Percepção de enfermeiras educadoras sobre treinamento simulado utilizando realidade virtual aplicado aos alunos do curso de enfermagem

Objetivo: Verificar a percepção de enfermeiros com experiência em educação, a respeito da proposta metodológica de treinamento baseado em simulação virtual usando uma plataforma de treinamento imersivo. Métodos: Uma plataforma educacional foi desenvolvida baseada em simulação virtual e metodologias ativas para o engajamento, aprendizado e avaliação dos alunos. A mesma emprega um processo andragógico na construção do conteúdo expondo os enfermeiros a situações simuladas da sua prática diária com foco na melhoria de sua atitude. Os conteúdos são relacionados aos cuidados específicos com o acesso venoso periférico, desde a punção, manutenção, prevenção e manejo de complicações. Foi composto um comitê de especialistas com 12 enfermeiras, com experiência mínima de cinco anos na área da educação, que praticaram o treinamento simulado, e posteriormente, preencheram um formulário da percepção que foi tabulado e analisado pelos pesquisadores do projeto. Resultados: 92% das enfermeiras acreditam que o treinamento simulado aproxima os usuários dos desafios da prática diária, e que realmente pode contribuir para a consolidação do conhecimento. Com relação ao conteúdo experimentado nos roteiros, 67% das profissionais consideraram a proposta "muito importante ou imprescindível" e 33% entenderam ser "importante". Conclusões: A percepção geral das enfermeiras foi muito positiva, especialmente com relação à importância do conteúdo apresentado, à proposta metodológica de imersão em cenários próximos à realidade, que trouxeram os desafios da prática; além das questões problematizadoras que possibilitaram uma reflexão para a melhor tomada de decisão.

Prevalence of pressure injury and associated factors in hospitalized adult patients with cancer.

INTRODUCTION: Hospitalized cancer patients experience limitations in their daily activities resulting from the severity of their condition. Such changes alter patients' sensory perception and hinder their mobility, thus predisposing them to the development of PI. OBJECTIVE: The goal of this study was to analyze the prevalence of PI and associated factors in hospitalized cancer patients. MATERIALS AND METHODS: This observational, epidemiological, cross-sectional, descriptive study was carried out in the inpatient and ICU settings of an oncological hospital in São Paulo, Brazil. RESULTS: A total of 341 patients who met the inclusion criteria and agreed to participate in the study were interviewed and assessed. Data obtained in the interviews were analyzed for logistic regression analysis. Pressure injury prevalence was 10% (34 patients). The use of disposable diapers was significantly associated with the development of PI, with a 6.077 increased chance of PI in such patients in the ICU setting. In this epidemiologic study of 341 hospitalized cancer patients, the prevalence of PI was 10%. The use of disposable diapers was the only factor associated with the presence of PI after logistic regression analysis. CONCLUSION: Knowing the risk factors of this specific population was essential to implement actions and optimize indications of disposable diaper use. There is an absence of epidemiologic records due to limited publications available on the subject; creating a program to prevent PI development within the inpatient, assisted population.

Incidence of hospital-acquired pressure injury: A cohort study of adults admitted to public and private hospitals in Sao Paulo, Brazil.

