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3.
Rev. bras. cancerol ; 67(2): e-201351, 2021.
Article in Portuguese | LILACS | ID: biblio-1223745

ABSTRACT

Introdução: Pacientes com câncer são mais suscetíveis à infecção e à maior gravidade da doença causada pelo novo coronavírus (Covid-19). Objetivo: Apresentar o cenário da assistência nutricional e o perfil clínico-nutricional de pacientes hospitalizadas com Covid-19 em uma instituição de tratamento de câncer de mama. Método: Foram apresentadas as práticas da assistência nutricional realizadas no Hospital do Câncer III do Instituto Nacional de Câncer José Alencar Gomes da Silva (HC III/INCA) durante a pandemia da Covid-19. Os dados clínicos das pacientes com câncer de mama e Covid-19 foram coletados em prontuários. Resultados: Algumas mudanças na rotina foram a suspensão das visitas dos nutricionistas em casos confirmados; a utilização de equipamentos de proteção individual; e as alterações na avaliação nutricional. Um total de 23 pacientes foi incluído, sendo hipertensão a comorbidade mais comum (56,5%) e o estadiamento clínico IV o mais frequente (43,5%). Dispneia (60,9%), febre (30,4%), tosse (13%), anemia, neutrofilia, proteína C reativa elevada, hipoalbuminemia e necessidade de oxigenioterapia durante a internação (73,9%) foram as principais características encontradas. A maioria recebeu dieta via oral líquida (52,2%) e, para 43,5%, foi prescrito suplemento nutricional. O excesso de peso foi o estado nutricional mais prevalente. Conclusão: Além do câncer de mama, podem se associar ao aumento do risco de complicações por Covid-19 nessas pacientes a alta prevalência de comorbidades, o excesso de peso e a metástase pulmonar. A presença de sintomas que influenciam na ingestão alimentar levou à necessidade de modificações na dieta para melhor aceitação alimentar.


Introduction: Cancer patients are more susceptible to infection and to the greatest severity of the disease caused by the new coronavirus (COVID-19). Objective: To present the scenario of nutritional care, clinical and nutritional profile of patients hospitalized with COVID-19 in a breast cancer treatment institution. Method: The nutritional care practices performed at the Hospital of Cancer III of the National Cancer Institute José Alencar Gomes da Silva (HC III/INCA) during the COVID-19 pandemic were presented. Clinical data from patients with breast cancer and COVID-19 were collected from medical records. Results: Some changes in the routine were the suspension of consultations with the nutritionists in confirmed cases, the use of personal protective equipment and changes in nutritional assessment. A total of 23 patients were included, hypertension was the most frequent comorbidity (56.5%), and the most frequent clinical staging was IV (43.5%). Dyspnea (60.9%), fever (30.4%), cough (13%), anemia, neutrophilia, high C-reactive protein, hypoalbuminemia and need for oxygen therapy during hospitalization (73,9%) were the main characteristics found. The majority received a liquid oral diet (52.2%) and 43.5% were prescribed a nutritional supplement. Overweight was the most prevalent nutritional status. Conclusion: In addition to breast cancer, an increased risk of complications from COVID-19 in these patients was associated with high prevalence of comorbidities, overweight and lung metastasis. The presence of symptoms influencing food intake led to the necessity of changes in the diet for better food acceptance.


Introducción: Los pacientes con cáncer son más susceptibles a la infección y a la mayor gravedad de la enfermedad provocada por el nuevo coronavirus (Covid-19). Objetivo: Presentar el escenario de asistencia nutricional y el perfil clínico y nutricional de pacientes hospitalizadas con Covid-19 en una institución de tratamiento de cáncer de mama. Método: Se presentaron las prácticas de asistencia nutricional realizadas en el Hospital do Cáncer III del Instituto Nacional del Cáncer José Alencar Gomes da Silva (HC III/INCA) durante la pandemia de Covid-19. Los datos clínicos de pacientes con cáncer de mama y Covid-19 se obtuvieron de los registros médicos. Resultados:Algunos cambios en la rutina fueron la suspensión de visitas de nutricionistas en casos confirmados, el uso de equipo de protección personal y cambios en la valoración nutricional. Se incluyeron un total de 23 pacientes, siendo la hipertensión la comorbilidad más común (56,5%) y la estadificación clínica IV más frecuente la (43,5%). Disnea (60,9%), fiebre (30,4%), tos (13%), anemia, neutrofilia, proteína C reactiva alta, hipoalbuminemia y necesidad de oxigenoterapia durante la hospitalización (73,9%) fueron las principales características encontradas. La mayoría recibió dieta líquida por vía oral (52,2%) y al 43,5% se le prescribió un suplemento nutricional. El sobrepeso fue el estado nutricional más prevalente. Conclusión: Además del cáncer de mama, un mayor riesgo de complicaciones por Covid-19 en estas pacientes se asoció con una alta prevalencia de comorbilidades, sobrepeso y metástasis pulmonares. La presencia de síntomas que influyen en la ingesta de alimentos llevó a la necesidad de cambios en la dieta para una mejor aceptación de los alimentos.


