Terapia Nutricional Em Uti Final

Terapia Nutricional em UTI André Lopes - R2 Clínica Médica Curso Teórico de Medicina Intensiva UTI- PS / Hospital São Paulo

Avaliação Nutricional ,[object Object],[object Object],Terapia Nutricional no paciente grave - TENUTI. Revinter 2001. Cap 1, p.1-6.

Variáveis que avaliam risco : ,[object Object],[object Object],[object Object],[object Object],[object Object],Regulamento ténico referente a requisitos mínimos exigidos para terapia nutricional. ANVISA. 2000. Triagem de Risco

Avalição do estado nutricional ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

[object Object],[object Object],[object Object],[object Object],[object Object],As variações nas concentrações dessas proteínas refletem, inicialmente, a intensidade do estresse e, tardiamente, o estado nutricional. < 7,0 mg/dL < 2,0 mg/dL < 100mg/dL Nutrition metabolism in the criticall patient. Philadelphia : Lippincott Williams & Wilkins, 2002.

[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],How valid are our reference standards of nutrition ? Nutrition, v.11,p.731, 1995 .

Requisito Nutricional American College of Chest Physicians ( ACCP )

Fontes de energia ,[object Object],[object Object],[object Object]

Gasto diário de energia ,[object Object],[object Object],Harris JA, Benedict FG. A biometric study of human basal metabolism . Proc Natl Acad Sci U S A 1918 ;4:370–373.

[object Object],[object Object],[object Object],[object Object],[object Object],Harris JA, Benedict FG. A biometric study of human basal metabolism. Proc Natl Acad Sci U S A 1918;4:370–373.

[object Object],[object Object],[object Object],[object Object],[object Object],CHAN, S.; MCCOWEN, K.C. ; Blackburn, G.L. Nutrition manegement in the ICU. Chest , v.115, p.145-48,1999.

Equivalente às Equações de Harris-Benedict: ,[object Object],Paauw JD, McCamish MA, Dean RE, et al. Assessment of caloric needs in stressed patients. J Am Coll Nutr 1984 ;3:51–59.

Ajudes para adequação do Gasto Energético : ,[object Object],[object Object],[object Object]

[object Object],[object Object],[object Object],[object Object],[object Object],Mann S, Westenskow DR, Houtchens BA. Measured and predicted caloricexpenditure in the acutely ill. Crit Care Med 1985;13:173–177.

Acurácia da correção do GBE : SUPERESTIMATIVA Kan MN, Chang HH, Sheu WF, et al. Estimation of energy requirements for mechanically ventilated, critically ill patients using nutritional status . Crit Care 2003;7:R108–R115.

Calorimetria Indireta ,[object Object],[object Object],Bursztein S, Saphar P, Singer P, et al. A mathematical analysis of indirect calorimetry measurements in acutely ill patients. Am J Clin Nutr 1989;50:227–230.

GER x GET - Calorimetria ,[object Object],[object Object],[object Object],Koea JB, Wolfe RR, Shaw JH. Total energy expenditure during total parenteral nutrition: ambulatory patients at home versus patients with sepsis in surgical intensive care. Surgery 1995;118:54–62.

[object Object],[object Object],[object Object],[object Object],McClave S, Snider H. Use of indirect calorimety in clinical nutrition. Nutr Clin Pract1992;7:207–221

[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Talpers SS, Romberger DJ, Bunce SB, et al. Nutritionally associated increased carbon dioxide production. Chest 1992;102:551–555.

[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Jones PJH, Kubow S. Lipids, sterols, and their metabolites. In: Shils ME et al.,eds. Modern nutrition in health and disease. 10th ed. Philadelphia: Lippincott Williams & Wilkins, 2006:92–121.

[object Object],[object Object],[object Object],[object Object],[object Object],Matthews DE. Proteins and amino acids. In: Shils ME et al., eds. Modern nutrition in health and disease. 10th ed. Philadelphia: Lippincott Williams & Wilkins,2006:23–61.

[object Object],[object Object],Burge J, Choban P, McKnight T. Urinary ammonia excretion as an estimate of total urinary nitrogen in patients receiving parenteral nutritional support. J Parenter Enteral Nutr 1993;17:529–531. Equilíbrio do Nitrogênio : ( Ingesta protéica/ 6,25 ) – ( NUU +4 ) Fator 4 = outras perdas diárias de nitrogênio

Vitaminas e microelementos : devemos ofertá-los ?

Nutritional support in critically ill patients. Intensive Care Med 1993; 8:16–33.

[object Object],[object Object],[object Object],[object Object],[object Object],Boni L, Kieckens L, Hendrikx A. An evaluation of a modified erythrocyte transketolase assay for assessing thiamine nutritional adequacy. J Nutr Sci Vitaminol (Tokyo) 1980;26:507–514.

Nutritional support in critically ill patients. Intensive Care Med 1993; 8:16–33

Hipoferremia : devemos tratá- la? Herbert V, Shaw S, Jayatilleke E, et al. Most free-radical injury is iron-related : it is promoted by iron, hemin, holoferritin and vitamin C, and inhibited by desferoxamine and apoferritin. Stem Cells 1994;12:289–303.

[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],J Parenter Enteral Nutr 2002;26:63–66.

Nutrição Enteral “ If the gut works, use it “

Epitélio = Barreira ,[object Object],Alpers DH. Enteral feeding and gut atrophy . Curr Opin Clin Nutr Metab Care 2002;5:679–683.

www.cstr.ufcg.edu.br/histologia/atlas_tec_conj_arquivos/image007.jpg

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Qual a importância ? ,[object Object],[object Object],Herskowitz K, Souba WW. Intestinal glutamine metabolism during critical illness . Nutrition 1990;6:199–206.

