Factores que afectan la meta calórica en pacientes de cuidados intensivos con insuficiencia o falla intestinal. Revisión sistemática / Factors affecting caloric goal in intensive care patients with intestinalinsufficiency or failure. Systematic review

Introducción: La insuficiencia y falla intestinal hacenparte de la disfunción gastrointestinal y ocurren en cerca del60% de los pacientes hospitalizados en cuidado intensivo, locual afecta el cumplimiento de las metas nutricionales. Objetivo: Establecer los factores que afectan el cumpli-miento de la meta calórica del soporte nutricional en pa-cientes de cuidado intensivo con insuficiencia o falla intes-tinal. Métodos: Se consultó en las bases de datos de MEDLINE,SCOPUS y COCHRANE, desde enero del 2015 hasta septiem-bre del 2020, sobre meta calórica e insuficiencia y falla intes-tinal en pacientes críticos. Dos investigadores realizaron labúsqueda, aplicaron los criterios de selección, extrajeron losdatos, y evaluaron la calidad metodológica de los estudios. Sehizo una matriz de comparación para los artículos encontra-dos y se evaluó su validez. Resultados: Los artículos evaluados fueron heterogeneose incluyeron pacientes críticos con diferentes trastornos gas-trointestinales. Los determinantes identificados como factoresque afectan la meta calórica fueron: intolerancia gástrica, nutrición postpilórica, uso de opioides, uso de proquinéticos,diarrea y equipo multidisciplinario. Conclusiones: Esta revisión, resalta la ausencia de pará-metros validados para calificar la insuficiencia o falla intesti-nal en pacientes con enfermedades críticas. Los seis aspectosidentificados que afectan el cumplimiento de la meta calóricase deben evaluar prospectivamente en esta población.(AU)

Introduction: Insufficiency and intestinal failure are partof gastrointestinal dysfunction and the occurrence of some ofthese situations is frequent in about 60% of patients hospi-talized in intensive care, which affects the fulfillment of nutri-tional goals. Objective: To establish the factors that affect the fulfill-ment of the caloric goal of nutritional support in intensive carepatients with intestinal insufficiency or failure. Methods: The MEDLINE, SCOPUS and COCHRANE data-bases were consulted, from January 2015 to September2020, on caloric goal and intestinal insufficiency and failure incritically ill patients. Two investigators conducted the search,applied the selection criteria, extracted the data, and as-sessed the methodological quality of the studies. A comparison matrix was made for the articles found and its validity wasevaluated. Results: The articles evaluated included critical patients,but with different gastrointestinal disorders according to thecut-off points used in each one. The determinants identifiedas factors that affect caloric goal were: gastric intolerance,post-pyloric nutrition, use of opioids, use of prokinetics, diar-rhea, and multidisciplinary team. No unified parameters werefound to measure caloric goal and intestinal insufficiency orfailure in most of the studies. Discussion: The articles evaluated were heterogeneousand included critical patients with different gastrointestinaldisorders. The determinants identified as factors that affectcaloric goal were: gastric intolerance, post-pyloric nutrition,use of opioids, use of prokinetics, diarrhea, and multidiscipli-nary team. Conclusions: This review highlights the absence of vali-dated parameters to qualify intestinal insufficiency or failurein critically ill patients. The six identified aspects that affectthe fulfillment of the caloric goal should be evaluatedprospectively in this population.

[Not Available]. / Timing versus caloric goal in nutritional therapy for critically ill patients.

INTRODUCTION: Enteral nutrition is an important therapy for severely critically ill patients. The timing and amount of energy have been highly debated. OBJECTIVE: The aim of the present study was to directly compare the timing and the caloric targets in critically ill patients. METHODS: Retrospective cohort study conducted at a single center, comparing timing and caloric goal for critically ill patients. Patients were stratified according to the start of nutritional therapy (24, 48, or more than 48 h) and the amount of energy delivered (target adequacy of previously calculated percentage in the first week). Statistical analysis was performed using parametric and non-parametric tests for independent samples and logistic regression. The results were expressed as mean ± standard deviation or incidence and percentage. RESULTS AND DISCUSSION: There were no differences in major clinical outcomes in relation to the achievement of percentage of caloric goal at the end of the first week of the study. The beginning of caloric intake on the first day of hospitalization was associated with reduced mortality in the intensive care unit, but not with hospital mortality. The strategy of an early and limited amount of calories seems to be associated with a better outcome. Prospective studies evaluating and comparing these strategies are recommended.