This study aimed to estimate the incidence of hospital-acquired pressure injury (PI) and its risk factors in inpatient and intensive care units of five hospitals (two public and three private) in the city of Sao Paulo, Brazil. A 6-month follow-up prospective cohort study (n = 1937) was conducted from April to September 2013. Baseline and follow-up measurements included demographic and care information, as well as risk assessments for both undernutrition (NRS-2002) and PI (Braden scale). Poisson regression with robust variance was used for data analysis. A total of 633 patients (32.60%) showed risk for PI. The incidence rate of PI was of 5.9% (9.9% in public hospitals vs 4.1% in private hospitals) and was higher in intensive care units, compared to inpatient care units (10% vs 5.7%, respectively). Risk for PI increased with age (RR = 1.05; 95% CI 1.04-1.07); was higher in in public hospitals, compared to private hospitals (RR = 4.39; 95% CI 2.92-6.61); in patients admitted for non-surgical reasons compared to those admitted for surgical reasons (RR = 1.91; 95% CI 1.12-3.27); in patients with longer hospital stays (RR = 1.04; 95% CI 1.03-1.06); high blood pressure (RR = 1.76; 95% CI 1.17-2.64); or had a risk for undernutrition (RR = 3.51; 95% CI 1.71-7.24). Higher scores in the Braden scale was associated with a decreased risk of PI (RR = 0.79; 95% CI 0.75-0.83). The results of our study indicate that 5.9% of all patients developed PI and that the most important factors that nurses should consider are: patient age, care setting, length of hospitalization, comorbidities, reason for admission and nutrition when planning and implementing PI-preventative actions.

Validity of the Braden Nutrition Subscale in predicting pressure ulcer development.

PURPOSE: The purpose of this study was to analyze the validity of the nutrition subscale from the Braden Scale for Predicting Pressure Sore Risk in hospitalized patients. DESIGN: A prospective, quasi-experimental, repeated-measures design guided data collection and analysis. SUBJECTS AND SETTINGS: One hundred seventy adult patients from 2 private hospitals located in urban areas in Southeastern Brazil, with a Braden Scale score of 18 or less, and who agreed to participate in the study were assessed between January and August 2006. Participants were primarily male (57.0%) and had a mean age of 67.0 ± 15.4 years (mean ± SD). METHODS: Objective assessment and subjective global assessment of nutritional status were performed on admission. Every 2 days, patients deemed at potential risk for pressure ulcer development underwent evaluation of protein-energy intake, skin assessment, and repeated risk assessment for pressure ulcer development via the Braden Scale. Univariate and multivariate logistic regression analyses were used to assess the predictive power of nutritional variables related to risk for pressure ulcer development. RESULTS: The mean length of stay among patients was 17.8 ± 16.8 days. Multivariate regression analysis revealed that serum albumin levels (odds ratio = 5.226; P < .001) and subjective global nutritional assessment (odds ratio = 3.246; P < .001) were the best nutritional predictors of pressure ulcer development. CONCLUSION: We did not find the Braden nutrition subscale score to be predictive for pressure ulcer development in hospitalized patients. Serum albumin levels and subjective global nutritional assessment were the best nutritional predictors of pressure ulcer development.

Predictive validity of the Braden scale for pressure ulcer risk in critical care patients.

This methodological study aimed to evaluate the predictive validity of the Braden scale in critical care patients. The study was conducted in four intensive care units of a general private hospital. After approval of the project by the Hospital Ethics Committee, during six months, adult patients admitted to ICUs with a Braden score <18 and without PU were assessed upon admission and at 48-hours intervals as long as the patient remained at risk or until the development of PU, patients' discharge, death or transfer from the ICU. The cut-off scores of the Braden scale in the first, second and third assessments were 12, 13 and 13, respectively. Sensitivity was 85.7%, 71.4% and 71.4% and specificity was 64.6%, 81.5% and 83.1%, respectively. Areas under the ROC curves revealed very good accuracy for the cut-off scores. The Braden cut-off score 13 in the third assessment showed the best predictive performance in critical care patients.

Predictive validity of the Braden scale for pressure ulcer risk in critical care patients / Validade preditiva da escala de Braden para o risco de desenvolvimento de úlcera por pressão, em pacientes críticos / Validez predictiva de la escala de Braden para el riesgo de úlceras por presión en pacientes críticos

This methodological study aimed to evaluate the predictive validity of the Braden scale in critical care patients. The study was conducted in four intensive care units of a general private hospital. After approval of the project by the Hospital Ethics Committee, during six months, adult patients admitted to ICUs with a Braden score <18 and without PU were assessed upon admission and at 48-hours intervals as long as the patient remained at risk or until the development of PU, patients' discharge, death or transfer from the ICU. The cut-off scores of the Braden scale in the first, second and third assessments were 12, 13 and 13, respectively. Sensitivity was 85.7 percent, 71.4 percent and 71.4 percent and specificity was 64.6 percent, 81.5 percent and 83.1 percent, respectively. Areas under the ROC curves revealed very good accuracy for the cut-off scores. The Braden cut-off score 13 in the third assessment showed the best predictive performance in critical care patients.

