ABSTRACT
Objetivo: descrever como a terapêutica nutricional domiciliar é realizada no Programa Melhor em casa do Ministério da Saúde e na Saúde suplementar. Método: Estudo transversal, com dados secundários, onde foram selecionados os perfis de profissionais atuantes em atenção domiciliaria no Brasil. A coleta de dados ocorreu de março a junho de 2018, depois de submetido e aprovado pelo Comitê de Ética e Pesquisa. Resultados: Dos 289 brasileiros, 74% eram profissionais atuantes na Assistência domiciliaria. O tipo de Terapia Nutricional realizada foi 67% enteral exclusiva seguida de 33% terapia mista. A prescrição realizada de dieta exclusiva artesanal foi de 9% e de dieta enteral mista 55%. A maioria recebe dieta por gravidade intermitente, seguida de administração em "bolus", gravitacional contínua e controle do gotejamento através da bomba de infusão. Conclusão: Os achados nos dão uma visão panorâmica da terapia nutricional enteral domiciliar no Brasil. A aumento da terapia nutricional domiciliaria se faz necessária especialmente pelo aumento da população idosa e consequentemente de maior presença das doenças crônicas que podem levar a incapacidade, dependência, maior tempo de hospitalização e custos para o sistema de saúde. É fundamental a presença da equipe interdisciplinar, de boas práticas e do acompanhamento das famílias nos domicílios.
Objective: To learn how home nutritional therapy is carried out in the Ministry of Health's Better Home Program and in Supplementary Health. Method: Cross-sectional study, with secondary data, in which the profiles of professionals working in home care in Brazil were selected. Data collection took place from March to June 2018, after being submitted and approved by the Ethics and Research Committee. Results: Of the 289 Brazilians, 74% were professionals working in home care. The type of nutritional therapy performed was 67% exclusive enteral followed by 33% mixed therapy. The prescription of an exclusive handmade diet was 9% and a mixed enteral diet 55%. Most receive intermittent gravity diet, followed by bolus administration, continuous gravitational and drip control through the infusion pump. Conclusion: The findings give us a panoramic view of home enteral nutritional therapy in Brazil. The increase in home nutritional therapy is necessary especially because of the increase in the elderly population and, consequently, the greater presence of chronic diseases that can lead to disability, dependence, longer hospitalization and costs for the health system. The presence of an interdisciplinary team, good practices and monitoring of families at home is essential.
Objetivo: Conocer cómo se lleva a cabo la terapia nutricional domiciliaria en el Programa Mejor Hogar del Ministerio de Salud y en Salud Complementaria. Método: Estudio transversal, con datos secundarios, en el que se seleccionaron los perfiles de los profesionales que trabajan en la atención domiciliaria en Brasil. La recolección de datos tuvo lugar de marzo a junio de 2018, luego de ser presentados y aprobados por el Comité de Ética e Investigación. Resultados: De los 289 brasileños, el 74% eran profesionales que trabajaban en la atención domiciliaria. El tipo de terapia nutricional realizada fue 67% enteral exclusiva seguida de 33% terapia mixta. La prescripción de una dieta exclusiva artesanal fue del 9% y una dieta enteral mixta del 55%. La mayoría recibe una dieta de gravedad intermitente, seguida de administración de bolo, control gravitacional continuo y de goteo a través de la bomba de infusión. Conclusión: Los hallazgos nos brindan una visión panorámica de la terapia nutricional enteral domiciliaria en Brasil. El aumento de la terapia nutricional domiciliaria es necesario sobre todo por el aumento de la población anciana y, en consecuencia, la mayor presencia de enfermedades crónicas que pueden derivar en discapacidad, dependencia, mayor internación y costos para el sistema de salud. La presencia de un equipo interdisciplinario, buenas prácticas y seguimiento de las familias en el hogar es fundamental.
Subject(s)
Enteral Nutrition , Nutrition Therapy , Parenteral Nutrition Solutions , Home NursingABSTRACT
Objective:To explore the application of home nutrition support in children with intestinal failure.Methods:Children with intestinal failure admitted to Division of Pediatric Gastroenterology and Nutrition and Department of Pediatric Surgery in Xinhua Hospital were retrospectively enrolled since January 2009. The details of home nutrition support, nutritional status and home parenteral nutrition (HPN) associated complications were collected.Results:A total of 10 children received HPN support, 7 of whom were with short bowel syndrome (SBS) and the other 3 with pediatric intestinal pseudo-obstruction. The average length of remnant small bowel in 7 SBS children was (36.7±32.4) cm. The average age at HPN onset was (5.4±4.7) years. The average duration of follow-up was (3.1±2.1) years. The average duration of HPN was (619.5±669.1) days after (391.8±340.1) days of parenteral nutrition support in our hospital. All 10 cases started home enteral nutrition (HEN) with tube feeding (3 cases transited to oral feeding during treatment). The average duration of HEN was (536.1±429.6) days. Daily calorie intake was 104.0%±39.0% of the recommended intake according to the guideline, with 46.5%±21.3% via HPN and 57.5%±29.2% via HEN. During follow-up, 3 cases were found with severe malnutrition, 5 with moderate malnutrition and 2 with mild malnutrition. Four children suffered from catheter-related thrombosis and five children were identified with catheter-related blood stream infection. No intestinal failure associated liver disease was observed.Conclusions:HPN is feasible but needs the support of national medical insurance policy. At present, there are still frequent nutritional deficiencies and complications in HPN. Nutrition support team (NST) should provide guidance for more scientific nutrition screening and nutrition management.