Subject(s)
Humans , Female , Adult , Middle Aged , Aged , Breast Neoplasms , Coronavirus Infections , Food Service, Hospital , Nutritional Support
4.
Diaeta (B. Aires) ; 38(173): 49-55, dic. 2020. graf
Article in Spanish | LILACS, BINACIS, UNISALUD | ID: biblio-1278982

ABSTRACT

Resumen Introducción: la aplicación de la telemedicina permite asegurar la atención sanitaria en el contexto de la pandemia por COVID-19. Objetivo: evaluar la telemedicina para el monitoreo de pacientes con nutrición enteral domiciliaria. Materiales y Método: estudio transversal, observacional y descriptivo, con muestreo no probabilístico intencional entre enero y junio de 2020. Se incluyeron pacientes con dificultad para acceder al cuidado domiciliario de profesionales en forma presencial. Todos los pacientes tenían seguro médico, sistema de emergencias a domicilio y un centro asistencial de referencia para derivación. Fueron excluidos pacientes que obligatoriamente necesitaban seguimiento presencial, imposibilidad de comunicación con familiar a cargo y negativa del paciente/familia a la modalidad remota. Variables: edad, sexo, diagnóstico médico, valoración global subjetiva (VGS) en las distintas comunicaciones con el paciente, adherencia a la indicación nutricional, satisfacción del paciente y complicaciones. Se realizó una encuesta telefónica de satisfacción. Las complicaciones se clasificaron en relacionadas y no relacionadas con el soporte nutricional enteral domiciliario (SNED). Resultados: se incluyeron 18 pacientes con diversos diagnósticos médicos. Se realizaron 80 comunicaciones con un total de 2370 días de seguimiento (131,7 ± 63,7 días/paciente), VGS inicial (n=18): 27,7% (n=5) estaba bien nutrido, 61,1% (n=11) en riesgo de desnutrición y 11,1% (n=2) presentaba desnutrición severa. En las 80 comunicaciones, el 97,5% (n=78) cumplió al 100% la prescripción nutricional y el 2,5% (n=2) la respetó en un 50%. Al finalizar el estudio, todos lograron cumplirla. Se observaron 15 eventos adversos: 13 relacionados con el SNED y 2 no relacionados. Dos pacientes fallecieron durante el seguimiento a causa de su patología de base. Satisfacción: el 72,2% (n=13) definió la atención general como muy buena, y el 27,7% (n=5) como excelente. En relación a la atención profesional se encontró que el 22,2% (n=4) la categorizó como excelente, 66,6% (n=12) muy buena y el 11,1% (n=2) buena. Conclusiones: la telemedicina es útil para monitorear el SNED permitiendo disminuir la inequidad geográfica y mejorar la accesibilidad a los cuidados de salud.


Abstract Introduction. telemedicine guarantees health care in the context of the COVID-19 pandemic. Objective: to evaluate telemedicine for monitoring patients with home enteral nutrition. Materials and methods: an observational, descriptive and cross-sectional study, with intentional non-probability sampling, was conducted between January and June, 2020. The patients included were the ones with difficulty to have access to home care by professionals face-to-face. All the patients had health insurance, a home emergency service and a referral center. Patients who necessarily needed face-to-face follow-up, impossibility of communication with a family member in charge, and refusal of the patient / family to the remote modality were excluded. Variables: age, gender, diagnosis, subjective global assessment (SGA) in the different communications with the patient, adherence to nutritional indication, patient satisfaction and complications. A telephone satisfaction survey was conducted. Complications were classified as related and unrelated to home enteral nutritional support (SNED). Results: 18 patients with various medical diagnoses were included. 80 communications were made with a total of 2370 days of follow-up (131.7 ± 63.7 days / patient). SGA (n = 80): 33.75% (n = 27) were well nourished, 58.75% (n = 47) at risk of malnutrition, and 7.5% (n = 6) had severe malnutrition. 97.5% (n = 78) complied 100% with the nutritional prescription and 2.5% (n = 2) respected it by 50%. At the end of the study, all were able to fulfil it. 15 adverse events were observed: 8 related to SNED and 7 unrelated. Two patients died during follow-up due to their underlying pathology. Satisfaction: 72.22% (n = 13) defined general care as very good, and 27.78% (n = 5) as excellent. In relation to professional care, it was found that 22.22% (n = 4) categorized it as excellent, 66.67% (n = 12) very good and 11.11% (n = 2) good. Conclusion: Telemedicine is useful to monitor the SNED, allowing to reduce geographic inequity and improve accessibility to health care.


Subject(s)
Home Care Services , Nutritional Support , COVID-19
6.
Rev. chil. nutr ; 47(4): 597-603, ago. 2020. tab
Article in English | LILACS | ID: biblio-1138594

ABSTRACT

ABSTRACT Background: Oral nutritional supplements aim at offsetting dietary deficits and helping to meet energy and protein targets. Due to the absence of data about their role in food intake, it is necessary to evaluate the contribution of these products to the estimated needs of hospitalized patients. Methods: This is a prospective longitudinal study with hospitalized patients over 18 years of age, admitted to a public university hospital, who were given oral nutritional supplements, according to clinical guidelines. Food intake was quantified throughout the period such products were prescribed. Results: 805-day food intake follow-up and record of 128 patients, who took supplements for 6.4 days on average. The use of nutritional supplements demonstrated a significant contribution to the input of both energy (1576 kcal/day versus 1263 kcal/day, p<0.001) and protein (68.7 g/day versus 50.3 g/day, p<0.001). Conclusions: Nutritional supplements help increase food intake and achieve nutritional goals when prescribed in a hospital setting.


RESUMEN Antecedentes: los suplementos nutricionales orales tienen como objetivo compensar los déficits dietéticos y ayudar a cumplir los objetivos de energía y proteínas. Debido a la ausencia de datos sobre su papel en la ingesta de alimentos, es necesario evaluar la contribución de estos productos a las necesidades estimadas de los pacientes hospitalizados. Métodos: Este es un estudio longitudinal prospectivo con pacientes hospitalizados mayores de 18 años, ingresados en un hospital universitario público, que recibieron suplementos nutricionales orales, según la derivación clínica. La ingesta de alimentos se cuantificó durante todo el período en que se prescribieron dichos productos. Resultados: seguimiento de la ingesta alimentaria de 805 días y registro de 128 pacientes, que tomaron suplementos durante 6,4 días en promedio. El uso de suplementos nutricionales demostró una contribución significativa al aporte de energía (1576 kcal/día versus 1263 kcal/día, p< 0,001) y proteína (68,7 g/día versus 50,3 g/día, p<0,001). Conclusiones: los suplementos nutricionales ayudan a aumentar la ingesta de alimentos y alcanzar objetivos nutricionales cuando se prescriben en un entorno hospitalario.