Translocação Bacteriana ,[object Object],[object Object]

Indicações de nutrição artificial: ,[object Object],[object Object],[object Object],Overview of enteral nutrition. UpToDate

Contra-indicações da NE: ,[object Object],[object Object],[object Object],[object Object],[object Object],Meier R, Ockenga J, Pertkiewicz M, et al. ESPEN guidelines on enteral nutrition: pancreas. Clin Nutr 2006;25:275–284.

Sonda : gástrica x duodenal ,[object Object],Meier R, Ockenga J, Pertkiewicz M, et al. ESPEN guidelines on enteral nutrition. Clin Nutr 2006;25:275–284.

[object Object],Acute complications associated with bedside placement of feeding tubes. Nutr Clin Pract 2006;21:40–55.

[object Object],[object Object],[object Object],[object Object],Pneumothorax following nasogastric feeding tube insertion in a tracheostomized patient after bilateral lung transplantation. Intensive Care Med 1997;23:440–442.

Fórmulas de Nutrição ,[object Object],[object Object],Enteral Nutrition Formulas (Systemic). 2006 . Available at: http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202673.html

[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Bistrian BR, McCowen KC. Nutritional and metabolic support in the adult intensive care unit: key controversies. Crit Care Med 2006;34:1525–1531.

[object Object],[object Object],[object Object],[object Object],[object Object],Malone A. Enteral formula selection: a review of selected product categories. Pract Gastroenterol 2005 ; June:44–74.

http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202673.html

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[object Object],[object Object],[object Object],[object Object],Malone AM. The use of specialized enteral formulas in pulmonary disease. Nutr Clin Pract 2004;19:557–562.

[object Object],[object Object],[object Object],[object Object],[object Object],Bistrian BR, McCowen KC. Nutritional and metabolic support in the adult intensive care unit: key controversies. Crit Care Med 2006;34:1525–1531 .

Aditivos dietéticos ,[object Object],[object Object],[object Object],Ziegler TR, Benfell K, Smith RJ, et al. Safety and metabolic effects of L-glutamine administration in humans. J Parenter Enteral Nutr 1990;14:137S–146S.

Clinical evidence for enteral nutritional support with glutamine:a systematic review . Nutrition 2003;19:809–811.

[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Rebouche CJ. Carnitine. In: Shils ME, et al., eds. Modern nutrition in health and disease. 10th ed. Philadelphia: Lippincott Williams & Wilkins, 2006:537–544.

[object Object],[object Object],[object Object],[object Object],. Dietary fiber: a brief review and potential application to enteral nutrition. Nutr Clin Pract.

Infusão da dieta enteral ,[object Object],[object Object],[object Object],[object Object],Mizock BA. Avoiding common errors in nutritional management. J Crit Illness 1993;10:1116–1127.

Complicações ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Eisenberg PG. Causes of diarrhea in tube-fed patients: a comprehensive approach to diagnosis and management. Nutr Clin Pract 1993;8:119–123.

Cheng EY et al. Unsuspected source of diarrhea in an ICU patient. Clin Intensive Care 1992; 3:33–36.

[object Object],Overview of diagnostic imaging in sepsis. New Horiz 1993

[object Object],[object Object],[object Object],[object Object],[object Object],Eisenberg PG. Causes of diarrhea in tube-fed patients: a comprehensive approach to diagnosis and management. Nutr Clin Pract 1993;8:119–123 .

[object Object],“ If the gut works, use it “

Indicação: Quando há contra-indicação para a nutrição enteral Dudrick SJ. Early developments and clinical applications of total parenteral nutrition. J Parenter Enteral Nutr 2003;27:291–299.

Fórmula ,[object Object],[object Object],[object Object],[object Object],Mirtallo J, Canada T, Johnson D, et al. Safe practices for parenteral nutrition . J Parenter Enteral Nutr 2004;28:S39–70.

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Driscoll DF. Compounding TPN admixtures: then and now. J Parenter Enteral Nutr 2003;27:433–438.

[object Object],[object Object],[object Object],[object Object],[object Object],Borgsdorf LR, Cada DJ, Cirigliano M, et al. Drug facts and comparisons. 60th ed.St. Louis, MO: Wolters Kluwer, 2006.

Drug Facts and Comparisons. 60th ed. St. Louis, MO: Wolters Kluwer, 2006.

[object Object],[object Object],[object Object],[object Object],De-Souza DA, Greene LJ. Intestinal permeability and systemic infections in critically ill patients: effect of glutamine . Crit Care Med 2005;33:1125–1135.

Dechelotte P, Hasselmann M, Cynober L, et al. L-Alanyl-L-glutamine dipeptide-supplemented total parenteral nutrition reduces infectious complications and glucose intolerance in critically ill patients: the French controlled, randomized, double-blind, multicenter study . Crit Care Med 2006;34:598–604.

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Podem ser infundidas separadamente ou adicionadas a misturas de dextrose - aminoácidos. Drug Facts and Comparisons. 60th ed. St. Louis, MO: Wolters Kluwer, 2006 .

[object Object],[object Object],[object Object],[object Object],Carpentier YA, Dupont IE. Advances in intravenous lipid emulsions. World J Surg 2000;24:1493–1497.

[object Object],[object Object],[object Object],[object Object],[object Object],Helphingstine CJ, Bistrian BR. New Food and Drug Administration Requirements for inclusion of vitamin K in adult parenteral multivitamins. J Parenter Enteral Nutr 2003;27:220–224.

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Complicações ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Trissel LA. Handbook on injectable drugs. 13th ed. Bethesda, MD: American Society Health System Pharmacists, 2005.

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Terapia Nutricional Em Uti Final

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