ABSTRACT
INTRODUCCIÓN: La Nutrición Parenteral Domiciliaria (NPD) ha demostrado ofrecer importantes be neficios para los pacientes y el sistema de salud. En Chile se desconoce el número de pacientes que se encuentran recibiendo esta modalidad de tratamiento o que podrían ser candidatos a ella. OBJETIVO: Determinar la prevalencia y características clínicas de pacientes con Insuficiencia Intestinal (II) que reciben actualmente NPD o que son candidatos a esta. PACIENTES Y MÉTODO: Estudio descriptivo transversal que incluyó pacientes de 0 a 18 años, con diagnóstico de II que se encontraban recibiendo NP por un tiempo superior a 3 meses en el domicilio, o en el hospital con situación clínica estable y con catéter venoso de larga duración (CVC). A través de una encuesta digitalizada se recolectaron y estudiaron las variables: sexo, antecedentes de nacimiento, indicación para iniciar soporte nutricional parenteral, edad de inicio de NP, tipo de CVC utilizado, frecuencia de NP, estado nutricional, alimentación al último control y complicaciones asociadas al uso de NP. Se utilizó el Programa SPSS Statistics, Versión 21, Macintosh, para el análisis de los datos. El análisis descriptivo consideró análisis de frecuencia y medidas de tendencia central. La prueba de Chi cuadrado y de Fisher se usaron para la comparación de proporciones. RESULTADOS: Se registraron datos de 46 pacientes, cuya edad promedio fue de 55,5 meses. La principal indicación para iniciar la Nutrición Parenteral (NP) fue la disminución de la superficie intestinal (78,3%.). El 63% de los pacientes se encontraba hospitalizado. No se encontraron diferencias significativas entre el lugar de tratamiento y las variables estado nutricional e infecciones de catéter en el último año. CONCLUSIONES: Se identificó la prevalencia de pacientes con NP prolongada y sus características clínicas. No se encontraron diferencias que respalden la entrega de este tratamiento en el hospital por sobre el domicilio. Es necesario desarrollar políticas públicas que garanticen la opción de recibir este tratamiento en el domicilio.
INTRODUCTION: Home parenteral nutrition (HPN) has been shown to offer important benefits for pa tients and the health system. In Chile, the number of patients who are receiving this type of treatment or who could be candidates for it is unknown. OBJECTIVE: To determine the prevalence and clinical characteristics of patients with intestinal insufficiency (II) currently receiving HPN or who are can didates for it. PATIENTS Y METHOD: Cross-sectional descriptive study which included patients aged between 0 to 18 years with diagnosis of II who were receiving parenteral nutrition (PN) for over three months, either at home or in the hospital, with a stable clinical situation and a long-term venous catheter (CVC). Through a digitalized survey, the following variables were collected and studied: gender, birth history, indication to initiate parenteral nutritional support, age of initiation of PN, type of CVC, frequency of PN, nutritional status and feeding in the last control and complications as sociated with the use of PN. Data analysis was performed using the SPSS Statistics Software, Version 21, Macintosh. The descriptive analysis considered frequency analysis and central trend measures. The Chi-square and Fisher tests were used for comparison of proportions. RESULTS: Data from 46 patients were recorded. The average age was 55.5 months. The main indication for initiating the PN was the decrease of the intestinal surface (78.3%). 63% of the patients were hospitalized. No significant differences were found between the place of treatment and the nutritional status and catheter infections variables in the last year. CONCLUSIONS: The prevalence of patients with long-term PN and their clinical characteristics were identified. No differences were found to support the administration of this treatment in the hospital over the home. Public policies must be developed to guarantee the option of receiving this treatment at home.