Subject(s)
Adult , Middle Aged , Proteins , Dietary Supplements , Eating , Patients , Nutritional Support , Hospitals
7.
Invest. educ. enferm ; 38(2): [e08], junio 30 2020.
Article in English | LILACS, BDENF, COLNAL | ID: biblio-1103578

ABSTRACT

Objective. This work sought to describe the meaning of receiving artificial nutritional support in people in the postoperative period of abdominal surgery. Methods. This was a qualitative study of grounded theory, following the guidelines by Corbin and Strauss. The information was collected through 26 in-depth interviews with 21 participants, interned in a tier III health care hospital in the city of Tunja, Colombia. Results. The study describes four categories, which account for the way in which the person experiences physical, physiological, emotional, and social changes when receiving artificial nutritional support. The categories include stopping eating and becoming artificially fed, decreasing the ability to move to recover movement, experiencing the difficulty of having artificial nutritional support, and reaching the disease to transform life. The data analysis shows that the basic surgical pathology and the artificial nutritional support are sudden events that fragment the daily life of the person. These individuals demand the mobilization of religious, family, and social resources to strengthen the person's internal and external environment and, thus, achieve the health situation. Conclusions. The analysis of the meanings shows how the person reflects and interprets the reality of receiving artificial nutritional support, an event that has implicit physical discomfort, emotional changes, and physical appearance, which are determinants in the behavior and practice of artificial nutrition. However, artificial nutritional support becomes for the person an alternative to live and recover the state of health.


Objetivo. Describir los significados de recibir soporte nutricional artificial en personas en periodo postoperatorio de cirugía abdominal. Métodos. Estudio cualitativo de teoría fundamentada, siguiendo los lineamientos de Corbin y Strauss. La información se recolectó a partir de 26 entrevistas en profundidad a 21 participantes internados en un hospital de tercer nivel de atención en salud de la ciudad de Tunja (Colombia). Resultados. El estudio describe cuatro categorías que dan cuenta de la forma en que la persona experimenta cambios físicos, fisiológicos, emocionales y sociales al recibir soporte nutricional artificial en el postoperatorio de cirugía abdominal: 1. dejar de comer y pasar a ser alimentado de manera artificial; 2. disminuyendo la capacidad de moverse hasta recobrar el movimiento; 3. experimentando lo difícil de tener el soporte nutricional artificial, y 4. la enfermedad llega para transformar la vida. La patología quirúrgica de base y el soporte nutrición artificial son eventos súbitos, que fragmentan la vida cotidiana de la persona. En consecuencia, demandan la movilización de recursos religiosos, familiares y sociales para el fortalecimiento del medio interno y externo de la persona y lograr así asumir la situación de salud. Conclusión. El análisis de los significados muestra cómo la persona reflexiona e interpreta la realidad de recibir soporte nutricional artificial, evento que tiene implícito molestias físicas, cambios emocionales y en la apariencia física, los cuales determinan en el comportamiento y prácticas de la persona. El soporte nutricional artificial se convierte para la persona en una alternativa para vivir y recuperar el estado de salud.


Objetivo. Descrever os significados de receber suporte nutricional artificial em pessoas no pós-operatório de cirurgia abdominal. Métodos Estudo qualitativo da teoria fundamentada, seguindo as diretrizes de Corbin e Strauss. As informações foram coletadas através de 26 entrevistas em profundidade com 21 participantes, internados em um hospital de terceiro nível para atendimento de saúde na cidade de Tunja (Colômbia). Resultados O estudo descreve quatro categorias que explicam a maneira pela qual a pessoa experimenta mudanças físicas, fisiológicas, emocionais e sociais, recebendo apoio nutricional artificial no período pós-operatório de cirurgia abdominal: parar de comer e se alimentar artificialmente, reduzindo a capacidade de se mover para recuperar o movimento, enfrentando a dificuldade de ter suporte nutricional artificial e levar a doença a transformar a vida. A patologia cirúrgica básica e o suporte nutricional artificial são eventos repentinos, que fragmentam o cotidiano da pessoa. Eles exigem a mobilização de recursos religiosos, familiares e sociais para fortalecer o ambiente interno e externo da pessoa e, assim, alcançar a situação de saúde. Conclusão A análise dos significados mostra como a pessoa reflete e interpreta a realidade de receber suporte nutricional artificial, um evento que implica desconforto físico implícito, mudanças emocionais e aparência física, determinantes de comportamento e prática diante da nutrição artificial. No entanto, o suporte nutricional artificial torna-se para a pessoa uma alternativa para viver e recuperar o estado de saúde.


Subject(s)
Humans , Postoperative Period , Enteral Nutrition , Parenteral Nutrition , Nutritional Support , Qualitative Research
8.
Diaeta (B. Aires) ; 38(172): 41-54, jun. 2020. graf
Article in Spanish | LILACS, BINACIS, UNISALUD | ID: biblio-1278975

ABSTRACT

Resumen Introducción: los pacientes en hemodiálisis (HD) presentan alta prevalencia de desgaste proteico energético (DPE), caracterizado por pérdida simultánea de grasa y de músculo, inflamación y menor supervivencia. La implementación del soporte nutricional (SN) es fundamental en el tratamiento precoz de la malnutrición. El objetivo general de esta revisión fue analizar la evidencia que existe sobre los resultados del SN en pacientes en HD con desnutrición establecida y/o con riesgo de padecerla y como objetivo específico detallar el efecto del SN en relación a parámetros antropométricos, bioquímicos y clínicos en pacientes en HD. Materiales y método: revisión y actualización bibliográfica, no sistemática. Se incluyeron revisiones sistemáticas, metaanálisis y artículos científicos con antigüedad inferior a 10 años de publicación, que estudiaron efectos de nutrición parenteral intradialítica (NPID) y/o suplemento nutricional oral (SNO) en adultos mayores a 18 años en HD, diseño comparativo intra o intersujeto y tiempo de seguimiento mínimo de 3 meses. Se realizaron búsquedas en Google Scholar, PudMed y Medline entre enero de 2018 a enero 2019. Fueron recolectados y analizados 17 estudios, con un total de 31.761 pacientes. Resultados y conclusiones: el asesoramiento nutricional y el SNO son la primera línea para abordar la malnutrición en HD. La implementación precoz del SN en cualquiera de sus formas es una estrategia eficaz que tiene el potencial de mejorar parámetros antropométricos, bioquímicos, calidad de vida y morbimortalidad. La mayoría de los estudios analizados presentan limitantes como pequeño tamaño muestral, heterogeneidad de la población y diversidad en los tiempos de seguimiento. Se requieren más estudios prospectivos y controlados para evaluar los efectos del SN sobre el estado nutricional y la sobrevida de pacientes en HD y para poder verificar la seguridad y eficacia de la intervención nutricional y su impacto en los resultados clínicos.


