Fatores de interferência na ministração das dietas enterais para pacientes em estado crítico: efeito da aplicação diária de organogramas específicos

Abstract

The prevalence of hospital malnutrition is reported to range between 20% and 50%. Due to increased metabolic demand, loss of body tissues and situations that impede or interfere the enteral feeding delivery, the prevalence of undernutrition among critically ill patients is even higher, ranging between 43%. The subjection of critically ill patients to hypocaloric diets or even fasting leads to metabolic changes and loss of body tissues, favoring undernutrition installation. Nutritional support enables the offer of energy and nutrients that are needed to impede undernutrition installation or even recover the nutritional status in already malnourished patients. The objectives of this study were to assess the nutritional therapy practices in the Adult Intensive Care Unit in the Clinical Hospital of the Federal University of Uberlândia, and afterwards, develop and implement an algorithm in an attempt to improve the nutritional therapy to the critically ill patients. This study was divided into two different phases. During the first phase the nutritional therapy routine was observed and registered. During the second phase, an algorithm was created and afterwards implemented in critically ill patients of the Adult Intensive Care Unit. Were enrolled in this study 32 critically ill patients, corresponding to 654 days, 542 enteral feeding days and 452 days of enteral feeding infusion. Four fasting periods were identified. After the algorithm implementation, the Initial Fasting Period decreased from 2.5 ± 2.4 in phase 1 to 1.0 ± 0.3 days in phase 2 (p=0.0465); the Tube Positioning Fasting Period remained the same, 2.0 ± 1.0 vs. 1.9 ± 0.9 days in phase 1 and 2, respectively (p=0.3126); the Diet Progress Fasting Period tended to decrease (7.2 ± 5.5 vs. 5.2 ± 1.3 days) (p=0.1398); and the Fasting Period Exclusively due to Interfering Factors was statistically the same, 13.1 ± 10.8 vs. 11.5 ± 5.7 days in phase 1 and 2, respectively (p=0.3486). During phase 1, patients remained in absolute fasting in 28.7% of the hospital days, and in phase 2 in 20.5% of the hospital days. If the effect of other study variables is controlled (sex, age, diagnosis, interfering factors, study phase, Acute Physiology and Chronic Health Evaluation II e hospital discharge), the proportion of infused volume / enteral feeding days (643 ml/day, p=0.006) and the proportion of infused kilocalories / enteral feeding days (612 kcal/day, p= 0.048) was higher in phase 2 than phase 1. During both phases it was also observed the incidence of interfering factors in tube feeding infusion. The main interfering factors were: tube feeding repositioning (phase 1 16.0%; phase 2 17.0%), vasoactive drugs prescription (phase 1 2.8%; phase 2 11.0%) and procedures (phase 1 7.0%; phase 2 6.2%). In this study, the algorithm implementation enabled early nutritional support, decreased patients exposure to fasting, improved the amount of energy and nutrients delivered to the patient and helped to control the enteral feeding interfering factors to critically ill patients.