Status and nutritional therapy in elective and emergency neurosurgery patients.

OBJEVECT: To evaluate the Nutritional Status (NS) and follow the Enteral Nutritional Therapy (ENT) of patients in neurosurgical intervention. METHOD: Cohort study in emergency or elective surgery patients with exclusive ENT. Anthropometric measurements (Arm Circumference (AC and Triceps Skinfold (TSF)) were measured on the first, seventh and 14th day. For the ENT monitoring, caloric/protein adequacy, fasting, inadvertent output of the enteral probe and residual gastric volume were used. RESULTS: 80 patients, 78.7% in emergency surgery and 21.3% in elective surgery. There was a reduction in AC and Body Mass Index (BMI) (p>0.01), especially for the emergency group. The caloric/protein adequacy was higher in the emergency group (86.7% and 81.8%). CONCLUSION: The EN change was greater in the emergency group, even with better ENT adequacy. Changes in body composition are frequent in neurosurgical patients, regardless of the type of procedure.

Status and nutritional therapy in elective and emergency neurosurgery patients / Estado y terapia nutricional en pacientes de neurocirugía electiva y urgencia / Estado e terapia nutricional em pacientes de neurocirurgia eletiva e urgência

ABSTRACT Objevect: To evaluate the Nutritional Status (NS) and follow the Enteral Nutritional Therapy (ENT) of patients in neurosurgical intervention. Method: Cohort study in emergency or elective surgery patients with exclusive ENT. Anthropometric measurements (Arm Circumference (AC and Triceps Skinfold (TSF)) were measured on the first, seventh and 14th day. For the ENT monitoring, caloric/protein adequacy, fasting, inadvertent output of the enteral probe and residual gastric volume were used. Results: 80 patients, 78.7% in emergency surgery and 21.3% in elective surgery. There was a reduction in AC and Body Mass Index (BMI) (p>0.01), especially for the emergency group. The caloric/protein adequacy was higher in the emergency group (86.7% and 81.8%). Conclusion: The EN change was greater in the emergency group, even with better ENT adequacy. Changes in body composition are frequent in neurosurgical patients, regardless of the type of procedure.

RESUMEN Objetivo: Evaluar el Estado Nutricional (EN) y acompañar la Terapia Nutricional Enteral (TNE) de pacientes en intervención neuroquirúrgica. Método: Estudio tipo cohorte en pacientes de cirugía de urgencia o electiva, con TNE exclusiva. Se midieron medidas antropométricas (Circunferencia del Brazo (CB) y Pliegue Cutáneo Tricipital (PCT)) en el primer, séptimo y decimocuarto días. Para el monitoreo de la TNE: adecuación calórica/proteica, desayuno, salida inadvertida de la sonda enteral y volumen residual gástrico. Resultados: 80 pacientes, 78,7% en cirugía de urgencia y 21,3% en electiva. Hubo reducción de la CB y del Índice Masa Corporal (IMC) (p> 0,01), en especial para el grupo de urgencia. La adecuación calórica/proteica fue superior en el grupo de urgencia (86,7% y 81,8%). Conclusión: La alteración del EN fue más alta en el grupo de urgencia mismo con mejor adecuación de la TNE. La alteración de la composición corporal es frecuente en pacientes neuroquirúrgicos independientemente del tipo de procedimiento.

RESUMO Objetivo: Avaliar o Estado Nutricional (EN) e acompanhar a Terapia Nutricional Enteral (TNE) de pacientes em intervenção neurocirúrgica. Método: Estudo tipo coorte em pacientes de cirurgia de urgência ou eletiva, com TNE exclusiva. Foram aferidas medidas antropométricas (Circunferência do Braço (CB) e Dobra Cutânea Tricipital (DCT)) no primeiro, sétimo e 14º dia. Para o monitoramento da TNE, utilizou-se: adequação calórico/proteica, jejum, saída inadvertida da sonda enteral e volume residual gástrico. Resultados: 80 pacientes, 78,7% em cirurgia de urgência e 21,3% em eletiva. Houve redução da CB e do Índice de Massa Corporal (IMC) (p>0,01), em especial para o grupo de urgência. A adequação calórica/proteica foi superior no grupo de urgência (86,7% e 81,8%). Conclusão: A alteração do EN foi maior no grupo de urgência mesmo com melhor adequação da TNE. A alteração da composição corporal é frequente em pacientes neurocirúrgicos, independentemente do tipo de procedimento.