Abstract Introduction: hemodialysis (HD) patients have a high prevalence of protein energy wasting, characterized by simultaneous loss of fat and muscle, inflammation and reduced survival. The implementation of nutritional support (NS) is essential in the early treatment of malnutrition. The general objective of this review was to analyze the evidence that exists on the results of the nutritional support in HD patients with established malnutrition and / or at risk of suffering it and, as a specific objective, to detail the effect of the nutritional support in relation to anthropometric, biochemical and clinical parameters in HD patients. Materials and method: review and bibliographic update, not systematic. Systematic reviews were included, as well as meta-analyzes and scientific articles less than 10 years old, that studied the effects of Intradialytic Parenteral Nutrition and / or oral nutritional supplements (ONS) in adults over 18 years old in HD, intra or inter-subject comparative design and minimum follow-up of 3 months. Searches on Google Scholar, PudMed and Medline were carried out between January 2018 and January 2019. 17 studies were collected and analyzed, with a total of 31,761 patients. Results and conclusions: nutritional assessment and ONS are the first line to address malnutrition in HD. The quick implementation of NS in any of its forms is an effective strategy that has the potential to improve anthropometric and biochemical parameters, quality of life, and morbidity. Most of the studies analyzed have limitations such as small sample size, heterogeneity of the population and diversity in follow-up times. Further prospective and controlled studies are required to assess the effects of nutritional support on the nutritional status and survival of HD patients and to verify the safety and efficacy of nutritional intervention and its impact on clinical results.


Subject(s)
Renal Dialysis , Nutrition Assessment , Nutritional Status , Nutritional Support , Malnutrition
9.
Article in Chinese | WPRIM | ID: wpr-828558

ABSTRACT

Severe and critically ill patients with coronavirus disease 2019 (COVID-19) were usually with underlying diseases, which led to the problems of complicated drug use, potential drug-drug interactions and medication errors in special patients. Based on ( 6), and -19: , we summarized the experience in the use of antiviral drugs, corticosteroids, vascular active drugs, antibacterial, probiotics, nutrition support schemes in severe and critically ill COVID-19 patients. It is also suggested to focus on medication management for evaluation of drug efficacy and duration of treatment, prevention and treatment of adverse drug reactions, identification of potential drug-drug interactions, individualized medication monitoring based on biosafety protection, and medication administration for special patients.


Subject(s)
Adrenal Cortex Hormones , Therapeutic Uses , Anti-Bacterial Agents , Therapeutic Uses , Antiviral Agents , Therapeutic Uses , Betacoronavirus , Coronavirus Infections , Drug Therapy , Critical Illness , Drug Therapy , Humans , Nutritional Support , Pandemics , Pneumonia, Viral , Drug Therapy , Probiotics
10.
Article in Chinese | WPRIM | ID: wpr-828490

ABSTRACT

Nutritional support is an indispensable part in the treatment of critically ill patients with coronavirus disease 2019 (COVID-19). Critically ill COVID-19 patients are often in a state of high inflammation, high stress, high catabolism, and their energy consumption increases significantly. All critically ill patients with COVID-19 should be screened for nutritional risk with NRS-2002 or Nutric tool in the early stage. If there is a risk of malnutrition, subjective global assessment (SGA) or Global Leadership Initiative on Malnutrition (GLIM) are further used for malnutrition assessment. After assessment, the daily energy, protein, electrolyte and liquid quantity needed by the patients should be determined according to the actual condition. Then, according to the degree of gastrointestinal function impairment in patients, the oral nutrition supplement, enteral nutrition, parenteral nutrition or their combination are selected for nutritional support. For patients with normal gastrointestinal function who require prone position ventilation or receive extracorporeal membrane oxygenation (ECMO) treatment, enteral nutrition is recommended as the first choice. In addition, in the process of nutrition implementation, it is necessary to closely monitor the adverse reactions such as abdominal distention, diarrhea, regurgitation, phlebitis and liver function damage, timely adjust the nutrition program to ensure the smooth implementation of nutritional support. Based on the metabolic characteristics of critically ill patients with COVID-19, this paper makes a summary and suggestion on the following perspectives such as nutritional risk screening and assessment, target amount of nutritional treatment, nutritional intervention and treatment, nutritional support of special populations, and common adverse reactions in nutritional support treatment, so as to provide reference for individualized nutritional support therapy of critically ill patients with COVID-19.


Subject(s)
Betacoronavirus , Coronavirus Infections , Critical Illness , Humans , Nutritional Support , Pandemics , Pneumonia, Viral
11.
Article in Chinese | WPRIM | ID: wpr-827533

ABSTRACT

Surgery, radiotherapy, and chemotherapy are the main treatments for tongue cancer, but the nutritional status of patients is not considered. Nutritional treatment is often not standard or by experience. This article reports a patient with tongue cancer who underwent preoperative chemotherapy and postoperative nutrition treatment. The entire process of individualized and sequential nutrition therapy was adopted, and the nutritional status of the patient was significantly improved. This paper describes the methods of nutrition therapy and evaluation and discusses the treatment process and key points in combination with relevant literature.


