13054-019-2415-8
Bendavid I, Zusman O, Kagan I, Theilla M, Cohen J, Singer P. Early administration of protein in critically ill patients: a retrospective cohort study. Nutrients. 2019;11(1):106. https://doi.org/10.3390/nu11010106
Arabi YM, Al-Dorzi HM, Sadat M. Protein intake and outcome in critically ill patients. Curr Opin Clin Nutr Metab Care. 2020;23(1):51-8. https://doi.org/10.1097/MCO.0000000000000619
Kim S, McClave SA, Martindale RG, Miller KR, Hurt RT. Hypoalbuminemia and clinical outcomes: what is the mechanism behind the relationship? Am Surg. 2017;83(11):1220-7. https://doi.org/10.1177/000313481708301123
Rocha AJSC, Oliveira ATV, Cabral NAL, Gomes RS, Guimarães TA, Rodrigues WB, et al. Causas de interrupção de nutrição enteral em unidades de terapia intensiva. Rev Pesq Saúde. 2018[citado 2020 ago 26];18(1):49-53. Disponível em: http://www.periodicoseletronicos.ufma.br/index.php/revistahuufma/article/download/7880/4875
Weijs PJM, Mogensen KM, Rawn JD, Christopher KB. Protein intake, nutritional status and outcomes in ICU survivors: a single center cohort study. J Clin Med. 2019;8(1):43. https://doi.org/10.3390/jcm8010043
Peev MP, Yeh DD, Quraishi SA, Osler P, Chang Y, Gillis E, et al. Causes and consequences of interrupted enteral nutrition: a prospective observational study in critically ill surgical patients. J Parenter Enteral Nutr. 2015;39(1):21-7. https://doi.org/10.1177/0148607114526887
Pinheiro DS, do Santo FHE, Ribeiro WA, Fassarella BPA. Fatores de interrupção de nutrição enteral em unidades de terapia intensiva adulto: revisão integrativa. Res Soc Dev. 2020;9(9):e985998188. https://doi.org/10.33448/rsdv9i9.8188
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Copyright (c) 2022 Leandro Augusto Kuhl OPSFELDER, Guilherme Welter WENDT, Danilo Rodrigues Pereira da SILVA, Marina Daros MASSAROLLO, Lirane Elize Defante FERRETO, Ana Paula VIEIRA
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