Sistematização do atendimento nutricional de um hospital universitário / Systematization of nutritional care of a university hospital

INTRODUÇÃO: As diferentes condutas nutricionais adotadas na prática clínica interferem diretamente no cuidado ao paciente. A criação de protocolos é necessária para otimizar a assistência nutricional, padronizar e sistematizar processos para maior segurança terapêutica, minimizando variações individuais e unificando o modelo de atendimento. OBJETIVO: Sistematizar as condutas nutricionais para pacientes de um Hospital Universitário a partir da realização da triagem, avaliação, aplicação dos protocolos e monitorização da terapia nutricional. MÉTODOS: Estudo do tipo coorte, prospectivo, quantitativo, realizado no período de junho a setembro de 2017. RESULTADOS: 297 indivíduos participaram do estudo, sendo 245 (82%) em terapia nutricional oral (Grupo 1) e 52 (18%) em terapia nutricional enteral ou parenteral exclusiva (Grupo 2).69% do grupo 1 foram triados nas primeiras 24 horas; a maioria classificado como eutrófico ou sobrepeso e 29,8% apresentavam risco nutricional. A consistência predominante da dieta foi geral ou branda, com boa aceitação em 69,8% dos casos. No grupo 2, 42,3% foram triados nas primeiras 24 horas, 28,8% foram classificados como baixo peso, porém 51,9% apresentavam risco nutricional. O tempo médio para alcance da meta nutricional foi de 3 dias. DISCUSSÃO: O diagnóstico nutricional é fundamental para a adoção de uma terapia precoce. O NRS 2002 tem sido considerado o melhor instrumento para detecção de risco nutricional. Recomenda-se o início precoce da terapia nutricional enteral entre 24-48 horas e alcance das metas nutricionais em 48-72 horas. CONCLUSÃO: A triagem nutricional mostrou-se mais sensível para a identificação do risco nutricional. Os indicadores de qualidade se encontram fora do preconizado pela literatura. A partir de sua mensuração, é possível a identificação dos fatores a serem modificados e o desenvolvimento de estratégias para otimização do cuidado prestado

INTRODUCTION: The different nutritional methods adopted in clinical practice interfere directly with patient care. The creation of protocols is necessary to optimize nutritional assistance, standardize and systematize processes for greater therapeutic safety, minimize individual variations and unify the care model. OBJECTIVE: To systematize the nutritional treatments for patients in a University Hospital for screening, evaluation, application of protocols and monitoring of nutritional therapy. RESULTS: 297 subjects participated in the study, being 245 (82%) in oral nutritional therapy (Group 1) and 52 (18%) in exclusive enteral or parenteral nutritional therapy (Group 2).69% of group 1 were screened in the first 24 hours; the majority classified as eutrophic or overweight and 29.8% presented nutritional risk. The predominant consistency of diet was general or mild, with good acceptance in 69.8% of the cases. In group 2, 42.3% were screened in the first 24 hours, 28.8% were classified as low weight, but 51.9% presented nutritional risk. The mean time to reach the nutritional goal was 3 days. DISCUSSION: The nutritional diagnosis is fundamental for the adoption of an early therapy. The NRS 2002 has been considered the best instrument for nutritional risk detection. Early initiation of enteral nutritional therapy is recommended between 24-48 hours and achieving nutritional goals within 48-72 hours. CONCLUSION: Screening from the nutritional was sensitive to the identification of nutritional risk. Quality indicators are out of line with the literature. From its measurement, it is possible to identify the factors to be modified and develop of strategies to optimize the care provided

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Triagem nutricional de pacientes internados no serviço de emergência / Nutritional screening of hospitalized patients in an emergency service