Este estudo metodológico foi desenvolvido em quatro unidades de terapia intensiva de um hospital geral, com o objetivo de avaliar a validade preditiva da escala de Braden em pacientes críticos. Após aprovação do projeto pelo Comitê de Ética em Pesquisa, da instituição, durante seis meses, pacientes adultos com escore total de Braden <18 e sem úlceras por pressão (UP) foram avaliados na admissão e a cada 48 horas, enquanto permaneceram em risco ou até o desenvolvimento de UP, alta, morte ou transferência da UTI. Os escores de Braden 12, 13 e 13, respectivamente na primeira, segunda e terceira avaliação apresentaram sensibilidade de 85,7, 71,4 e 71,4 por cento e especifidade de 64,6, 81,5 e 83,1 por cento. As áreas sob a curva ROC (Receiver Operating Characteristics) revelaram acurácia muito boa para os escores de corte obtidos. O escore de corte da escala de Braden igual a 13, na terceira avaliação, apresentou a melhor performance preditiva em pacientes críticos.

Se tuvo por objetivo evaluar la validez predictiva de la Escala de Braden en los pacientes críticos. Se trata de un estudio metodológico, en cuatro unidades de cuidados intensivos de un hospital general. Después de la aprobación del proyecto por el Comité de Ética de la Institución, durante seis meses, los pacientes adultos con puntuación total de Braden <18 y sin úlceras por presión (UP) fueron evaluados en la admisión y a cada 48 horas, mientras permanecieron en riesgo o hasta: el desarrollo de UP, el alta, la muerte o removidos de la UCI. Las puntuaciones de Braden 12, 13 y 13, respectivamente en la primera, segunda y tercera evaluaciones presentaron sensibilidad de 85,7 por ciento, 71,4 por ciento y 71,4 por ciento y especificidad de 64,6 por ciento, 81,5 por ciento y 83,1 por ciento respectivamente. Las área bajo las curvas ROC muestrearon muy buena precisión de las puntuaciones obtenidas. Se concluye que la puntuación de Braden 13, en la tercera evaluación, presentó el mejor desempeño predictivo en los pacientes críticos.

Predictive validity of Waterlow Scale for pressure ulcer development risk in hospitalized patients.

AIM: We sought to evaluate the predictive validity of the Waterlow Scale in hospitalized patients. SUBJECTS AND SETTING: The study was conducted at a general private hospital with 220 beds and a mean time of hospitalization of 7.4 days and a mean occupation rate of approximately 80%. Adult patients with a Braden Scale score of 18 or less and a Waterlow Scale score of 16 or more were studied. The sample consisted of 98 patients with a mean age of 71.1 + or - 15.5 years. METHODS: Skin assessment and scoring by using the Waterlow and Braden scales were completed on alternate days. Patients were examined at least 3 times to be considered for analysis. The data were submitted to sensitivity and specificity analysis by using receiver operating characteristic (ROC) curves and positive (+LR) and negative (-LR) likelihood ratios. RESULTS: The cutoff scores were 17, 20, and 20 in the first, second, and third assessment, respectively. Sensitivity was 71.4%, 85.7%, and 85.7% and specificity was 67.0%, 40.7%, and 32.9%, respectively. Analysis of the area under the ROC curve revealed good accuracy (0.64, 95% confidence interval [CI]: 0.35-0.93) only for the cutoff score 17 in the first assessment. The results also showed probabilities of 14%, 10%, and 9% for the development of pressure ulcer when the test results were positive (+LR) and of 3% (-LR) when the test results were negative for the cutoff scores in the first, second, and third assessment, respectively. CONCLUSION: The Waterlow Scale achieved good predictive validity in predicting pressure ulcer in hospitalized patients when a cutoff score of 17 was used in the first assessment.

