Variáveis associadas à sonda de alimentaçao em pacientes adultos em estado crítico internados em uma unidade de terapia intensiva de um hospital universitário

Abstract

Introduction:The administration of enteral diets for feeding tubes is common practice among hospitalized patients, since it provides a more effective supply of nutrients necessary to maintain or recover nutritional status. In the literature there is no sufficient definition of the criteria for indication gastric or post-pyloric position of the extremity of the feeding tube. However, to critically ill patients the post-pyloric position is usually indicated due to the high frequency of clinical conditions associated with increased gastric residual volume. Objective: The aim of this study was to analyze variables associated with feeding tube in critically ill patients admitted to the Adult Intensive Care Unit, Clinical Hospital, Universidade Federal de Uberlândia (ICU-CH-UFU). Also was analyzed the accuracy of the ultrasound examination in the diagnostic of the positioning of the extremity of the feeding tube. Material and methods:The procedure of passing and positioning of tubes was performed by the "blindfold" method by the nurses of ICU-CH-UFU, according to the protocol established by the Center for Research and Continuing Education in Nursing. Was analyzed the success rate in the obtaining of post-pyloric positioning of the tube, the period of permanence, the causal factors associated with unplanned removal and the number of x-rays performed. The ultrasound examination has been used as an alternative method for identifying the position of the tube tip, and its efficacy compared with that obtained with the x-ray examination. Results: The initiation of enteral feeding, after obtaining the first successful attempt at positioning post-pyloric tube, it was possible for 44% of patients. For five patients the nutritional support was implemented only after five attempts positioning. Patients with nasal insertion had higher minimum period (front mounting) and maximum period (fixing nasofrontal) of permanence of the tube. The removal of the tubes occurred mainly by agitation, vomiting and intentional withdrawal in critically ill patients with nasal insertion (p = 0.015). For critically ill patients who had post-pyloric positioning of the tube (n = 52) were performed 134 procedures passage (x =2,58) and 292 x-rays for identifying the positioning (x =5,62). The ultrasound examination showed high sensitivity and moderate specificity in identifying the positioning of the tube extremity. Conclusion:The results presented in this study indicate that monitoring variables associated with feeding tubes are required for reduction of periods of fasting and protein-energy malnutrition among critically ill patients. In addition, a higher number of studies must be performed to better clarify the real contribution of ultrasound examination for identifying the post-pyloric positioning of the feeding tube.