Subject(s)
Enteral Nutrition , Humans , Nutritional Support , Postoperative Period , Tongue Neoplasms
12.
Einstein (Säo Paulo) ; 18: eRW5774, 2020. tab
Article in English | LILACS | ID: biblio-1133745

ABSTRACT

ABSTRACT Coronavirus disease 2019 (COVID-19) is a disease caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which has spread globally in pandemic proportions. Accumulative evidence suggests SARS-CoV-2 can be transmitted through the digestive system, the so-called fecal-oral route of transmission, and may induce several gastrointestinal manifestations. MEDLINE® and Embase databases were extensively searched for major clinical manifestations of gastrointestinal involvement in children and adolescents with COVID-19 reported in medical literature, and for nutritional therapy-related data. Findings and recommendations were pragmatically described to facilitate overall pediatric approach. A total of 196 studies addressing gastrointestinal or nutritional aspects associated with the global COVID-19 pandemic were found. Of these, only 17 focused specifically on pediatric patients with regard to aforementioned gastrointestinal or nutritional aspects. Most articles were descriptive and six addressed guidelines, established protocols, or expert opinions. Children and adolescents with gastrointestinal symptoms, such as nausea, vomiting and diarrhea, should be seriously suspected of COVID-19. Gastrointestinal signs and symptoms may occur in 3% to 79% of children, adolescents and adults with COVID-19, and are more common in severe cases. These include diarrhea (2% to 50%), anorexia (40% to 50%), vomiting (4% to 67%), nausea (1% to 30%), abdominal pain (2% to 6%) and gastrointestinal bleeding (4% to 14%). Patients with inflammatory bowel disease or chronic liver disease are not at greater risk of infection by SARS-CoV-2 relative to the general population. Nutritional support plays an important role in treatment of pediatric patients, particularly those with severe or critical forms of the disease. The digestive system may be a potential route of COVID-19 transmission. Further research is needed to determine whether the fecal-oral route may be involved in viral spread. Nutritional therapy is vital to prevent malnutrition and sarcopenia in severe cases.


RESUMO A doença pelo coronavírus 2019 (COVID-19) é causada pelo coronavírus da síndrome respiratória aguda grave 2 (SARS-CoV-2) e foi amplamente disseminada em todo o mundo em proporções pandêmicas. Evidências crescentes sugerem que o sistema digestivo pode ser uma via potencial para a infecção pelo SARS-CoV-2, para a disseminação do vírus por via fecal-oral, e estar relacionado com vários sintomas gastrintestinais. Realizamos uma extensa revisão da literatura médica utilizando os bancos de dados MEDLINE® e Embase, com o objetivo de identificar as principais manifestações clínicas do envolvimento gastrintestinal e analisar a terapia nutricional em crianças e adolescentes com COVID-19. Os achados e as recomendações foram descritos de maneira pragmática, para facilitar a abordagem do pediatra em geral. Foram analisados 196 estudos relacionados ao envolvimento do trato gastrintestinal ou aspectos nutricionais associados à pandemia de COVID-19 em todo o mundo. Destes estudos, apenas 17 incluíram a população pediátrica exclusivamente com aspectos gastrintestinais ou nutricionais específicos. Os artigos, em sua maioria, foram descritivos, sendo seis relacionados a diretrizes, protocolos instituídos ou opiniões de especialistas. Crianças e adolescentes com sintomas gastrintestinais, como náusea, vômito e diarreia, devem ser avaliados como pacientes suspeitos de COVID-19. Os sinais e sintomas gastrintestinais podem ocorrer em 3% a 79% das crianças, adolescentes e adultos com COVID-19, estando mais frequentemente presentes em casos graves. Incluem diarreia (2% a 50%), anorexia (40% a 50%), vômitos (4% a 67%), náusea (1% a 30%), dor abdominal (2% a 6%) e sangramento gastrintestinal (4% a 14%). Pacientes com doença inflamatória intestinal ou doenças hepáticas crônicas não apresentam maior risco de infecção por SARS-CoV-2 do que a população em geral. O suporte nutricional é parte muito importante do tratamento de pacientes pediátricos, principalmente nas formas graves ou críticas da doença. O trato gastrintestinal pode ser uma via potencial para a infecção por COVID-19. Mais pesquisas são necessárias para determinar a possibilidade da transmissão fecal-oral, importante para a disseminação viral. A terapia nutricional é essencial para prevenir desnutrição e sarcopenia nos casos graves.


Subject(s)
Humans , Child , Adolescent , Pneumonia, Viral/therapy , Coronavirus Infections/therapy , Nutritional Support , Gastrointestinal Diseases/virology , Pneumonia, Viral/complications , Coronavirus Infections/complications , Pandemics , Pediatricians , Betacoronavirus , SARS-CoV-2 , COVID-19
13.
Clin. biomed. res ; 40(3): 167-172, 2020. graf, tab
Article in English | LILACS | ID: biblio-1248222

ABSTRACT

Introduction: To assess the use of nutritional support in children and adolescents submitted to autologous hematopoietic stem cell transplantation (HSCT), and analyze changes in nutritional status at hospital discharge after HSCT. Methods: A retrospective observational study was conducted on pediatric oncology patients hospitalized for autologous HSCT between 2010 and 2017. Nutritional therapy was evaluated based on the duration of enteral tube feeding (ETF) and parenteral nutrition (PN), either alone or in combination. The length of hospital stay was measured in days. Nutritional status was assessed at admission and discharge, and classified according to World Health Organization criteria. Results: The sample consisted of 68 patients, 54.4% of whom were boys. Most participants (89.7%) had solid tumors. Nutritional therapy was required in over half (52.9%) of cases, with PN being the most common indication. There was a reduction in the percentage of overweight patients and an increase in the percentage of underweight patients at discharge relative to admission. Conclusions: The use of nutritional therapy is highly prevalent in this population, and HSCT has a negative impact on nutritional status at discharge. (AU)