Subject(s)
Humans , Male , Female , Infant, Newborn , Infant , Child, Preschool , Child , Adolescent , Parenteral Nutrition, Home/adverse effects , Intestinal Diseases/therapy , Chile/epidemiology , Prevalence , Cross-Sectional Studies , Treatment Outcome , Intestinal Diseases/diagnosis , Intestinal Diseases/epidemiologyABSTRACT
Intestinal failure (IF) is the critical reduction of the gut mass or its function below the minimum needed to absorb nutrients and fluids required for adequate growth in children. Severe IF requires parenteral nutrition (PN). Pediatric IF is most commonly due to congenital or neonatal intestinal diseases or malformations divided into 3 groups: 1) reduced intestinal length and consequently reduced absorptive surface, such as in short bowel syndrome (SBS) or extensive aganglionosis; 2) abnormal development of the intestinal mucosa such as congenital diseases of enterocyte development; 3) extensive motility dysfunction such as chronic intestinal pseudo-obstruction syndromes. The leading cause of IF in childhood is the SBS. In clinical practice the degree of IF may be indirectly measured by the level of PN required for normal or catch up growth. Other indicators such as serum citrulline have not proven to be highly reliable prognostic factors in children. The last decades have allowed the development of highly sophisticated nutrient solutions consisting of optimal combinations of macronutrients and micronutrients as well as guidelines, promoting PN as a safe and efficient feeding technique. However, IF that requires long-term PN may be associated with various complications including infections, growth failure, metabolic disorders, and bone disease. IF Associated Liver Disease may be a limiting factor. However, changes in the global management of IF pediatric patients, especially since the setup of intestinal rehabilitation centres did change the prognosis thus limiting “nutritional failure” which is considered as a major indication for intestinal transplantation (ITx) or combined liver-ITx.
Subject(s)
Child , Humans , Bone Diseases , Citrulline , Enterocytes , Intestinal Diseases , Intestinal Mucosa , Intestinal Pseudo-Obstruction , Liver Diseases , Micronutrients , Parenteral Nutrition , Parenteral Nutrition, Home , Prognosis , Rehabilitation , Short Bowel SyndromeABSTRACT
Este trabalho avaliou a eficácia da terapia nutricional (TN) adjuvante em portadores de síndrome do intestino curto (SIC) em regime de NPT domiciliar por 2 a 4,5 anos. A interrupção da terapia deu-se por sepse por cateter em dois pacientes, trombose venosa profunda em dois e embolia pulmonar em um. A dieta enteral foi introduzida após um a seis meses de suspensão de NPT. A via de acesso da TN enteral foi nasotenral (um paciente), gastronomia (três) e oral (um). A dieta enteral utilizada foi polimérica isomolar com fibras (três pacientes) e sem fibras (dois). A técnica de infusão foi cíclica noturna e/ou diurna em sistema fechado com bomba de infusão (50 a 83 ml/h) ou oral fracionada. Os resultados permitiram concluir que a TN enteral adjuvante nesta população permitiu prover as necessidades calóricas sem NPT, com manutenção de peso corpóreo, constituindo-se alternativa viável no manuseio nutricional de SIC.
This study evaluated the efficacy of nutritional therapy (NT) adjuvant in patients with short bowel syndrome (SBS) on a home TPN for 2 to 4.5 years. Discontinuation of therapy was given by catheter sepsis in two patients, deep vein thrombosis and pulmonary embolism in two in one. Enteral feeding was introduced after a six-month suspension of NPT. The route of enteral access was nasotenral TN (one patient), food (three) and oral (a). Enteral nutrition was used isomolar polymeric fibers (three patients) and no fiber (two). The infusion technique was cyclical and nighttime or daytime in a closed system using an infusion pump (50-83 ml / h) or divided oral doses. The results showed that NT enteral adjuvant allowed this population to provide the caloric needs without TPN, with maintenance of body weight, becoming a viable alternative in the nutritional management of SBS.
Este estudio evaluó la eficacia de la terapia nutricional (NT) adyuvante en pacientes con síndrome de intestino corto (SIC) en un TPN en casa por 2 a 4,5 años. La interrupción del tratamiento fue dado por sepsis por catéter en dos pacientes, la trombosis venosa profunda y embolismo pulmonar en dos en uno. La alimentación enteral se introdujo después de una suspensión de seis meses del TNP. La ruta de acceso enteral fue nasotenral TN (un paciente), alimentos (tres) y oral (a). La nutrición enteral se utilizó isomolar fibras poliméricas (tres pacientes) y sin fibra (dos). La técnica de infusión era cíclico y la noche o de día en un sistema cerrado mediante una bomba de infusión (50 a 83 ml / h) o divide las dosis orales. Los resultados mostraron que adyuvante NT enteral permite a esta población para cubrir las necesidades de calorías sin RPT, con el mantenimiento del peso corporal, convirtiéndose en una alternativa viable en el manejo nutricional de SBS.