Introdução: A identificação do risco nutricional na admissão do indivíduo hospitalizado é fundamental, pois auxilia no estabelecimento de prioridades e assistência nutricional adequadas. Portanto, o objetivo deste estudo foi identificar o risco nutricional dos pacientes internados no serviço de emergência e associar com idade, morbidade, avaliação antropométrica, tempo de internação e readmissão. Método: O estudo foi exploratório, descritivo, transversal, com abordagem quantitativa, realizado no setor de emergência de um hospital universitário, em pacientes acima de 18 anos. Para identificação do risco nutricional, foi aplicado instrumento de triagem nutricional (NRS/2002) nas primeiras 72 horas da internação hospitalar e realizada coleta e aferição de variáveis antropométricas, como peso, estatura, circunferência do braço, circunferência da panturrilha e altura do joelho. Para as associações estatísticas, foram utilizados os testes Mann-Whitney e Qui-quadrado. Resultados: Foram avaliados ao final 208 pacientes, maioria do sexo masculino (53,4%) e idosos (62%), sendo que 63% da população total apresentaram risco nutricional, 62% nível de assistência nutricional secundário e a predominância da presença de risco nutricional foi observada nos indivíduos com comprometimento do sistema digestório e glândulas anexas (21,2%), idosos (67,4%), câncer (80,8%) e mortalidade (17,6%). Apesar de não ter apresentado resultado significativo, o tempo de internação foi maior nos pacientes com risco nutricional. Conclusão: A associação de diferentes vertentes está em concordância com outros trabalhos realizados no mesmo âmbito e aponta a necessidade de mais estudos, a fim de otimizar as demandas deste setor e realizar intervenções precoces.(AU)

Introduction: The identification of nutritional risk at admission of hospitalized patient is fundamental, as it helps on establishment of appropriate priorities and nutritional assistance. Therefore, the aim of this study was to identify the nutritional risk of admitted patients at emergency department and associate it with age, morbidity, anthropometric assessment, length of stay and readmission. Methods: It was an exploratory, descriptive, cross-sectional study, with a quantitative approach, performed in the emergency department of a university hospital, in patients over 18 years of age. In order to identify the nutritional risk, a nutritional screening instrument (NRS / 2002) was applied in the first 72 hours of admission and the collection and measurement of anthropometric variables such as weight, height, arm and calf circumference, and knee height were also accomplished. For statistical associations were used the Mann-Whitney and Chi-square tests. Results: A total of 208 patients were evaluated, the majority of them (53.4%) were male, 62% elderly. 63% of the total population presented nutritional risk. 62%, secondary nutritional assistance level. The prevalence of nutritional risk was observed in those with digestive system compromised and attached glands (21.2%), elderly (67.4%), cancer (80.8%) and mortality (17.6%). Although it had not present significant result, the length of stay was longest in patients with nutritional risk. Conclusion: The association of different studies is in accordance with other ones accomplished in this field and points out the need of more researches in order to optimize the demands of this sector and perform early interventions.(AU)

Assessment and nutrition education in patients with amyotrophic lateral sclerosis.

Neurological patients with amyotrophic lateral sclerosis (ALS)often deteriorate to a worsening nutritional status. The aim of this study was to compare the nutritional status and food intake after nutrition education in patients with ALS. Clinical, anthropometric and functional variables were analyzed. Fifty-three patients were monitored at an early stage of the disease. The average score on the functionality scale was 33 points. Initially only 3.8% were classified as low body weight. After three months, 50% showed significant variation in anthropometric measures related to muscle mass and body fat reserves without association with clinical variables. After nutritional guidance, there was an increase in the intake of all food groups, especially the dairy group (p <0.05).The change of the nutritional status occurs early in patients with amyotrophic lateral sclerosis, even in those previously eutrophic or over weight. There was an increase in food intake after nutritional guidance according to the food guide adapted to the Brazilian population.

Avaliação do estado nutricional em pacientes hospitalizados com cirrose hepática / Nutritional assessment in hospitalized patients with liver cirrhosis