Subject(s)
Humans , Male , Female , Infant, Newborn , Infant , Child, Preschool , Child , Adolescent , Nutritional Status , Nutritional Support , Transplant Recipients , Thinness , Enteral Nutrition , Parenteral Nutrition , Hematopoietic Stem Cell Transplantation , Length of Stay , Obesity
14.
Rev. Paul. Pediatr. (Ed. Port., Online) ; 37(4): 472-478, Oct.-Dec. 2019. tab, graf
Article in English | LILACS | ID: biblio-1041354

ABSTRACT

ABSTRACT Objective: To create an electronic instrument in order to analyze the adequacy of the preterm infants' nutritional therapy, checking the difference between the prescribed and the administered diet. Methods: A prospective and observational study on newborns with birthweight ≤1,500g and/or gestational age ≤32 weeks, without congenital malformations. The electronic instrument was developed based on Microsoft Excel 2010 spreadsheets and aimed at automatically calculating body weight gain, calories and macronutrients received daily by each patient from parenteral nutrition, intravenous hydration and enteral feedings. The weekly means of each nutrient were used to compare the prescribed and administered diets. Results: To evaluate the instrument, 60 newborns with a birth weight of 1,289±305 g and a gestational age of 30±2 weeks were included. Of them, 9.6% had restricted growth at birth and 55% at discharge. The median length of stay was 45±17 days. There were significant differences between prescribed and administered diet for all of the macronutrients and for total calories in the first three weeks. The lipid was the macronutrient with the greatest percentage error in the first week of life. Conclusions: The use of a computational routine was important to verify differences between the prescribed and the administered diet. This analysis is necessary to minimize calculation errors and to speed up health providers' decisions about the nutritional approach, which can contribute to patients' safety and to good nutritional practice. Very low birth weight infants are extremely vulnerable to nutritional deficiencies and any reduction in macronutrients they receive may be harmful to achieve satisfactory growth.


RESUMO Objetivo: Elaborar um instrumento eletrônico para análise da adequação da terapia nutricional dos recém-nascidos pré-termo, verificando a diferença entre a dieta prescrita e a administrada. Métodos: Estudo observacional prospectivo em recém-nascidos com peso de nascimento ≤1.500 g e/ou idade gestacional ≤32 semanas, sem malformações congênitas. O instrumento eletrônico foi desenvolvido com base em planilhas do Microsoft Excel 2010 para calcular automaticamente ganho de peso corporal, calorias e macronutrientes diariamente recebidos pelos pacientes por meio de dietas parenteral e enteral. Para comparar a dieta prescrita e a administrada, foram utilizados os resultados das médias semanais. Resultados: Para avaliar o instrumento, foram incluídos 60 recém-nascidos com peso de nascimento de 1.289±305 g e idade gestacional de 30±2 semanas. Destes, 9,6% apresentavam restrição de crescimento no nascimento e 55% no momento da alta. A média de internação foi de 45±17 dias. Foram verificadas diferenças significativas entre a dieta prescrita e a administrada para todos os macronutrientes e calorias totais nas três primeiras semanas. O lipídeo foi o macronutriente com o maior erro percentual na primeira semana. Conclusões: O emprego de uma rotina computacional foi importante para verificar discrepâncias entre a dieta prescrita e a administrada. Essa análise é necessária para minimizar erros de cálculo e agilizar as decisões da equipe de saúde acerca da abordagem nutricional, podendo contribuir para a segurança do paciente e para a boa prática nutricional. Os recém-nascidos de muito baixo peso são extremamente vulneráveis às deficiências nutricionais e qualquer redução nos macronutrientes recebidos pode ser deletéria para o crescimento satisfatório.


Subject(s)
Humans , Male , Female , Infant, Newborn , Nutritional Support/standards , Medical Errors/statistics & numerical data , Electronic Health Records , Infant Care/standards , Practice Patterns, Physicians' , Brazil , Infant, Premature/physiology , Prospective Studies , Nutritional Support/statistics & numerical data , Medical Errors/prevention & control , Patient Safety , Infant Care/statistics & numerical data , Nutritional Physiological Phenomena
15.
Rev. chil. nutr ; 46(5): 535-544, oct. 2019. tab, graf
Article in Spanish | LILACS | ID: biblio-1042693

ABSTRACT

El soporte nutricional que se brinda a los pacientes críticos, constituye para la mayoría la única vía de acceso a través de la cual es posible cubrir sus requerimientos nutricionales diarios. Sin embargo, se ha identificado que la presencia de deuda calórica impide cubrir dichos requerimientos. Este estudio determinó la deuda calórica y su potencial efecto clínico a través de una cohorte prospectiva que incluyó 191 pacientes que recibieron soporte nutricional en unidades de cuidado intensivo (UCI). Se evaluó la magnitud de la deuda calórica, los principales factores que la favorecen y se exploraron diferencias en desenlaces clínicos relacionados con mortalidad, complicaciones infecciosas y tiempo de estancia en UCI. Los resultados evidenciaron que la deuda calórica estuvo presente en el 73,8%(IC 95% = 67%-80%) de los pacientes evaluados; la principal causa estuvo relacionada con la interrupción de la nutrición enteral y no se encontró asociación entre el porcentaje de adecuación calórico y los desenlaces evaluados. Esta evaluación permitió establecer que la mayoría de los pacientes, a pesar de recibir soporte nutricional, se encuentran expuestos a deuda calórica siendo necesario generar estrategias de atención que permitan disminuir la exposición de esta población a dicha condición.


