Nutrición artificial en las unidades de cuidados intensivos pediátricos

Pérez-Navero, Juan Luís; Martínez-Romillo, Paloma Dorao; Cid, J. López-Herce; Rosa, I. Ibarra de la; Jover, Manuel; Tezanos, M.T. Hermana

doi:10.1157/13071305

Cited by 20 publications

(12 citation statements)

References 21 publications

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“…The frequency of gastrointestinal complications in critically ill adults fed with enteral nutrition can reach 62%, and withdrawal of the nutrition is required in 15% of the patients (Montejo et al, 2002;Ho et al, 2006). In our study, the incidence of gastrointestinal complications was lower similar to the figures reported in other studies in critically ill children (Sánchez Sánchez et al, 2003;Meert et al, 2004;Briassoulis et al, 2005;Pérez-Navero et al, 2005), and the TEN was definitively suspended owing to gastrointestinal complications in only 2.1% of the patients.…”

Section: Discussionsupporting

confidence: 84%

Risk factors for gastrointestinal complications in critically ill children with transpyloric enteral nutrition

et al. 2007

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Objective: To study the risk factors for gastrointestinal complications related to enteral nutrition in critically ill children. Design: A prospective, observational study. Setting: Pediatric intensive care unit Subjects: Five hundred and twenty-six critically ill children who received transpyloric enteral nutrition(TEN). Methods: Univariate and multivariate logistic regression analysis were used to identify risk factors for gastrointestinal complications Results: Sixty six patients (11.5%) presented gastrointestinal complications, 33 (6.2%) abdominal distension and/or excessive gastric residue, 34 (6.4%) diarrhea, one gastrointestinal bleeding, three necrotizing enterocolitis and one duodenal perforation. Enteral nutrition was definitively suspended because of gastrointestinal complications in 11 (2.1%) patients. Fifty patients (9.5%) died. Gastrointestinal complications were more frequent in the patients who died. Death was related to complications of the nutrition in only one patient. The frequency of gastrointestinal complications was significantly higher in children with shock, acute renal failure, hypokalemia, hypophosphatemia and in those receiving dopamine, epinephrine and vecuronium. The stepwise multivariate logistic regression analysis showed that the most important factors associated with gastrointestinal complications were shock, epinephrine at a rate higher than 0.3 mg/kg/min and hypophosphatemia. Conclusions: The tolerance of TEN in critically ill children is good, although the incidence of gastrointestinal complications is higher in patients with shock, acute renal failure, hypokalemia, hypophosphatemia, and those receiving epinephrine, dopamine, and vecuronium.

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Section: Discussionsupporting

confidence: 84%

Risk factors for gastrointestinal complications in critically ill children with transpyloric enteral nutrition

et al. 2007

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“…Although nutrition is receiving ever more attention as a part of the treatment of the critically ill child, there are few studies that have systematically analyzed its efficacy [30,31], and recommendations are almost wholly based on expert opinion [2,11,17]. At the present time there are many questions and little evidence regarding the energy delivery and type of nutrients that a critically ill child must receive, the time of starting nutrition, and the most appropriate route for administration and monitoring methods.…”

Section: Importance Of Nutrition In the Critically Ill Childmentioning

confidence: 99%

“…The majority of critically ill children receive gastric enteral nutrition as it is more physiological, simpler, and can be started more quickly [31,32]. In many PICUs, gastric nutrition is administered continuously due to the belief that this facilitates tolerance and reduces the volume of gastric residue and, thus, the risk of aspiration.…”

Section: Gastric or Duodeno-jejunal Nutrition?mentioning

confidence: 99%

Section: How Should Nutrition Be Monitored In the Critically Ill mentioning

confidence: 99%

“…The most common gastrointestinal complications are abdominal distension, excessive gastric residues, vomiting, diarrhoea, and constipation [31,38]. In one study, the incidence of complications of enteral nutrition was the following: vomiting, 17.9%; abdominal distension, 13.2%; excessive gastric residues, 4.7%; and diarrhoea, 11.3% [31]. In our experience, the incidence of gastrointestinal complications in 526 critically ill children receiving transpyloric enteral nutrition was 11.5%, though definitive withdrawal of the nutrition was required in only 2.1% of patients [38].…”

Section: How Should Nutrition Be Monitored In the Critically Ill mentioning

confidence: 99%

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Malnutrition in the Critically Ill Child: The Importance of Enteral Nutrition

Prieto

Cid

2011

IJERPH

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Malnutrition affects 50% of hospitalized children and 25–70% of the critically ill children. It increases the incidence of complications and mortality. Malnutrition is associated with an altered metabolism of certain substrates, increased metabolism and catabolism depending on the severity of the lesion, and reduced nutrient delivery. The objective should be to administer individualized nutrition to the critically ill child and to be able to adjust the nutrition continuously according to the metabolic changes and evolving nutritional status. It would appear reasonable to start enteral nutrition within the first 24 to 48 hours after admission, when oral feeding is not possible. Parenteral nutrition should only be used when enteral nutrition is contraindicated or is not tolerated. Energy delivery must be individually adjusted to energy expenditure (40–65 kcal/100 calories metabolized/day) with a protein delivery of 2.5–3 g/kg/day. Frequent monitoring of nutritional and metabolic parameters should be performed.

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