Nutrición enteral precoz versus tardía en unidades de cuidados intensivos. Análisis de resultados

  1. Bermejo de las Heras, Sara
  2. de la Calle de la Rosa, Licia
  3. Blesa, Antonio
  4. Giner, Manuel
  5. Arias Díaz, Javier
Journal:
Journal of Negative and No Positive Results: JONNPR

ISSN: 2529-850X

Year of publication: 2017

Volume: 2

Issue: 8

Pages: 343-350

Type: Article

DOI: 10.19230/JONNPR.1508 DIALNET GOOGLE SCHOLAR lock_openOpen access editor

More publications in: Journal of Negative and No Positive Results: JONNPR

Sustainable development goals

Abstract

Introduction: Malnutrition is particularly prevalent in Intensive Care Units (ICU) and associated with poor clinical outcomes. Enteral nutrition (EN) has multiple benefits in critically ill patients, particularly when started early at the ICU. A series of studies corroborate this fact; however, other studies present conflicting results.Objective: To assess the clinical results of ICU patients receiving EN, according to EN starting time (early versus late).Patients and method: Basic variables were recorded in all ICU patients who received NE along the study period, as well as time from ICU admission to the start of EN, ICU length of stay, characteristic gastrointestinal complications of EN (gastric residue, constipation, diarrhea, vomiting, regurgitation, abdominal distension and bronchoaspiration) and mortality.Results: There was a significant association between early EN and mortality reduction. However, there were no differences in ICU length of stay according to EN starting time. The most frequent complications in the sample were high gastric residue (17.9%), abdominal distension (22.5%) and constipation (42.2%). However, no significant differences were observed as a function of the EN starting time.Discussion: Our results, although discrepant at times, do not contradict with those of other studies. EN has shown to be effective as a therapeutic strategy. Therefore, it is recommended the early start of EN in the ICU. 

