Terapia nutricional no paciente adulto em oxigenação por membrana extracorpórea: revisão de literatura

Abstract

Introduction: Extracorporeal membrane oxygenation (ECMO) provides partial or total cardiopulmonary support to patients with severe, acute and reversible cardiac or pulmonary failure. Despite the increasing use of the technique in adult patients, information on nutritional care is scarce. The objective was to investigate available data on the nutritional support of adult patients using ECMO in order to assist in the development of institutional protocols. Methods: A narrative review of the literature was led in order to showing the management of nutritional support, reasons for low nutritional adequacy, nutritional needs and the role of nutrition in ECMO complications. Results: Search strategies identified studies published up to October 11th, 2019. Only primary studies, indexed in the MEDLINE, Scopus and Web of Science data bases were evaluated, resulting in the inclusion of 11 studies. There is evidence that early enteral nutrition is safe and well tolerated and can be initiated via the gastric route. Gastrointestinal dysfunction with high gastric residual volumes is a common finding. However, there is positive evidence of treatment with prokinetic drugs, with the option of using a nasojejunal tube and parenteral nutrition. It is possible to achieve nutritional adequacy (>80%), which is associated with lower mortality. However, malnutrition is recurrent, among the main reasons is the interruption of the diet for therapeutic/diagnostic procedures. Supplemental parenteral nutrition is an important strategy, but it requires special care with the associated administration of glucose and fats. Data on nutritional needs are controversial, as well as the differences in nutritional support and intercurrences between types of ECMO (VA and VV). Conclusion: It is concluded that although most studies are observational retrospective, the evidence shows that nutrition is safe, well tolerated and is associated with lower mortality of patients on ECMO.