Introdução: A cirrose surge devido a um processo crônico e progressivo de inflamações. O tipo mais comum é a cirrose hepática (CH). Pacientes com CH apresentam baixa ingestão alimentar, alterações bioquímicas e grande depleção de massa muscular. A avaliação do estado nutricional pode detectar as alterações do estado nutricional e fornecer informação prognóstica. O diagnóstico nutricional dos pacientes com CH representa grande desafio devido à retenção hídrica frequentemente encontrada. Objetivo: Caracterizar o estado nutricional dos pacientes com CH hospitalizados. Método: O método de avaliação utilizado no estudo foi a Avaliação Global do Royal Free Hospital (RFH-GA), um instrumento validado em 2006 no Royal Free Hospital de Londres, que consiste em uma avaliação nutricional específica para pacientes cirróticos. Resultados: Foram avaliados 26 pacientes, predominantemente do sexo masculino, com média de idade de 54,2 anos, sendo a principal etiologia a cirrose hepática alcóolica. As seguintes variáveis foram consideradas: sintomas gastrointestinais, disfunções clínicas, consumo alimentar, avaliação da composição corporal subjetiva e antropometria objetiva. Conclusão: O presente trabalho verificou alta taxa de desnutrição e o instrumento de avaliação do RFH-GA foi adequado para classificação do estado nutricional.(AU)

Introduction: Cirrhosis arises due to a chronic and progressive process of inflammation, the most common type is liver cirrhosis (LC). LC patients have low food intake, biochemical and great loss of muscle mass. The nutritional assessment can detect changes in the nutritional status and provide prognostic information. Nutritional diagnosis of patients with LC is a challenge due to water retention often found. Objective: To characterize the nutritional status of hospitalized patients with LC. Methods: The evaluation method used in the study was the Global Assessment of the Royal Free Hospital (RFH-GA), a nutritional assessment tool validated in 2006 at the Royal Free Hospital in London, that consists of a specific nutritional assessment for cirrhotic patients. Results: We evaluated 26 patients, predominantly male, with an average age of 54.2 years, the main cause being the alcoholic liver cirrhosis. The following variables were considered: gastrointestinal symptoms, clinical disorders, food intake, body composition assessment of subjective and objective anthropometry. Conclusion: The present work verified a high rate of malnutrition and the evaluation tool for the RFH-GA was adequate to assess the nutritional status.(AU)

Assessment and nutrition education in patients with amyotrophic lateral sclerosis / Avaliação e educação nutricional em pacientes com esclerose lateral amiotrófica

ABSTRACT Neurological patients with amyotrophic lateral sclerosis (ALS)often deteriorate to a worsening nutritional status. The aim of this study was to compare the nutritional status and food intake after nutrition education in patients with ALS. Clinical, anthropometric and functional variables were analyzed. Fifty-three patients were monitored at an early stage of the disease. The average score on the functionality scale was 33 points. Initially only 3.8% were classified as low body weight. After three months, 50% showed significant variation in anthropometric measures related to muscle mass and body fat reserves without association with clinical variables. After nutritional guidance, there was an increase in the intake of all food groups, especially the dairy group (p <0.05).The change of the nutritional status occurs early in patients with amyotrophic lateral sclerosis, even in those previously eutrophic or over weight. There was an increase in food intake after nutritional guidance according to the food guide adapted to the Brazilian population.

RESUMO Pacientes neurológicos com esclerose lateral amiotrófica frequentemente evoluem com piora do estado nutricional. O objetivo desse estudo foi comparar o estado nutricional e a ingestão alimentar depois da orientação nutricional em pacientes com ELA. Variáveis clínicas,antropométricas e funcionais foram analisadas. 53 pacientes foram avaliados na fase inicial da doença. A pontuação média da escala de funcionalidade foi de 33 pontos. Inicialmente apenas 3,8% foram classificados como baixo peso. Após três meses, 50% apresentaram variação significativa nas medidas antropométricas relacionadas com reservas de massa muscular e gordura corporal, sem associação com variáveis clínicas. Após orientação nutricional, houve um aumento na ingestão de alimentos de todos os grupos com relevância para o grupo de lacticínios (p <0,05). A mudança do estado nutricional ocorre precocemente em pacientes com ELA, mesmo naqueles anteriormente eutróficos ou sobrepeso. Houve um aumento na ingestão de alimentos após orientação nutricional de acordo com o guia alimentar adaptado da população brasileira.

Anthropometry of Arm: Nutritional Risk Indicator in Amyotrophic Lateral Sclerosis.