Malnutrition as a risk factor for the development of pressure ulcers / Desnutrição como fator de risco para o desenvolvimento de úlceras por pressão / Desnutrición como factor de riesgo para el desarrollo de las úlceras por presión

Malnutrition - as a fundamental aspect both in genesis as in healing of pressure ulcers - is the object of this update paper. Countless studies point out that malnutrition, immune function alterations, hypoalbuminemia, low hemoglobin levels, as well as low diet intake, as responsible for an increase in the risk of developing these lesions. Therefore, it is essential to include the assessment of the nutrition status - monitoring of the calorie-protein intake and the difficulties to use the nutrients - in the prevention and treatment protocols of this type of chronic wound.

A desnutrição - como aspecto fundamental tanto na gênese como na cicatrização das úlceras por pressão - é objeto deste artigo de atualização. Inúmeros estudos salientam a desnutrição, alterações da função imune, hipoalbuminemia, níveis baixos de hemoglobina bem como a baixa aceitação dietética como responsáveis por aumentar o risco para o desenvolvimento dessas lesões. É, portanto, fundamental incluir a avaliação do estado nutricional - monitorização da ingestão calórico-protéica e das dificuldades para o aproveitamento dos nutrientes nos protocolos de prevenção e tratamento desse tipo de ferida crônica.

La desnutrición - como aspecto fundamental en la génesis y cicatrización de las úlceras por presión (UP) - es el tema de esta atualización. Muchos estudios destacan la desnutrición, los cambios del funcionamiento imunológico, la hipoalbuminemia, los bajos niveles de hemoglobina así como la baja aceptación alimentaria como los responsables del aumento del riesgo para el desarrollo de las UP. En conclusión, es fundamental incluir la evaluación del estado nutricional en los protocolos de prevención y tratamiento de las UP. Esa evaluación debe incluir medidas objetivas, seguimiento de la ingestión calórica y protéica y además de las dificultades para el aprovechamiento de los nutrientes.

Capacidade preditiva da subescala Nutrição da Escala de Braden para avaliar o risco de desenvolvimento de úlceras por pressão / Predictive capacity of nutrition sub scale of Braden scale to assessment Pressure ulcer development risk

Variáveis nutricionais têm sido consideradas preditoras de risco para o desenvolvimento de úlceras por pressão (UP). A subescala nutrição da escala de Braden, que avalia o consumo alimentar, parece apresentar certa fragilidade para especificar o risco. Muitos estudos ressaltam aspectos mais amplos do estado nutricional associados ao risco de UP. O objetivo deste estudo foi avaliar a capacidade da subescala Nutrição da escala de Braden para predizer o risco de desenvolver UP e verificar as associações estatísticas existentes entre essa subescala e indicadores nutricionais objetivos e sujetivos, além das variáveis demográficas e clínicas, e o desenvolvimento de UP. Após aprovação pelos comitês de ética de duas instituições privadas do Município de SP, 170 pacientes adultos hospitalizados, em risco para desenvolvimento de UP (escore de =18), foram avaliados durante, no mínimo, uma semana. Os pacientes foram submetidos à avaliação do risco para UP - por meio da Escala de Braden - e da pele a cada 48 horas, às avaliações objetivas e subjetivas na admissão e a cada sete dias e avaliação da aceitação da terapia nutricional diariamente. Para estabelecer o poder preditivo das variáveis independentes em relação ao desenvolvimento de UP, empregaram-se análises de regressão logística univariada e múltipla (quatro modelos). A maioria dos pacientes era do sexo masculino (57,05%); média etária de 66,99 ±15,43 e 17,76 ± 16,77 dias de internação, em média. Os escores médios de riscoforam 12,26 e 15,03, respectivamente para os pacientes com e sem UP (p<0,001). Quatorze pacientes desenvolveram UP, gerando incidência de 8,23%. Na modelo 4 da análise da regressão logística multivariada, a subescala nutrição não permanece, sendo a albumina (OR=5,226, p< 0,001), a ANSG (OR=3,246, p< 0,001) e a idade (OR=1,594, p< 0,001) as preditoras mais importantes. Os resultados evidenciaram que, ao não permanecer no modelo final de regressão, ) a subescala nutrição da escala de Braden não foi preditora para desenvolvimento de UP na amostra do estudo. Embora a albumina tenha sido o indicador preditivo mais importante - fato corroborado na literatura internacional - seu custo limita sua utilização. Por outro lado, a ANSG desponta como parâmetro nutricional complementar interessante e promissor por ser simples, de baixo custo e de uso multidisciplinar.

