Como a ingestão nutricional pode repercutir no desfecho clínico de pacientes em ventilação mecânica?

Abstract

Introduction: Attention to Nutritional Therapy in patients submitted to Mechanical Ventilation is extremely important as it contributes to the recovery of the patient's metabolic state. This critical patient needs greater care because they are more susceptible to infections, bronchoaspiration, Ventilation Associated Pneumonia, longer hospital stay, malnutrition, among others. Having seen the delicacy of the critical patient under mechanical ventilation, it is fundamental that greater care is taken in the administration of Nutritional Therapy, either by Enteral and / or Parenteral. Objective: To investigate the repercussion of Nutritional Therapy on the clinical outcome of patients in Mechanical Ventilation, found in the literature. Methodology: The research was carried out through data from scientific articles indexed in databases such as: Academic, Scielo, PubMed, Lilacs, Medline, Bireme and Capes Periodical, as well as private collections and / or found in the library of the Federal University of Campina Grande (UFCG). This study used as a methodological tool the integrative literature review, including articles published between the period from 2000 to 2017. Subsequent to the counting of patients by type of Nutritional Therapy, the influence of the infusion start time of the Therapy was calculated and discussed Nutritional status or the adequacy thereof, related to the following categories: Duration of Mechanical Ventilation, Permanence in ICU, Ventilation, Infection and Death Associated Pneumonia. Results: We found 91 articles, where 15 were selected, based on the inclusion criteria. It can be seen that the duration of Mechanical Ventilation, on average, was 1 day less in patients who received Early Nutrition Therapy when compared to Late Nutrition Therapy. Regarding the adequate supply of Nutritional Therapy, it presented about 5 more days when compared to the reduced supply of food. The ICU stay in patients who received an adequate supply of food was 18.3 days and a shortened supply was 13.5 days and as regards the beginning of infusion of food, 8.5 patients presented nutritional therapy Late and 4.7 patients in Early Nutritional Therapy. Ventilation Associated Pneumonia presented a 9 mean incidence rate of 11.2% and in patients in Early Nutrition Therapy, while the latter presented a percentage of 9.5% and, when related to the caloric supply, 16.6% on offer decreased and 24.05% in adequate supply. The infection presented an average percentage of caloric supply decreased by 10.53%, while the adequate supply of 7.2%. The percentage of deaths in patients who received early nutritional therapy and late nutritional therapy was respectively 4.65% and 5.75%, while those who received a reduced and adequate supply were 37.53% and 48 , 18%. Conclusion: Patients who used Early Nutrition Therapy obtained a better clinical evolution, from the categories listed, than patients who were under Late Nutrition Therapy, except for Ventilation Associated Pneumonia, who obtained a lower incidence in patients who did use of Late Nutrition Therapy. Regarding nutritional adequacy, patients who had a lower caloric intake had a better clinical outcome than patients who had an adequate intake, with Restriction of Infection, which presented a lower incidence with the nutrition recommended by the Brazilian Guideline of Mechanical Ventilation.