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.
Dedicatória À minha família, principalmente aos meus pais, Motonori Shima e Setsuko Shima, que sempre incentivaram os estudos, a formação pessoal e profissional. vi Agradecimentos Ao meu orientador, Prof. Dr. Oscar Fernando Pavão dos Santos, profissional de referência, pelo incentivo e sempre mostrar o caminho do conhecimento e busca contínua pelo aprimoramento. Agradeço a oportunidade de aprendizado, o acolhimento e confiança que depositou em mim desde o início. Ao meu coorientador, Dr. Milton Steinman, referência da telemedicina do Hospital Israelita Albert Einstein, pelo apoio técnico e orientação sobre o tema, auxiliando na busca do conhecimento. À minha coorientadora, Dra. Andrea Pereira, pelo incentivo e sempre estar disponível para auxiliar no estudo e aprimoramento do conhecimento. À minha coordenadora do Serviço de Nutrição Clínica, Silvia Maria Fraga Piovacari, pela oportunidade de realizar a pós-graduação, pela confiança e incentivo pelo estudo em todos os momentos. Agradeço o incentivo incondicional e auxilio em todos os momentos. Às nutricionistas do Serviço de Nutrição Clínica, que participaram da coleta dos dados, pelo incentivo e companhia em todos os momentos.
Background: Hospitals are constantly searching for opportunities to improve efficiency, and telehealth (TH) has recently emerged as a strategy to assist in patient flow. We evaluated two methods of dietary counseling offered to patients in the time period between the medical and final hospital discharge. Counseling was given either via the TH group or the face to face (FTF) group to the patients and their respective impact was evaluated on the patients' satisfaction and on the hospital patient flow. Methods: This study was a prospective, randomized clinical trial where patients were randomized to receive dietary counseling via TH (use of tablet) or FTF at the time of hospital discharge. We evaluate the duration of time between medical discharge and hospital discharge; between requesting dietary counseling and dietitian's arrival; and duration of dietary counseling. At the end of dietary counseling, both groups received a patient satisfaction questionnaire to answer. Results: A total of 159 patients were randomized to receive dietary counseling via TH (TH, n = 78) or FTF (FTF, n = 81). The two groups TH and FTF did not differ in terms of the median time between (1) medical and hospital discharge; (2) requesting counseling and the dietitian's arrival; and (3) duration of dietary counseling. Both groups mostly reported being “satisfied” or “above expectations,” and the FTF group scored “highest satisfaction” more often relative to the dietitian's work and interaction and on confidence in the dietitian's orientations. Finally, in the TH group, 90.7% graded likely-4 or very likely-5 when asked whether dietary counseling can be conducted entirely via TH, and 92% answered “4” or “5” when asked whether they would recommend dietary counseling via TH. Conclusions: Although the FTF group had a greater overall satisfaction relative to the TH group, TH proved to be a useful tool for dietary counseling. The trial has only Institutional Review Board approval (protocol 2685-16).
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