The nutritional variables have been considered as risk predictors for development of pressure ulcers (PU). The nutrition sub scale of Braden scale - which assesses the usual food intake pattern - seems to be quite fragile in predicting those wounds. Plenty of studies have pointed out broad aspects of the nutritional status related the risk to develop pressure ulcer. The objective of this study is to evaluate the capacity of nutrition sub scale of Braden for predicting pressure sore risk and to determine the statistical associations with nutrition sub scale and objective and subjective nutritional indicators, demographic and clinic characteristics and PU development. The project was previously approved for both Hospitals Ethical Committes. A hundred and seventy adult patients from two private hospitals in São Paulo - Brazil, with risk but without pressure sores. Pressure ulcer risk was assessed using the Braden scale (score = 18) on admission and every 48 hours for a minimum one week. The patients were submitted to skin each alternate days, to objective and subjective assessment at admission and every seven days and to caloric and protein intake assessment daily. Univariate and multivariate (four models) logistic regression analysis were used to determine the predictive power of independent variables related to the development of PU. Subjects were 57,05% male, had a mean age of 66,99 ± 15,43 and length of stay mean 17,76 ± 16,77.The mean Braden scale scorefor subjects without ulcers was 15,03, and it was 12,26 for those with ulcers (p< 0,001). Fourteen of 170 subjects (8,3%) developed pressure ulcers. After multivariate logistic regression, the nutrition sub scale of Braden did not appear as a powerful predictive factor for PU development. The best predictors were albumin (OR=5,226, p< 0,001), SGA (OR= 3,246, p< 0,001) and age (OR=1,594, p< 0,001). In this study the nutrition sub scale could not predicting PU because.

Effects of continuous versus bolus infusion of enteral nutrition in critical patients.

PURPOSE: Enteral alimentation is the preferred modality of support in critical patients who have acceptable digestive function and are unable to eat orally, but the advantages of continuous versus intermittent administration are surrounded by controversy. With the purpose of identifying the benefits and complications of each technique, a prospective controlled study with matched subjects was conducted. PATIENTS AND METHODS: Twenty-eight consecutive candidates for enteral feeding were divided into 2 groups (n = 14 each) that were matched for diagnosis and APACHE II score. A commercial immune-stimulating polymeric diet was administered via nasogastric tube by electronic pump in the proportion of 25 kcal/kg/day, either as a 1-hour bolus every 3 hours (Group I), or continuously for 24 hours (Group II), over a 3-day period. Anthropometrics, biochemical measurements, recording of administered drugs and other therapies, thorax X-ray, measurement of abdominal circumference, monitoring of gastric residue, and clinical and nutritional assessments were performed at least once daily. The principal measured outcomes of this protocol were frequency of abdominal distention and pulmonary aspiration, and efficacy in supplying the desired amount of nutrients. RESULTS: Nearly half of the total population (46.4%) exhibited high gastric residues on at least 1 occasion, but only 1 confirmed episode of pulmonary aspiration occurred (3.6%). Both groups displayed a moderate number of complications, without differences. Food input during the first day was greater in Group II (approximately 20% difference), but by the third day, both groups displayed similarly small deficits in total furnished volume of about 10%, when compared with the prescribed diet. CONCLUSIONS: Both administration modalities permitted practical and effective administration of the diet with frequent registered abnormalities but few clinically significant problems. The two groups were similar in this regard, without statistical differences, probably because of meticulous technique, careful monitoring, strict patient matching, and conservative amounts of diet employed in both situations. Further studies with additional populations, diagnostic groups, and dietetic prescriptions should be performed in order to elucidate the differences between these commonly used feeding modalities.

