Enteral Nutrition in the Mechanically Ventilated Patient

Allen, Karen; Hoffman, Leah

doi:10.1002/ncp.10242

Cited by 50 publications

(41 citation statements)

References 118 publications

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“…Além disso, pacientes graves com COVID-19, possivelmente, necessitarão de ventilação mecânica em posição prona, onde a infusão de terapia nutricional enteral pode ser desafiadora 19 . Existem poucos trabalhos avaliando esta situação, porém foi evidenciado que, mantendo-se a cabeceira elevada, o uso de procinético profilático (eritromicina) e a infusão da fórmula enteral até 85 mL/h, houve boa tolerância, baixo resíduo gástrico, sem aumento de complicações 20,21 . Conclui-se então que, pacientes em posição prona poderão receber terapia nutricional enteral, provavelmente em um volume (mL/h) não muito elevado, situação onde fórmulas com elevada densidade energética seriam vantajosas.…”

Section: Discussionunclassified

Necessidade de módulo proteico para pacientes em estado grave: estudo das fórmulas enterais em sistema fechado disponíveis no mercado

Silvah¹,

Nicoletti²,

Lima³

et al. 2020

Braspen J

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Introduction: The nutritional support of critically ill patients must be individualized and meet the daily energy and protein needs. Despite the fact that health entities publish their respective nutritional therapy recommendations for these patients, guidelines on the use of protein modules are still scarce and controversial. This study aimed to evaluate the protein / energy adequacy of the industrialized enteral formulas existing in the Brazilian market used in the nutritional therapy of adult patients, as well as the need to use protein modules. Methods: 46 enteral formulas found in the Brazilian market were evaluated, by means of mathematical simulations, in relation to the adequacy against protein recommendations, without extrapolating the energy supply (limit of 110% of the daily requirement). For the simulations, comprising the protein module, the energy supply of the module was included in the analysis. Results: The protein / calorie ratio varied between 3.1 and 9.2. For patients without obesity, only the Peptamen Intense - Nestlé formula [protein ratio (g)/100 kcal = 9.2] reaches at least 100% of the protein requirement (1.5 to 2g protein/kg/day), with a volume calculated to 20 to 25 kcal/kg. For patients with BMI between 30 and 36 kg/m2, there is no formula that achieves the recommendation in isolation. The Peptamen Intense - Nestlé formula meets the recommendations for patients with a BMI between 36 and 40 and a BMI> 44 kg/m2. The comparison of the Peptamen Intense - Nestlé formula with the rest of the formulas available on the market plus protein module shows that Fresubin 2 kcal HP - Fresenius needs the lowest volume of the set (enteral formula + protein module) to reach 1000 kcal and 92 g of protein (25.5% less than Peptamen Intense - Nestlé). Conclusion: Most of the enteral formulas available in the Brazilian market are not able to offer, in isolation, an adequate protein supply, without generating excess energy supply (overfeeding). The use of protein modules can bring benefits to the recovery of patients, including those infected by COVID-19.

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Section: Discussionunclassified

Necessidade de módulo proteico para pacientes em estado grave: estudo das fórmulas enterais em sistema fechado disponíveis no mercado

Silvah¹,

Nicoletti²,

Lima³

et al. 2020

Braspen J

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show abstract

“…Evaluar la presencia de riesgo nutricional a través de herramientas de tamizaje, como la universal de detección de desnutrición (MUST) o la escala de riesgo nutricional (NRS-2002), que han mostrado tener una sensibilidad y especificidad superior al resto de las herramientas disponibles en la literatura, o bien identificar la presencia de desnutrición a través de la Valoración Global Subjetiva (VGS) (25) . La nutrición enteral (NE) es la vía de provisión de nutrientes más adecuada, es segura incluso en pacientes que reciben VMI en posición prono (26,27) . Se sugiere su inicio en las primeras 24 -48 horas postintubación independiente del estado nutricional, al asociarse el inicio temprano a una menor mortalidad (28) , postergando su inicio en casos de inestabilidad hemodinámica que ameriten la prescripción de fármacos vasopresores (29,30) .…”

Section: Lineamientos De Soporte Nutricional En El Paciente Con Ventiunclassified

Terapia nutricional a pacientes con insuficiencia respiratoria aguda y ventilación mecánica no invasiva: revisión narrativa de la literatura

Osuna-Padilla¹,

Maldonado-Valadez²,

Rodríguez-Llamazares³

2020

Rev. Nutr. Clin. Metab.

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Background: In acute respiratory failure patients, noninvasive ventilation has a negative impact on nutritional status. Respiratory muscles deterioration secondary to nil per os prescription affects ventilator capacity. Aim: The aim of this review was to analyze the literature of nutritional therapy in patients with acute respiratory failure and noninvasive ventilation. Additionally, we proposed and algorithm of nutritional intervention. Method: The search was conducted using PubMed and Hinari. Key terms included (non invasive ventilation OR noninvasive ventilation) AND (nutrition OR nutritional OR intake). Inclusion criteria for this review include primary articles; human adult's studies only and individuals with acute lung injury or acute respiratory failure. Four studies met the inclusion criteria. And additionally review of ASPEN and ESPEN safes practices and guidelines was conducted to propose an algorithm for nutritional intervention. Result: Currently, there are no consensus documents for the nutritional therapy of this population, however, considering the associations between the deficit of energy and protein and the clinical outcomes reported in the hospitalized patients, is essential the implementation of protocols and promoting optimal nutritional therapy for each patient in order to malnutrition treatment or prevention.

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“…Se sugiere iniciar NE en las primeras 48 horas de estancia en la UCI, 6 debido a sus beneficios en la mucosa gástrica, síntesis de hormonas y enzimas y regulación de la respuesta inmunológica. 12 Si existiese contraindicación para NE, deberá instaurarse NP entre los tres y siete días. Se deberá considerar la utilización de NP temprana y progresiva en los sujetos severamente desnutridos, con contraindicación o intolerancia a NE.…”

Section: Carta Al Editorunclassified

Optimización de la terapia nutricional en el paciente crítico con COVID-19

Yanowsky-Escatell¹,

Osuna-Padilla²

2020

GMM

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Enteral Nutrition in the Mechanically Ventilated Patient

Cited by 50 publications

References 118 publications

Necessidade de módulo proteico para pacientes em estado grave: estudo das fórmulas enterais em sistema fechado disponíveis no mercado

Necessidade de módulo proteico para pacientes em estado grave: estudo das fórmulas enterais em sistema fechado disponíveis no mercado

Terapia nutricional a pacientes con insuficiencia respiratoria aguda y ventilación mecánica no invasiva: revisión narrativa de la literatura

Optimización de la terapia nutricional en el paciente crítico con COVID-19

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