ObjectiveTo evaluate the intra- and inter-reliability and the ease of measuring the
quadriceps muscle thickness using bedside ultrasound.MethodsThis is a prospective, observational study. The assessment of quadriceps
muscle thickness was performed at two reference points and was quantified
using portable B-mode ultrasound in two healthy volunteers. For
standardization of measurements and validation of image collections, the
team was trained through theoretical and practical classes, with a 6-hour
workload.ResultsA total of 112 images were examined by the coach and compared with the
trainees. Pearson's correlation analysis found an excellent relationship
between the coach and all trainees (R2 > 0.90). The best
association was between the coach and the dietitians (R2: 0.99; p
< 0.001), and the worst association was between the coach and the medical
trainees (R2: 0.92; p < 0.001). In the Bland-Altman
comparison, the highest error rate found between coach and trainees was
5.12% (95% confidence interval [CI] 3.64-12.37), and the lowest was 1.01%
(95%CI 0.72 - 2.58); the highest bias of the values described was -0.12
± 0.19, and the lowest was -0.01 ± 0.04.ConclusionThe data analyzed showed a good correlation between the measurements made by
the coach and trainees, indicating that ultrasound of the quadriceps muscle
is a viable and easily applicable tool.
Introduction: Extracorporeal membrane oxygenation (ECMO) provides partial or total cardiopulmonary support to patients with severe, acute and reversible cardiac or pulmonary failure. Despite the increasing use of the technique in adult patients, information on nutritional care is scarce. The objective was to investigate available data on the nutritional support of adult patients using ECMO in order to assist in the development of institutional protocols. Methods: A narrative review of the literature was led in order to showing the management of nutritional support, reasons for low nutritional adequacy, nutritional needs and the role of nutrition in ECMO complications. Results: Search strategies identified studies published up to October 11th, 2019. Only primary studies, indexed in the MEDLINE, Scopus and Web of Science data bases were evaluated, resulting in the inclusion of 11 studies. There is evidence that early enteral nutrition is safe and well tolerated and can be initiated via the gastric route. Gastrointestinal dysfunction with high gastric residual volumes is a common
finding. However, there is positive evidence of treatment with prokinetic drugs, with the option of using a nasojejunal tube and parenteral nutrition. It is possible to achieve nutritional adequacy (>80%), which is associated with lower mortality. However, malnutrition is recurrent, among the main reasons is the interruption of the diet for therapeutic/diagnostic procedures. Supplemental parenteral nutrition is an important strategy, but it requires special care with the associated administration of
glucose and fats. Data on nutritional needs are controversial, as well as the differences in nutritional support and intercurrences between types of ECMO (VA and VV). Conclusion: It is concluded that although most studies are observational retrospective, the evidence shows that nutrition is safe, well tolerated and is associated with lower mortality of patients on ECMO.
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