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      Resolution of control and monitoring instrument of nutritional therapy in the intensive care unit of a university hospital Translated title: Resolución del instrumento de control y monitorización de la terapia nutricional en la unidad de cuidados intensivos de un hospital universitario

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          Abstract

          Abstract Introduction: Patients in intensive care status are in nutritional threat and frequently present innutrition, therefore monitoring the nutritional offer becomes indispensable. Aim: To purpose a control and monitoring form of enteral nutritional therapy and to evaluate its resoluteness. Methods: Observational, analytical and retrospective study performed in intensive care patients receiving an enteral diet exclusively and/or associated with the oral/parenteral route, from January to April 2015 and from January to April 2016. An enteral nutritional therapy control form was purposed and applied in 2016 and the results were compared to those of the previous year. In both of these years, five quality indicators proposed by the task force of clinical nutrition from the International Life Sciences Institute (Brazil, 2008) were applied. Results: Ninety-four patients, mostly aged, were included (47 per year) in the study. There was an increase in the number of patients that presented diarrhea (p = 0.007) and hyperglycemia (p = 0.013) as well as an increase in the occurrence of these episodes among patients (p = 0.018, p = 0.032, respectively). The frequency of diarrhea, fasting of more than 24 hours and hypoglycemia did not correspond to the goal established by the indicators. Energy and protein estimations were reported, as well as their compliance with the literature. Conclusion: After using the form, a greater report of clinical intercurrences and information on caloric and protein estimates was observed, thus demonstrating its effectiveness with respect to data recording.

          Translated abstract

          Resumen Introducción: los pacientes en terapia intensiva presentan riesgo nutricional y frecuentemente se encuentran en estado de malnutrición, por lo que es fundamental la monitorización de la oferta nutricional. Objetivo: proponer una forma de control y seguimiento de la terapia nutricional enteral y evaluar su efectividad. Métodos: estudio de observación, analítico y retrospectivo, realizado en pacientes ingresados en una unidad de cuidados intensivos que reciben dieta por vía enteral exclusiva y/o asociada a vía oral/parenteral, en el periodo de enero a abril de 2015 y de enero a abril de 2016. En 2016 se propuso y aplicó un instrumento de control y monitorización de la terapia nutricional enteral en la unidad de cuidados intensivos y los resultados fueron comparados con los del año anterior. En ambos periodos se aplicaron cinco indicadores de calidad propuestos por el grupo especial de nutrición clínica del International Life Sciences Institute, de Brasil (2008). Resultados: se incluyen 94 pacientes y se estudiaron 47 en cada año, la mayoría de ellos ancianos. Hubo un aumento del número de pacientes que desarrollaron diarrea (p = 0,007) e hiperglucemia (p = 0,013) y también de la cantidad de episodios de estas complicaciones (p = 0,018 y p = 0,032, respectivamente). La frecuencia de diarrea, ayuno superior a 24h e hipoglucemia no correspondía a la meta fijada por los indicadores. Se recogieron datos del aporte energético y proteico, así como su comparación con lo publicado. Conclusión: después de la utilización del instrumento hubo un aumento en el registro de complicaciones clínicas y la información referente a la estimación calórica y proteica, lo que demuestra su efectividad en el registro de datos para el cual fue desarrollado.

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          Most cited references24

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          ESPEN Guidelines on Enteral Nutrition: Intensive care.

          Enteral nutrition (EN) via tube feeding is, today, the preferred way of feeding the critically ill patient and an important means of counteracting for the catabolic state induced by severe diseases. These guidelines are intended to give evidence-based recommendations for the use of EN in patients who have a complicated course during their ICU stay, focusing particularly on those who develop a severe inflammatory response, i.e. patients who have failure of at least one organ during their ICU stay. These guidelines were developed by an interdisciplinary expert group in accordance with officially accepted standards and are based on all relevant publications since 1985. They were discussed and accepted in a consensus conference. EN should be given to all ICU patients who are not expected to be taking a full oral diet within three days. It should have begun during the first 24h using a standard high-protein formula. During the acute and initial phases of critical illness an exogenous energy supply in excess of 20-25 kcal/kg BW/day should be avoided, whereas, during recovery, the aim should be to provide values of 25-30 total kcal/kg BW/day. Supplementary parenteral nutrition remains a reserve tool and should be given only to those patients who do not reach their target nutrient intake on EN alone. There is no general indication for immune-modulating formulae in patients with severe illness or sepsis and an APACHE II Score >15. Glutamine should be supplemented in patients suffering from burns or trauma.
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            Stress hyperglycemia: an essential survival response!

            Stress hyperglycemia is common in critically ill patients and appears to be a marker of disease severity. Furthermore, both the admission as well as the mean glucose level during the hospital stay is strongly associated with patient outcomes. Clinicians, researchers and policy makers have assumed this association to be causal with the widespread adoption of protocols and programs for tight in-hospital glycemic control. However, a critical appraisal of the literature has demonstrated that attempts at tight glycemic control in both ICU and non-ICU patients do not improve health care outcomes. We suggest that hyperglycemia and insulin resistance in the setting of acute illness is an evolutionarily preserved adaptive responsive that increases the host's chances of survival. Furthermore, attempts to interfere with this exceedingly complex multi-system adaptive response may be harmful. This paper reviews the pathophysiology of stress hyperglycemia and insulin resistance and the protective role of stress hyperglycemia during acute illness.
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              Canadian clinical practice guidelines for nutrition support in mechanically ventilated, critically ill adult patients

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                Author and article information

                Journal
                nh
                Nutrición Hospitalaria
                Nutr. Hosp.
                Grupo Arán (Madrid, Madrid, Spain )
                0212-1611
                1699-5198
                February 2018
                : 35
                : 1
                : 19-24
                Affiliations
                [2] Campo Grande-MS Mato Grosso do Sul orgnameUniversidade Federal de Mato Grosso do Sul orgdiv1Biologic and Health Sciences Center Brazil
                [1] Campo Grande-MS Mato Grosso do Sul orgnameUniversidade Federal de Mato Grosso do Sul orgdiv1University Hospital Maria Aparecida Pedrossian Brazil
                Article
                S0212-16112018000100019 S0212-1611(18)03500100019
                10.20960/nh.1088
                6aec402c-1069-4c04-b8bf-92da4cdb6280

                This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.

                History
                : 18 October 2017
                : 03 March 2017
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 24, Pages: 6
                Product

                SciELO Spain

                Categories
                Original Papers

                Enteral nutrition,Indicators of quality in health care,Calidad de la asistencia sanitaria,Indicadores de calidad en asistencia sanitaria,Cuidados intensivos,Nutrición enteral,Quality of health care,Critical care

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