Effects of continuous versus bolus infusion of enteral nutrition in critical patients

PURPOSE: Enteral alimentation is the preferred modality of support in critical patients who have acceptable digestive function and are unable to eat orally, but the advantages of continuous versus intermittent administration are surrounded by controversy. With the purpose of identifying the benefits and complications of each technique, a prospective controlled study with matched subjects was conducted. PATIENTS AND METHODS: Twenty-eight consecutive candidates for enteral feeding were divided into 2 groups (n = 14 each) that were matched for diagnosis and APACHE II score. A commercial immune-stimulating polymeric diet was administered via nasogastric tube by electronic pump in the proportion of 25 kcal/kg/day, either as a 1-hour bolus every 3 hours (Group I), or continuously for 24 hours (Group II), over a 3-day period. Anthropometrics, biochemical measurements, recording of administered drugs and other therapies, thorax X-ray, measurement of abdominal circumference, monitoring of gastric residue, and clinical and nutritional assessments were performed at least once daily. The principal measured outcomes of this protocol were frequency of abdominal distention and pulmonary aspiration, and efficacy in supplying the desired amount of nutrients. RESULTS: Nearly half of the total population (46.4 percent) exhibited high gastric residues on at least 1 occasion, but only 1 confirmed episode of pulmonary aspiration occurred (3.6 percent). Both groups displayed a moderate number of complications, without differences. Food input during the first day was greater in Group II (approximately 20 percent difference), but by the third day, both groups displayed similarly small deficits in total furnished volume of about 10 percent, when compared with the prescribed diet. CONCLUSIONS: Both administration modalities permitted practical and effective administration of the diet with frequent registered abnormalities but few clinically significant problems. The two groups were similar in this regard, without statistical differences, probably because of meticulous technique, careful monitoring, strict patient matching, and conservative amounts of diet employed in both situations. Further studies with additional populations, diagnostic groups, and dietetic prescriptions should be performed in order to elucidate the differences between these commonly used feeding modalities

Complicaçäo da nutriçäo enteral em pacientes de UTI: comparaçäo entre os métodos de administraçäo contínua e intermitente / Enteral nutrition complications in ICU patients: comparative study between continuous and intermitent methods of administration

