Nutrição enteral precoce e desfechos clínicos em pacientes de terapia intensiva

Abstract

Introduction: Early nutritional support is a therapeutic strategy in critically ill patients, however, it has been shown to be controversial in relation to clinical outcomes. The aim of the study was to investigate the effects of early enteral nutritional therapy (ENT) and the initial caloric-protein supply on the clinical outcomes of patients in Intensive Care Units (ICU) of a hospital in Southwest Bahia. Methods: Prospective cohort study approved by the ethics committee. Information was collected on nutritional screening, anthropometric assessment, estimated nutritional needs and nutritional goals. The time of introduction of NET was classified as early, when started in the first 48 hours of admission and late. The volume and characteristics of the enteral diet were monitored daily, as well as the length of stay in the ICU and mechanical ventilation and mortality. Patients were followed up until discharge from the ICU or death. To test the association between the outcomes of mechanical ventilation time and ICU stay and nutritional variables, linear regression was used, while, for mortality, logistic regression. Results: 88 patients were included, of which 96.6% had nutritional risk at admission, determined by the severity of the condition. Early NET was received by 67 patients, with a mean of 39 ± 11.69 hours to onset and significant variation in relation to late NET (77.76 ± 32.11 hours), with no association with outcomes. The caloric and protein averages received in the first three days of NET were significantly higher in the early NET group (p = 0.000), which were associated with longer ICU stays and mechanical ventilation, even with a high frequency of protein inadequacy. No late ENT patient presented protein adequacy until the third day. Conclusion: Early NET was not associated with the clinical outcomes of critically ill patients, however, the greater energy supply increased the ICU stay and mechanical ventilation times.