Bibliographic References

  • Arabi MY, Aldawood SA, Haddad HS, et al. Permissive underfeeding or standard enteral feeding in critically ill adults. N Engl J Med. 2015; 372:2398-408
  • Choi EY, Park DA, Park J. Calorie intake of enteral nutrition and clinical outcomes in acutely critically ill patients: a meta-analysis of randomized controlled trials. JPEN J Parenter Enteral Nutr. 2015; 39(3):291-300
  • Doig GS, Hieghes PT, Simpson F, et al. Early enteral nutrition reduces mortality in trauma patients requiring intensive care: A meta- analysis of randomised controlled tirals. Injury Int J Care Injured. 2011; 42:50-6
  • Doig GS, Hieghes PT, Simpson F, et al. Early enteral nutrition, provided within 24 h of injury or intensive care unit admission, significantly reduces mortality in critically ill patients: a meta-analysis os randomised controlled trials. Intensive Care Med. 2009; 35:2018-27
  • Doig GS, Simpson F, Finfer S, et al. Effect of Evidence-Based Feeding Guidelines on Mortality of Critically Ill Adults. A Cluster Randomized Controlled Trial. JAMA. 2008; 300 (23):2731-41
  • Hegazi R, Raina A, Graham T, et al. Early jejunal feeding initiation and clinial outcomes in patients with severe acute pancreatitis. JPEN J Parenter Enteral Nutr. 2011; 35(1):91-6
  • Kreymann KG, Berger MM, Deutz NEP, et al. ESPEN Guidelines on Enteral Nutrition: Intensive care. Clin Nutr. 2006; 25:210-23
  • León C, Cuñat J, Palencia E, et al. Sociedad Española de Medicina Intensiva, Crítica y Unidades Coronarias (SEMICYUC). Indicadores de calidad en el enfermo crítico. [Internet]. Actualización 2011. Madrid, España; 2011. [citado 3 may 2016]. Disponible en: http://www.semicyuc.org/temas/calidad/indicadores-de-calidad
  • Li CH, Chen DP, Yang J. Enteral nutritional support in patients with head injuries after craniocerebral surgery. Turk Neurosurg. 2015; 25(6):873-6
  • Li X, Ma F, Jia K. Early enteral nutrition within 24 hours or between 24 and 72 hours for acute pancreatitis: evidence based on 12 RCTs. Med Sci Monit. 2014; 20:2327-35
  • Llopis-Salvia P, Luna-Calatayud P, Avellana-Zaragoza JA, Bou-Monterde R. Organization and management of nutritional care process in hospitalized patients: the model implemented in the "Hospital Universitario de La Ribera”. Nutr Hosp. 2012; 27(2):529-36
  • McClave SA, Taylor BE, Martindale RG, et al. Guidelines for the Provision and Assessment of Nutrition Support Therapy in the Adult Critically Ill Patient: Society of Critical Care Medicine (SCCM) and American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.). JPEN J Parenter Enteral Nutr. 2016 Feb; 40(2):159-211
  • Orejana Martín M, Torrente Vela S, Murillo Pérez MA et al. Análisis del estreñimiento en pacientes con traumatismo grave. Enferm Intensiva. 2014; 25(2):46-51
  • Ponce G, Mayagoitia JJ, Cornejo JM, et al. Nutrición enteral en pacientes con traumatismo craneoencefálico: revisión sistemática de ensayos clínicos. RICS. 2015; 4(7)
  • Preiser JC, van Zanten AR, Berger MM, et al. Metabolic and nutritional support of critically ill patients: consensus and controversies. Crit Care. 2015; 19:35
  • Reid DB, Chapple LS, O’Connor SN, et al. The effect of augmenting early nutritional energy delivery on quality of life and employment status one year after ICU admission. Anaesth Intensive Care. 2016; 44(3):406-12
  • Reignier J, Mercier E, Le Gouge A, et al. Clinical Research in Intensive Care and Sepsis (CRICS) Group. Effect of not monitoring residual gastric volumen on risk of ventilator-associated pneumonia in adults receiving mechanical ventilation and early enteral feeding: a randomidez controlled trial. JAMA. 2013; 309(3):249-56
  • Ren G. Application of Early Nutrition Support in Neurosurgical Coma patients. Indian J Surg. 2015; 77(3):1205-8
  • Ridley E, Gantner D, Pellegrino V. Nutrition therapy in critically ill patients. A review of current evidence for clinicians. Clin Nutr. 2015; 34(4):565-71
  • Serón Arbeloa C, Zamora Elson M, Labarta Monzón L, et al. Resultados del soporte nutricional en una UCI polivalente. Nutr Hosp. 2011; 26(6):1469-77
  • Sociedad Española de Medicina Intensiva, Crítica y Unidades Coronarias (SeMicyuc). Indicadores de calidad en el enfermo crítico. Actualización 2011 [Internet]. Madrid, España; 2011. [citado 13 sep 2016]. Disponible en: http://www.semicyuc.org/temas/calidad/indicadores-de-calidad
  • Soguel L, Revelly JP, Schaller MD, Longchamp C, Berger MM. Energy deficit and length of hospital stay can be reduced by a two-step quality improvement of nutrition therapy: the intensive care unit dietitian can make the difference. Crit Care Med. 2012; 40(2):412-9
  • Sun JK, Mu XW, Li WQ, et al. Effects of early enteral nutrition on inmune function of severe acute pancreatitis patients. World J Gastroenterol. 2013; 19(6):917-22
  • Sungur G, Sahin H, Tasci S. The effects of implementing a nutritional support algorithm in critically ill medical patients. J Pak Med Assoc. 2015; 65(8):810-4
  • Sánchez C1, López-Herce J, Carrillo A, Mencía S, Vigil D. Early transpyloric enteral nutrition in critically ill children. Nutrition. 2007; 23(1):16-22
  • Van Zanten AR, Sztark F, Kaisers UX, et al. High-protein enteral nutrition enriched with inmune-modulating nutrients vs standard high- protein enteral nutrition and nosocomial infections in the ICU: a randomized clinical trial. JAMA. 2014; 312(5):514-24
  • Wan B, Fu H, Yin J. Early jejunal feeding by bedside placement of a nasointestinal tube significantly improves nutritional status and reduces complications in critically ill patients versus enteral nutrition by a nasogastric tube. Asia Pac J Clin Nutr. 2015; 24(1):51-7
  • Wereszczynska-Siemiatkowska U, Swidnicka-Siergiejko A, Siemiatkowski A, et al. Early enteral nutrition is superior to delayed enteral nutrition for the prevention of infected necrosis and mortality in acute pancreatitis. Pancreas. 2013; 42(4):640-6
  • Yi F, Ge L, Zhao J, et al. Meta-analysis: total parenteral nutrition versus total enteral nutrition in predicted severe acute pancreatitis. Intern Med. 2012; 51(6):523-30
  • Yuan Y, Ren J, Gu G, et al. Early enteral nutrition improves outcomes of open abdomen in gastrointestinal fistula patients complcated with severe sepsis. Nutr Clin Pract. 2011; 26(6):688-94
  • Zheng T, Zhu X, Liang H, et al. Impact of early enteral nutrition on short term prognosis after acute stroke. J Clin Neurosci. 2015; 22(9):1473-6
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