Este estudo é um ensaio clínico prospectivo e comparativo, que teve por objetivos identificar a incidência de complicaçäo da terapia nutricional enteral em uma amostra de pacientes de Unidade de Terapia Intensiva (UTI) e analisar comparativamente a ocorrência dessas complicaçöes, de acordo com o método de administraçäo: contínua e intermitente. Foram estudados 28 pacientes internados na UTI de um hospital geral, de atendimento particular, do Município de Säo Paulo. Foram constituídos dois grupos pareados de 14 pacientes, correspondendo a cada um dos métodos estudados: administraçäo contínua (Grupo C) e intermitente (Grupo I). Os critérios para o pareamento foram o diagnóstico médico principal e o nível de gravidade, medido pelo índice APACHE II. Doenças neurológicas (50 porcento), respiratórias (29 porcento), cardiológicas (14 porcento) e sepse (7 porcento) foram principais motivos de internaçäo. A maioria dos pacientes apresentou índice de gravidade no intervalo entre 10 a 19 pontos, com média de 15,14 (DP=3,44). Os grupos mostraram-se também homogêneos em relaçäo às seguintes variáveis: idade, sexo, tempo de permanência na UTI, risco de mortalidade, tempo para início da nutriçäo enteral (NE), medidas antropométricas e bioquímicas, uso de ventilaçäo mecânica, sedaçäo e antibioticoterapia. Houve diferença estatisticamente significante apenas em relaçäo ao uso de drogas vasoativas, predominantemente entre os pacientes do Grupo I. Todos os pacientes foram acompanhados durante três dias consecutivos, após o início da NE. As seguintes análises estatísticas foram utilizados: descritiva, de associaçäo e de comparaçäo, adotando-se o nível de significância de 5 porcento. Quanto à incidência de complicaçöes na amostra estudada, a principal delas foi o alto resíduo gástrico, observada em 13 dos 28 pacientes (46,42 porcento), seguida da distensäo abdominal, em 8 (28,57 porcento), e do deslocamento da sonda, em 7 (25,00 porcento). Vômito e diarréia incidiram em proporçäo igual de 14,28 porcento (4 pacientes). Em apenas um paciente (3,57 porcento) foi observada aspiraçäo pulmonar e obstruçäo da sonda. O déficit de volume infundido ocorreu em 26 dos 28 pacientes (92,85 porcento), secundário a alguma complicaçäo ou interferências externas. A análise comparativa dos Grupos C e I demonstrou que houve diferença estatisticamente significante entre eles (p=0,0117), em apenas uma das complicaçöes: o déficit no volume total administrado, no primeiro dia de...

Complicações da nutrição enteral em pacientes de UTI: comparação entre os métodos de administração contínua e intermitente / Enteral nutrition complications in ICU patients comparative study between continuous and intermitent methods of administration

Este estudo é um ensino clínico prospectivo e comparativo, que teve por objetivo identificar a incidencia de complicações da terapia nutricional enteral em uma amostra de pacientes de Unidade de Terapia Intensiva (UTI) e analisar comparativamente a ocorrência dessas complicações, de acordo com o método de administração; contínua e intermitente. Foram estudados 28 pacientes internados na UTI de um hospital geral, de atendimento particular, no Município de São Paulo. Foram constituídos dois grupos pareados de 14 pacientes, correspondendo a cada um dos métodos estudados: administração contínua (Grupo C) e intermitente (Grupo I). Os critérios para o pareamento foram o diagnóstico médico principal e o nível de gravidade, medido pelo índice APACHE II. Doenças neurológicas (50%), respiratórias (29%), cardiológicas (14%) e sepse (7%) foram os principais motivos de internação. A maioria dos pacientes apresentou índice de gravidade no intervalo entre 10 a 19 pontos, com média de 15,14 (DP=3,44). Os grupos mostraram-se também homogêneos em relação às seguintes variáveis: idade, sexo, tempo de permanência na UTI, risco de mortalidade, tempo para início da nutrição enteral (NE), medidas antropométricas e bioquímicas, uso de ventilação mecânica, sedação e antibioticoterapia. Houve diferença estatisticamente significante apenas em relação ao uso de drogas vasoativas, predominante entre os pacientes do Grupo I. Todos os pacientes foram acompanhados durante três dias consecutivos, após o início da NE. As seguintes análises estatísticas foram utilizadas: descritiva, de associação e de comparação, adotando-se o nível de significância de 5%. Quanto à incidência de complicações na amostra estudada, a principal delas foi o alto resíduo gástrico, observada em 13 dos 28 pacientes (46,42%), seguida da distensão abdominal, em 8 (28,57%), e do deslocamento da sonda, em 7 (25,00%). Vômito e diarréia incidiram em proporção igual de ) 14,28% (4 pacientes). Em apenas um paciente (3,57%) foi observada aspiração pulmonar e obstrução da sonda. O déficit de volume infundido ocorreu em 26 dos 28 pacientes (92,85%), secundário a alguma complicação ou interferências externas. A análise comparativa dos Grupos C e I demonstrou que houve diferença estatisticamente significante entre eles (p=0,0117), em apenas uma das complicações: o déficit no volume total administrado, no primeiro dia de observação, foi maior no Grupo I (-186,07ml) do que no Grupo C (-34,14ml). A suspensão da dieta ocorreu em 67,85% dos pacientes no primeiro e terceiro dias do estudo e em 60,71% no segundo dia, pelo menos uma vez. Os principais motivos de suspensão da NE, no Grupo C foram: arbitrárias (desacertos como alteração do gotejamento e suspensão quando o volume residual era menor que o estipulado) seguido de procedimentos diagnósticos e terapêuticos e em terceiro o alto refluxo. Já no Grupo I, a NE foi suspensa principalmente, pela ocorrência de alto refluxo, seguida de procedimentos diagnósticos e terapêuticos e em terceiro lugar arbitrárias. Os grupos estudados não diferiram entre si quanto aos motivos da suspensão da dieta. Os resultados obtidos neste estudo sugerem que o método de administração contínua pode se constituir em alternativa útil na implementação do suporte nutricional em pacientes de UTI, tendo em vista os indícios de sua vantagem, ainda que pequena no alcance da meta calórica desses pacientes. Estudo com amostras maiores, prospectivos e controlados, serão necesários para se obter resultados mais conclusivos