The nutritional support offered to critically ill patients is, for most of them, the only means to fulfill their daily nutritional requirements. However, it has been documented that nutritional support is not enough to cover such needs, due to the presence of caloric debt. We seek to determine the caloric debt and its potential to clinical affect critically ill patients that receive nutritional support in the Intensive Care Unit (ICU). We conducted a prospective cohort study with 191 patients. We assessed the magnitude of caloric debt and its related factors. We also explored variations in clinical outcomes related to mortality, infectious complications and ICU stay length. Caloric debt was found in 73.8% (95% CI = 67-80%) of patients who received less than 80% of their daily caloric requirements. Main causes were related to enteral nutrition interruption. We found no association between caloric debt and the evaluated outcomes. This evaluation made it possible to establish that the majority of patients, despite receiving nutritional support, were exposed to caloric debt, and it is necessary to generate care strategies to reduce the patients' exposure to this condition.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Enteral Nutrition , Parenteral Nutrition , Caloric Restriction/adverse effects , Intensive Care Units , Prospective Studies , Risk Factors , Follow-Up Studies , Critical Illness , Nutritional Support , Eating , Hospitalization
16.
Rev. bras. ter. intensiva ; 31(2): 171-179, abr.-jun. 2019. tab, graf
Article in Portuguese | LILACS | ID: biblio-1013772

ABSTRACT

RESUMO Objetivo: Avaliar as diferenças entre os desfechos da terapia nutricional com ingestão ideal de calorias mais alto teor proteico e do padrão de cuidados nutricionais em pacientes críticos adultos. Métodos: Randomizamos pacientes com previsão de permanecer na unidade de terapia intensiva por pelo menos 3 dias. No grupo com ingestão ideal de calorias mais alto teor proteico, a necessidade de ingestão calórica foi determinada por calorimetria indireta e a ingestão proteica foi estabelecida em níveis de 2,0 a 2,2g/kg/dia. O grupo controle recebeu calorias em nível de 25kcal/kg/dia e 1,4 a 1,5g/kg/dia de proteínas. O desfecho primário foi o escore do sumário do componente físico obtido aos 3 e 6 meses após a randomização. Os desfechos secundários incluíram força de preensão manual quando da alta da unidade de terapia intensiva, duração da ventilação mecânica e mortalidade hospitalar. Resultados: A análise incluiu 120 pacientes. Não houve diferença significante entre os dois grupos em termos de calorias recebidas. Contudo, a quantidade de proteínas recebidas pelo grupo com nível ideal de calorias mais alto teor de proteínas foi significantemente mais alta do que a recebida pelo grupo controle. O escore do sumário componente físico aos 3 e 6 meses após a randomização não diferiu entre ambos os grupos, assim como não diferiram os desfechos secundários. Entretanto, após ajuste para covariáveis, um delta proteico negativo (proteínas recebidas menos a necessidade proteica predeterminada) se associou com escore do sumário do componente físico mais baixo nas avaliações realizadas 3 e 6 meses após a randomização. Conclusão: Neste estudo, a estratégia com ingestão calórica ideal mais elevado teor proteico não pareceu melhorar a qualidade de vida física em comparação aos cuidados nutricionais padrão. Contudo, após ajuste para covariáveis, um delta proteico negativo se associou com escores do sumário do componente físico mais baixos nas avaliações realizadas aos 3 e aos 6 meses após a randomização. Esta associação ocorreu independentemente do método de cálculo do alvo proteico.


ABSTRACT Objective: To evaluate differences in outcomes for an optimized calorie and high protein nutrition therapy versus standard nutrition care in critically ill adult patients. Methods: We randomized patients expected to stay in the intensive care unit for at least 3 days. In the optimized calorie and high protein nutrition group, caloric intake was determined by indirect calorimetry, and protein intake was established at 2.0 to 2.2g/kg/day. The control group received 25kcal/kg/day of calories and 1.4 to 1.5g/kg/day protein. The primary outcome was the physical component summary score obtained at 3 and 6 months. Secondary outcomes included handgrip strength at intensive care unit discharge, duration of mechanical ventilation and hospital mortality. Results: In total, 120 patients were included in the analysis. There was no significant difference between the two groups in calories received. However, the amount of protein received by the optimized calorie and high protein nutrition group was significantly higher compared with the control group. The physical component summary score at 3 and 6 months did not differ between the two groups nor did secondary outcomes. However, after adjusting for covariates, a negative delta protein (protein received minus predetermined protein requirement) was associated with a lower physical component summary score at 3 and 6 months postrandomization. Conclusion: In this study optimized calorie and high protein strategy did not appear to improve physical quality of life compared with standard nutrition care. However, after adjusting for covariates, a negative delta protein was associated with a lower physical component summary score at 3 and 6 months postrandomization. This association exists independently of the method of calculation of protein target.


Subject(s)
Humans , Aged , Aged, 80 and over , Energy Intake , Dietary Proteins/administration & dosage , Nutritional Support/methods , Critical Care/methods , Quality of Life , Respiration, Artificial/statistics & numerical data , Prospective Studies , Hospital Mortality , Critical Illness , Intensive Care Units , Middle Aged , Nutritional Requirements
17.
Neumol. pediátr. (En línea) ; 14(1): 34-40, abr. 2019. ilus, tab
Article in Spanish | LILACS | ID: biblio-995735

ABSTRACT

Extracorporeal membrane oxygenation (ECMO) is an ever more available technique for reversible catastrophic heart or pulmonary failure that requires permanent training and actualization. This article reviews inclusion criteria, basic concepts, anticoagulation management, use of vasoactive drugs, respiratory support, laboratory tests and weaning. An up to date and easy to use reference material we hope will facilitate the study and implementation of ECMO in centers that are, or look to be, providers. The authors have made an exhaustive review of published literature and have also referenced the Extracorporeal Life Support Organization (ELSO) guidelines.