The aim of the paper is to examine the correlation between clinical data, nutritional, respiratory and functional parameters in amyotrophic lateral sclerosis (ALS). This is a descriptive study of 111 ALS patients [91 spinal onset (GS) and 20 bulbar onset (GB)] carried on using nutritional and respiratory parameters and amyotrophic lateral sclerosis functional rating scale (ALSFRS). ALSFRS was analyzed in the main domains (D1, D2 and D3). Forced vital capacity and anthropometric measurements, there was significant association for GS and GB, and in GS there was positive correlation with midarm circumference (MAC) (r=0.30; P=0.020), midarm muscle circumference (r=0.29; P=0.026), arm muscle area (r=0.28; P=0.033) and protein-caloric malnutrition score (r=0.27; P=0.039), while for GB only with body weight (r=0.64; P=0.024). On correlation of nutritional parameters and ALSFRS for GS patients we observed that MAC and %MAC presented positive association with both issues of D1 and D2. For GB, the total score in addition to correlate positively with anthropometric parameters related to lean body mass also presented negative association with a parameter associated with body fat. In summary, it is suggested that the application of anthropometry of arm could be useful in routine monitoring of ALS patients.

Nutritional care in motor neurone disease/ amyotrophic lateral sclerosis.

Patients with amyotrophic lateral sclerosis (ALS) often present changes in nutritional status. Based on weight loss and on difficulty in nutritional management, this study aims to review the different possibilities and to present guidelines concerning nutritional treatment to such patients. Diet characteristics, types of treatment and nutritional therapy indicating administration routes and discussing the details of the disease are described herein. Nutritional therapy has been a substantial therapeutic resource for ALS development.

Nutritional care in motor neurone disease/ amyotrophic lateral sclerosis / Assistencia nutricional nas doencas do neuronio motor/esclerose lateral amiotrofica

Patients with amyotrophic lateral sclerosis (ALS) often present changes in nutritional status. Based on weight loss and on difficulty in nutritional management, this study aims to review the different possibilities and to present guidelines concerning nutritional treatment to such patients. Diet characteristics, types of treatment and nutritional therapy indicating administration routes and discussing the details of the disease are described herein. Nutritional therapy has been a substantial therapeutic resource for ALS development.

Pacientes com esclerose lateral amiotrófica (ELA) frequentemente apresentam alteração do estado nutricional. Baseado na perda ponderal de peso e na dificuldade no manejo nutricional, o objetivo desse estudo é rever as estratégias de tratamento nutricional para a manutenção do estado nutricional desses doentes. Nesse trabalho, descrevem-se as características da dieta, as formas de tratamento e terapia nutricional com indicação das vias de administração, bem como discuti-se as particularidades da doença. A terapia nutricional tem se mostrado um recurso terapêutico primordial atuante na evolução da ELA.

Nurse to bed ratio and nutrition support in critically ill patients.

BACKGROUND: Inadequate nutrition support is common among critically ill patients, and identification of risk factors for such inadequacy might help in improving nutrition support. OBJECTIVE: To determine how often daily calorie goals are met and the factors responsible for inadequate nutrition support. Methods A single-center prospective cohort study. Each patient's demographic and clinical characteristics, the need for ventilatory support, the use and dosage of medications, the number of nursing staff per bed, the time elapsed from admission to the intensive care unit until the effective start of enteral feeding, and the causes for nonadministration were recorded. Achievement of daily calorie goals was determined and correlated with risk factors. RESULTS: A total of 262 daily evaluations were done in 40 patients. Daily calorie goal was achieved in only 46.2% of the evaluations (n = 121), with a mean of 74.8% of the prescribed volume of enteral nutrition infused daily. Risk factors for inadequate nutrition support were the use of midazolam (odds ratio, 1.58; 95% CI, 1.18-2.11) and fewer nursing professionals per bed (odds ratio, 2.56; 95% CI, 1.43-4.57). Conclusion Achievement of daily calorie goals was inadequate, and the main factors associated with this failure were the use and dosage of midazolam and the number of nurses available.