This study is a prospective and comparative clinical trial designed to identify enteral nutrition therapy (ENT) related complications in a group of intensive care unit (ICU) patients, and compare these complications between two methods of administration: continuous and intermitent. Twenty-eight ICU patients from a general, private hospital, in São Paulo city, were studied. They were randomly assigned between two groups: continuos (group C) and intermitent (group I), with 14 patients each. The criteria of pairing the patients were the main diagnostic and the severity, measured by the APACHE II index. Neurological diseases (50%), respiratory diseases (29%), cardiac problems (14%) and sepse (7%) were the main diagnostics. The majority of the patients presented APACHE II score between 10 to 19 points, mean of 15,14 (DP=3,44). The groups were similars in terms of age, sex, stay in ICU settings, mortality risk, start of ENT, anthropometric and bioquemical assessment, use of mechanical ventilation, use of sedatives and antibiotics. Nevertheless, there was a statistically significant difference related to vasoactive drugs, mainly, among patients in group I. All patients were followed for 3 consecutive days, after the begining of ENT. The folowing statistics analysis were used: descriptive, of association and comparative, and the level of significance was 5%. High gastric residual was the most frequent complication in 13 of 28 patients (46,42%), followed by abdominal distension in eight patients (28,57%) and dislogment of tube feeding in seven (25%). Vomiting and diarrhea occured at the same rate, in four patients (14,28%). Only one patient (3,57%) had pulmonary aspiration and clogg of the tube feeding. Tenty-six patients (92,85% of 28 patients) received less volume than was prescribed, because of a complication or others external causes. The comparative analysis of group C and I showed a statistically significant difference between the groups (p=0,0117) in only one complication: deficiency of total volume infused, in the first day of study, was greater in group I (-186,07 ml) than was in group C (-34,14 ml). Formula infusion was interupted in 67,85% of 28 patients in the first and third days of study, and in 60,71% in the second day, at least once. The main reasons of ENT interruption in group C were arbitraries (changes in infusion rate and interruption of the formula when the gastric residual was low (<150 ml)). The second reason was diagnostics and therapeutics procedures, and the third one was high gastric residual. In group I ENT was interrupted mainly, because of high gastric residual, followed by diagnostics and therapeutics procedures, and the third cause was arbitrary. The groups studied did not differ between them terms of formula interruption reasons. The results suggest that continuous method of administration may be a good alternative in the implementation of nutritional support in ICU patients, because of its advantage, although small, in achieving caloric intake goal. More prospectives and controled studies, with bigger samples are needed for more conclusive results