La oxigenación de membrana extracorpórea (ECMO) es una técnica indicada para falla cardiológica y/o pulmonar catastrófica de etiología recuperable, cada vez más disponible, lo que hace necesario que los prestadores de cuidados intensivos estén actualizados en esta técnica. Este artículo repasa conceptos, criterios de inclusión, manejo de anticoagulación, uso de drogas vasoactivas, apoyo ventilatorio, exámenes paraclínicos y destete de la asistencia. El tener una referencia actualizada, fácil y concreta facilita el estudio e implementación de ECMO en centros que van a disponer del mismo o que ya la están desarrollando. Los autores hicieron una revisión exhaustiva de la literatura publicada y de la normativa internacional disponible de la Organización del soporte de vida extracorpóreo (ELSO por su sigla en inglés Extracorporeal Life Support Organization).


Subject(s)
Humans , Child , Respiratory Insufficiency/therapy , Extracorporeal Membrane Oxygenation/standards , Extracorporeal Membrane Oxygenation/adverse effects , Extracorporeal Membrane Oxygenation/methods , Patient Selection , Nutritional Support , Monitoring, Physiologic
18.
Rev. Col. Bras. Cir ; 46(5): e20192267, 2019. tab, graf
Article in Portuguese | LILACS | ID: biblio-1057167

ABSTRACT

RESUMO Várias doenças da cavidade abdominal têm, na abordagem cirúrgica, sua principal forma de tratamento. Entretanto, o próprio procedimento cirúrgico é um agente estressor que pode promover efeitos adversos não relacionados com o objetivo do tratamento. A pré-habilitação emergiu como um programa multifatorial de condicionamento de saúde pré-operatório, que promove melhora na capacidade funcional e na evolução pós-operatória. O presente estudo faz uma revisão da literatura usando os bancos de dado MEDLINE, Ovid, Google Scholar e Cochrane para determinar o conceito, as indicações, os meios de seleção dos pacientes, e para sugerir as formas de implementação do programa de pré-habilitação em cirurgias abdominais de grande porte.


ABSTRACT Surgical approach is the main form of treatment for several diseases of the abdominal cavity. However, surgical procedure itself is a stressor that may lead to adverse effects unrelated to the treatment goal. Prehabilitation has emerged as a multifactorial preoperative health conditioning program, which promotes improvement in functional capacity and postoperative evolution. The present study reviews literature using MEDLINE, Ovid, Google Scholar, and Cochrane databases in order to determine the concept of prehabilitation program and the indications and means of patient selection for it, as well as to suggest ways to implement this program in cases of major abdominal surgeries.


Subject(s)
Humans , Male , Female , Postoperative Complications/prevention & control , Preoperative Care/methods , Elective Surgical Procedures/psychology , Abdomen/surgery , Postoperative Period , Psychotherapy , Preoperative Care/psychology , Exercise , Risk Factors , Nutritional Support , Recovery of Function
19.
Article in English | WPRIM | ID: wpr-719561

ABSTRACT

Tube feeding is used to provide nutritional support to patients who have difficulty taking food orally. A nasogastric tube is commonly used for these patients but there are some complications. Therefore, the oro-esophageal tube feeding method was developed to avoid these disadvantages. A 33-year-old male with a history of right basal ganglia intracranial hemorrhage was admitted to the rehabilitation department for the treatment of dysphagia caused by a new onset left basal ganglia intracranial hemorrhage. After the videofluoroscopic swallowing study, the nasogastric tube feeding was changed to intermittent feeding via an oro-esophageal tube. Unfortunately, the patient swallowed the tube during insertion. Hence, an emergent endoscopy was performed for tube removal. This article reports a rare case of a patient who underwent oro-esophageal tube removal with an esophagogastroduodenoscopy after tube swallowing during insertion. The insertion of an oro-esophageal tube requires a careful approach after considering the cognitive function, muscle strength, and family education.


Subject(s)
Adult , Basal Ganglia , Cognition , Deglutition , Deglutition Disorders , Education , Endoscopy , Endoscopy, Digestive System , Enteral Nutrition , Humans , Intracranial Hemorrhages , Male , Methods , Muscle Strength , Nutritional Support , Rehabilitation
20.
Article in Korean | WPRIM | ID: wpr-765994

ABSTRACT

PURPOSE: Poor nutrition in hospitalized patients is closely linked to an increased risk of infection, which can result in complications affecting mortality, as well as increased length of hospital stay and hospital costs. Therefore, adequate nutritional support is essential to manage the nutritional risk status of patients. Nutritional support needs to be preceded by nutrition screening, in which accuracy is crucial, particularly for the initial screening. To perform initial nutrition screening of hospitalized patients, we used the Catholic Kwandong University (CKU) Nutritional Risk Screening (CKUNRS) tool, originally developed at CKU Hospital. To validate CKUNRS against the Patient-Generated Subjective Global Assessment (PG-SGA) tool, which is considered the gold standard for nutritional risk screening, results from both tools were compared. METHODS: Nutritional status was evaluated in 686 adult patients admitted to CKU Hospital from May 1 to July 31, 2018 using both CKUNRS and PG-SGA. Collected data were analyzed, and the results compared, to validate CKUNRS as a nutrition screening tool. RESULTS: The comparison of CKUNRS and PG-SGA revealed that the prevalence of nutritional risk on admission was 15.6% (n = 107) with CKUNRS and 44.6% (n = 306) with PG-SGA. The sensitivity and specificity of CKUNRS to evaluate nutritional risk status were 98.7% (96.8 ~ 99.5) and 33.3% (28.1 ~ 39.0), respectively. Thus, the sensitivity was higher, but the specificity lower compared with PG-SGA. Cohen's kappa coefficient was 0.34, indicating valid agreement between the two tools. CONCLUSION: This study found concordance between CKUNRS and PG-SGA. However, the prevalence of nutritional risk in hospitalized patients was higher when determined by CKUNRS, compared with that by PG-SGA. Accordingly, CKUNRS needs further modification and improvement in terms of screening criteria to promote more effective nutritional support for patients who have been admitted for inpatient care.


Subject(s)
Adult , Hospital Costs , Humans , Inpatients , Length of Stay , Mass Screening , Mortality , Nutritional Status , Nutritional Support , Prevalence , Sensitivity and Specificity
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