Abordagem dos efeitos colaterais da cisplatina no estado nutricional dos pacientes com carcinoma de cabeça e pescoço / Approach the side effects of cisplatin on the nutritional status of patients with head and neck carcinoma / Enfoque de los efectos secundarios del cisplatino en el estado nutricional de los pacientes con carcinoma de cabeza y cuello

Introdução: A tendência dos pacientes com carcinoma da cabeça e pescoço (CCP) é cursar com desnutrição e caquexia. Objetivo: Avaliar o estado nutricional (EN) do paciente com CCP antes e durante a quimioterapia com o uso da cisplatina no ambulatório de quimioterapia de um hospital público de São Paulo. Método: Por meio da elaboração de um questionário de efeitos colaterais (DEC) as reações foram avaliadas juntamente com a avaliação antropométrica. Resultados: Apesar da cisplatina, 100% dos pacientes não apresentaram emese, observou-se que 83% faziam radioterapia e quimioterapia associadas, sendo que 50% destes haviam feito cirurgia. Conclusão: Os danos provocados pela cisplatina são menores do que o diagnóstico tardio, que é o verdadeiro responsável pelo prognóstico reservado do paciente de CCP, pois, além de limitar a qualidade de vida, eleva muitos os custos do tratamento.

Introduction: The tendency of patients with carcinoma of the head and neck (CCP) is present with malnutrition and cachexia. Objective: To evaluate the nutritional status (EN) of patients with PBC before and during chemotherapy using cisplatin chemotherapy in the outpatient clinic of a public hospital in São Paulo. Method: Through the development of a questionnaire on side effects (DEC) reactions were evaluated with anthropometric measurements. Results: Although cisplatin, 100% of patients had no emesis was observed that 83% were associated with radiotherapy and chemotherapy, and 50% of these had surgery done. Conclusion: The damage caused by cisplatin are smaller than late diagnosis, which is the true responsible for the prognosis of PBC patients, because in addition to limiting the quality of life raises many of the costs of treatment.

Introducción: La tendencia de los pacientes con carcinoma de cabeza y cuello (CCP) se presenta con la desnutrición y caquexia. Objetivo: Evaluar el estado nutricional (EN) de los pacientes con PBC antes y durante la quimioterapia con cisplatino en la clínica ambulatoria de un hospital público de São Paulo. Método: Mediante el desarrollo de un cuestionario sobre los efectos secundarios (DEC), las reacciones fueron evaluados con las medidas antropométricas. Resultados: Aunque el cisplatino, el 100% de los pacientes no emesis se observó que 83% estaban asociados con la radioterapia y la quimioterapia, y hecho el 50% de estos tenían la cirugía. Conclusión: Los daños causados ​​por el cisplatino es menor que el diagnóstico tardío, que es el responsable de verdad para el pronóstico de los pacientes con CBP, ya que además de limitar la calidad de vida plantea muchos de los costos del tratamiento.

Nutritional status improvement in neurologically impaired patients by percutaneous endoscopic gastrostomy feeding

With increased use of percutaneous endoscopic gastrostomy, it became clear that neurologically impaired patients might benefit from its use. From August 1996 to july 1997, we performed 19 percutaneous endoscopic gastrotomies in patients with neurological sequelae, who were incapable to maintain their nutritional status by oral ingestion or had repeated episodes of aspiration. Sixteen patients were followed prospectively, from 30 days to 11 months (median: 6,4 months). Average weight (38.2 Kg to 44,8 Kg), BMI (14.8 kg/m2 to 17.8 Kg/m2), weight/height ratio (23.5 Kg/cm to 28 Kg/cm), mid-upper arm circumference (19.4 cm to 21.6 cm) and triceps skinfold thickness (10.3 mm to 12.6 mm) were significantly increased (P<0.01). Before percutaneous endoscopic gastromoty, there were 10 (10/16, 62.5 per cent) patients with grade III thinness. In this group, 3/10 patients (30 per cent) showed improvement to grade I (two individuals) and II (one patient). All but five patients (68.75 per cent) were below the fifth percentile of normal distribution for mid-upper arm circuference. One patient (6.2 per cent) showed improvement of her status (between 25 th and 50 th percentiles). Four patients (25 per cent) started the follow-up below the fifth percentile for normal distribution of triceps skinfold thickness, and showed no improvement. There were no early complications secondary the procedure. Late complications included granulation tissue on ostomy site (18.8 per cent) and ostomy infection (6.2 per cent). Statistical analysis showed significant improvement of anthropometric data. Percutaneous endoscopic gastrostomy is a simple, highly succesful and safe procedure, when performed in neurologically impaired patients. It is efficient as a long-term enteral feeding method.