| Asociación entre severidad de la enfermedad y el tiempo de inicio de alimentación enteral en pacientes graves. Estudio retrospectivo observacional |
Association between illness severity and timing of initial enteral feeding in critically ill patients: A retrospective observational study.
Huang HH, Hsu CW, Kang SP, Liu MY, Chang SJ.
Nutr J. 2012 May 3;11(1):30.
Abstract
BACKGROUND: Early enteral nutrition is recommended in cases of critical illness. It is unclear whether this recommendation is of most benefit to extremely ill patients. We aim to determine the association between illness severity and commencement of enteral feeding. METHODS: One hundred and eight critically ill patients were grouped as "less severe" and "more severe" for this cross-sectional, retrospective observational study. The cut off value was based on Acute Physiology and Chronic Health Evaluation II score 20. Patients who received enteral feeding within 48 h of medical intensive care unit (ICU) admission were considered early feeding cases otherwise they were assessed as late feeding cases. Feeding complications (gastric retention/vomiting/diarrhea/gastrointestinal bleeding), length of ICU stay, length of hospital stay, ventilator-associated pneumonia, hospital mortality, nutritional intake, serum albumin, serum prealbumin, nitrogen balance (NB), and 24-h urinary urea nitrogen data were collected over 21 days. RESULTS: There were no differences in measured outcomes between early and late feedings for less severely ill patients. Among more severely ill patients, however, the early feeding group showed improved serum albumin (p = 0.036) and prealbumin (p = 0.014) but worsened NB (p = 0.01), more feeding complications (p = 0.005), and prolonged ICU stays (p = 0.005) compared to their late feeding counterparts. CONCLUSIONS: There is a significant association between severity of illness and timing of enteral feeding initiation. In more severe illness, early feeding was associated with improved nutritional outcomes, while late feeding was associated with reduced feeding complications and length of ICU stay. However, the feeding complications of more severely ill early feeders can be handled without significantly affecting nutritional intake and there is no eventual difference in length of hospital stay or mortality between groups. Consequently, early feeding shows to be a more beneficial nutritional intervention option than late feeding in patients with more severe illness.
http://www.nutritionj.com/content/pdf/1475-2891-11-30.pdf
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| Albúmina en pacientes graves: controversias y recomendaciones |
Albumin in critically ill patients: controversies and recommendations
Haroldo Falcao, André Miguel Japiassú
Rev Bras Ter Intensiva. 2011; 23(1):87-95
ABSTRACT
Human albumin has been used as a therapeutic agent in intensive care units for more than 50 years. However, clinical studies from the late 1990s described possible harmful effects in critically ill patients. These studies' controversial results followed other randomized controlled studies and metaanalyses that showed no harmful effects of this colloid solution. In Brazil, several public and private hospitals comply with the Agencia Nacional de Vigilancia Sanitaria (the Brazilian Health Surveillance Agency) recommendations for appropriate administration of intravenous albumin. This review discusses indications for albumin administration in critically ill patients and analyzes the evidence for metabolic and immunomodulatory effects of this colloid solution. We also describe the most significant studies from 1998 to the present time; these reveal an absence of incremental mortality from intravenous albumin administration as compared to crystalloid solutions. The National Health Surveillance Agency indications are discussed relative to the current body of evidence for albumin use in critically ill patients.
Keywords: Albumin; Edema; Sepsis; Hypovolemia; Colloid osmotic pressure;
http://www.scielo.br/pdf/rbti/v23n1/en_a14v23n1.pdf
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