Atuação da equipe multidisciplinar na terapia nutricional de pacientes sob cuidados intensivos

Clinical conditions and complications associated with parenteral nutrition use in critically ill patients admitted to an intensive care unit of a general hospital

Introduction

Objective: the aim of this study was to evaluate the clinical conditions, the existing complications, and the drug prescription profile of patients who received parenteral nutrition in the intensive care unit. Material and methods: this retrospective, analytical cohort study was carried out among individuals admitted to a public general hospital ICU. For data collection, the electronic medical records for the entire period of inpatient treatment were analyzed. Results: in total, 213 individuals who had received parenteral nutrition for a period greater than 48 hours were included in the study. Most participants were male and mean age was < 60 years; death occurred in 75 % of patients, and abdominal surgery was the main indication for parenteral nutrition. Hyperglycemia was the most common complication. The Mann-Whitney test showed that the individuals who died were using a higher number of medications. The increased use of medications correlated with use of PN and led to an increase in hospital length of stay and death rate (p-value < 0.001). There was a higher proportion of deaths among patients using standard parenteral nutrition solutions (76.9 %) as compared to the period when patients started receiving custom-made parenteral nutrition solutions (71.7 %). However, there was no statistical evidence of the association between type of nutrition and the outcome of death (p-value = 0.395). Conclusions: custom-made parenteral nutrition may result in benefits for the patients, such as a decrease in the number of medications used. The relationship between type of nutrition and the outcome of death did not prove to be statistically significant.

Conhecimentos e atitudes de cirurgiões frente aos conceitos de terapia nutricional

OBJETIVO: comparar o conhecimento e percepção em terapia nutricional (TN) de residentes de cirurgia e cirurgiões. MÉTODOS: foram aplicados dois questionários padronizados sobre conhecimentos, atitudes e condutas em TN de 50 médicos (35 residentes e 15 cirurgiões) de 12 áreas cirúrgicas distintas. Utilizando-se o teste exato de Fisher, com significância de 5% com p<0,05, foi comparada a proporção de acertos, de acordo com a percepção a respeito do assunto de cada grupo. RESULTADOS: mais de 80% não se sentiram seguros frente à TN e 46% negaram conhecimento de equipe multiprofissional de TN (EMTN). Houve maior percentual de acertos, dentre os residentes, nos itens: trauma operatório e sua influência nutricional no paciente (p=0,047); IMC normal (p=0,036); e TN no pré-operatório (p=0,007) e indicação da TN pré-cirúrgico no grupo que diz que interagem com EMTN (p=0,02). Dentre os cirurgiões: complicações da TN e TN em pacientes previamente desnutridos (p=0,044); e Métodos de avaliação nutricional no pré-operatório no grupo que diz que interagem com EMTN (p=0,01). CONCLUSÃO: há falhas na educação médica. Apenas 13,3% estavam seguros quanto à TN, sendo que os seus conhecimentos não justificaram tal confiança. Não houve diferenças entre os acertos dos confiantes e não confiantes em TN na maioria dos assuntos. Destacaram-se melhores resultados no grupo que afirmou ser assistido por alguma EMTN. Baseando-se nos resultados, a indicação de melhores programas médicos educacionais deve ser objetivo para esta universidade.

[Nutritional care in public hospitals of four Brazilian states: contributions of health evaluation to health surveillance services]

Considering the importance of nutritional care for the quality of care provided to hospitalized patients, the study aims to assess health care in eight public hospitals that have received support from QualiSUS in four Brazilian states. There were semi-structured interviews with nutritionists, direct observation and review of 219 records of patients admitted to the medical clinics. The findings suggest weaknesses in the hospital nutritional care, poor integration between the production of food and nutritional care in the surveyed hospitals, in addition to structural deficiencies. We highlight problems related to the nutritional care process, including its documentation. In 93% of the records there were no records on the nutritional status on admission, or nutritional assessment of patients in nutritional therapy. It was observed that the assessment made by the health surveillance in routine inspections, focusing on the verification of compliance and structural aspects, does not include the detection of a possible nutritional risk for the patient. We suggest the inclusion of other criteria and strategies for surveillance, among them a review of open medical records.